Effect of Ramadan fasting on emergency walk-in-clinics in Jordan.

Ramadan is the month of fasting for Muslims; they fast from dawn to sunset. I studied patients attending walk-inclinics in the emergency department of Al-Bashir Hospital1 during the month of Ramadan 2010, 11 August to 9 September. A total of 7770 patients attended: 2566 (33%) attended in shift A, 8:00–18:00 hours (divided in two sessions), 2124 (27%) in shift B, 18:00–23:00 hours, and 3080 (40%) in shift C, 23:00–8:00 hours. There were 4198 (54%) males and 3572 (46%) females, with a male:female ratio of 1.17:1. There were 1951 (25%) patients aged 1–5 years and 6458 (83%) aged 1–40 years. Patients of <1 year old are admitted directly to the paediatric emergency room. The main presenting complaint was upper respiratory tract infection in 1889 patients (24%), followed by acute simple gastroenteritis in 1313 (17%), abdominal pain in 726 (9%), skin problems in 456 (6%), renal problems (urinary tract infection and renal colic) in 443 (6%), and 224 (3%) requesting sick leave. A total of 724 (9%) were referred back to on-call teams. In Ramadan, young patients with upper respiratory problems were the main attendees, and shift C was the busiest. I was able to compare these figures with observations made in the same clinic over a 1-month period earlier in the year (18 April to 17 May 2010), during which time 10 000 patients consulted. The age and sex distribution of attendees during Ramadan was similar to this period, but the proportion of patients attending during shifts B and C was almost reversed: 27% and 40% respectively during Ramadan compared with 43% and 24% during the earlier observation period. The main reasons for attendance were also similar in both cohorts. These findings are surprisingly similar to data collected in the UK. Salisbury and Munro’s review article in 2002,2 concluded that young patients with minor problems, mainly upper respiratory symptoms, were the main attendees for walk-in-centres. Dale and co-workers3 at King’s College School of Medicine and Dentistry concluded that young patients with minor problems were also the main characteristics of primary care patients attending the emergency department. However, the constraints of Ramadan appear to modify the timing of the presentation of these problems, but not their frequency.