Meningococcal disease is a major health problem in both developing and developed countries. Annually, more than two million pilgrims from more than 140 countries gather in Saudi Arabia to perform Hajj in a limited area. Meningococcal meningitis causes considerable morbidity and mortality during Hajj in Saudi Arabia. The movement of Hajjes along with intense heat, congestion, and mass movement from one place to another during the pilgrimage can contribute to the occurrence of epidemics of meningitis. The aim of the present study is to find out risk factors of meningitis in Makkah during hajj season of 1421 H.
Methodology
This study was conducted using a case control approach in Makkah hospitals during the period 1 - 15 Dull Hijjah, 1421 H. For each case, four controls were selected from the same hospital and matched for age (within five years), sex, and hajji status (either hajji or not). Data were collected using a pre-structured questionnaire by interview with cases and controls. All cases of meningitis reported to the Health Department in Makkah were included. These cases should have been both clinically diagnosed and laboratory confirmed as meningitis during the study period.
Results
During the period of 1-15 Dhull Hijjah, 23 cases of meningitis were diagnosed in Makkah hospitals and 92 controls were selected for them. The study revealed that overcrowding was found to be significantly associated with occurrence of meningitis (P = 0.003). The study also showed a significant effect of nationality, whereby those from the Indian subcontinent had the highest risk of acquiring meningitis (OR=7.65, 95% CI= 2.11-30.76). Other factors including smoking, vaccination status, chemoprophylaxis, place of residence in Makkah, type of accommodation, joining Hamla and socio-economic factors were not statistically significant.
Conclusion
This pilot study revealed that overcrowding and nationality are significant risk factors of meningitis. It was recommended to improve housing conditions and decrease overcrowding in Hajj, in addition to health education and vaccination.