Article Info
Year: 2006
Month: April
Issue: 2
Reference: Sultan B., Choudhry A., .Saudi Epidemiology Bulletin. 2006;13(2):.
During Hajj season, the Saudi government provides free health services for all pilgrims (hajjis). In recent years, some local hajj organizers (hamlas) have provided additional health services for their hajjis within their camps in Mina. This study was conducted to evaluate these health services, while assessing their benefits and their role in reducing utilization of governmental health facilities. A cross sectional study was conducted in Mina area among a sample of 30 randomly selected camps from the Ministry of Hajj records. Data was collected from the 8th to the 12th of Dhul Hijjah 1426H (9th to 13th January 2006).
Of the 30 selected hamlas, 20 (66.7%) provided health care services. Hamlas with health services had a significantly higher number of hajjis (P=0.026), and were significantly more expensive (P= 0.0002).
Physicians were available in all (100%); all allowed the medical staff to perform their hajj free, and only 15.8% offered financial reward.
Hamla directors gave several reasons for providing health services within their camps, the most frequent was providing care for minor illness (75%), immediate care for serious illness (65%), to attract a larger number of hajjis to the hamla (60%), to reduce the load on Ministry of Health (50%), and finally to raise the cost of joining the hamla (15%). However, hajjis were not asked to pay extra fees for using these health services
The study also involved interviewing physicians working with the hamlas. The total number interviewed was 20; their mean age was 42.5 years (SD ±8.3). Non-Saudi nationality accounted for 95%, and 95% were males. They were either general practitioners (60%) or specialists (40%); 60% belonged to private sector, 25% other governmental health sectors, and 15% belonged to Ministry of Health. Only 35% had received training for medical management in hajj.
Among hamlas that provided health services, only 30% had a specific location for the health facility, 80% had a designated area for clinical examination and diagnosis, 70% had a pharmacy, 70% had a dressing area, and 5% had a CPR facility.
Most of the hamla health facilities (75%) received a daily average of up to 10 sick hajjis. Only 5% received 51 or more. In addition to examination and diagnosis, other health services included providing medicines for minor aliments (100%), emergency medicines (95%), and simple laboratory investigations (5%).
The most common reasons stated by physicians for hajjis to seek the hamlasE¼ health facilities were: diagnosis and treatment of an acute illness (80%), obtaining medication for a known diagnosis (60%), routine checkup of blood pressure (25%), routine checkup of blood sugar level (20%), routine checkup of a chronic disease (40%), and administration of routine injections e.g. insulin (30%).
According to the physicians, the three most common presenting health problems of hajjis were acute respiratory tract infection (ARI) (80%), gastroenteritis (75%), and injuries (45%). The three most commonly prescribed medications were analgesics/ antipyretics (100%), antibiotics (90%), and antihistamines or decongestants (80%). Most of the sick hajjis were given medical advice along with the medications (90%).
The study also involved interviewing 500 hajjis from the 30 camps. Among them (79.4%) were males. Most were Saudi (74.8%), those from Arab countries (19.8%), and Non-Arab countries (5.4%). During their stay in Mina, 101 (20.2%) of the total hajjis had fallen sick. Of 68 (67.3%) sick hajjis belonging to hamlas with health facilities, 63 (92.7%) had sought medical advice from their hamla physicians. However, among hajjis belonging to hamlas with health facilities 54.9% had not visited the health facilities, and 38.7% were satisfied with the services provided.
Among the total hajjis interviewed, 28.8% had specifically planned to join hamlas with health facilities, and 93.2% planned to perform future hajj with hamlas that provided health facilities. Male gender and married hajjis were more likely to join hamlas with health facilities (Table 1).
Editorial note:
More than 2 million pilgrims gather during Hajj, and are therefore prone to different communicable diseases. Fatigue and lack of sleep from the physically demanding regimen of hajj rites lower immunity, leading to higher vulnerability to disease. ARI is very common during hajj.[1]
In recent years, a number of local hamlas have provided health facilities for their hajjis, in an effort to increase the number of hajjis in the hamla, or raising the price of these hamlas.
Emergency situations are common during hajj, such as heat exhaustion, sunstroke, dehydration, injuries; in addition to complications of certain chronic diseases.[2,3] The most common illness among hajjis in this study was ARI. As previously reported, almost 40% of hajjis may suffer from ARI during hajj.[3]
Another very important effect of having health facilities in the camps is reducing the load on ministry of health facilities. In this study, hajjis who did not have health facilities at their camps sought health care at governmental health facilities when they became ill. It has been reported that 27.4% of hajjis utilize governmental health facilities during their stay in Mina.[4]
This study showed that health services within the camps are of benefit to hajjis, and may also reduce the load on governmental health facilities. However, the high cost of these hamlas may hinder hajjis' from joining them. Training of hamla physicians is recommended, and they should remain in contact with MOH.
References
- Madrasa alinaam. Camperdown, South Africa: Common health problems during hajj. [Updated 2006 Feb 16; cited 2006 May 22]. http://www.alinaam.org.za/library/ cproblem.htm
- Al-Azeri A, Ashoor B, Al-Tuhami H, Al-Rabeah A, Al-Hamdan N, Al-Jefri M, et al. Meningococcal carriage among hajjis in Makkah, 1421 H. SEB 2002; 9(1):3, 4.
- Al-Mudameigh K, Al-Naji A, Al-Enzi M, Choudhry A, Turkistani AM. Incidence of hajj-related Acute Respiratory Infection among hajjis from Riyadh, 1423 H(2003 G). SMJ, 2003;10(4):25,26.
- Abdullah A, Abu Dahish M, El-Bushra HE. The utilization of primary health care services at Mina during hajj, 1998. SEB, 1999;6(1):4,5.
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Table 1: Impact of health education program on food practices and dietary related habits among girls' in a primary school, Riyadh, Saudi Arabia
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|||||
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Hamlas with health facilities
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Hamlas without health facilities
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P value
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|||
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No
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%
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No
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%
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||
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Number of hajjis
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|||||
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< 500
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3
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15.0
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5
|
50.0
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0.026
|
|
500-800
|
7
|
35.0
|
3
|
30.0
|
|
|
> 800
|
10
|
20.0
|
2
|
20.0
|
|
|
Total
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20
|
100
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10
|
100
|
|
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Free paid to hamla
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|||||
|
3000
|
4
|
21.0
|
8
|
88.9
|
0.0002
|
|
3000-4000
|
12
|
63.2
|
1
|
11.1
|
|
|
>4000
|
3
|
15.8
|
0
|
0
|
|
|
Total
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19
|
100
|
9
|
100
|
|
|
Marital status
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|||||
|
Married
|
260
|
66.7
|
130
|
33.3
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0.020
|
|
Single
|
64
|
58.2
|
46
|
41.8
|
|
|
Total
|
324
|
64.8
|
171
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34.2
|
|
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Utilization of governmental PHC
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|||||
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Yes
|
8
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11.8
|
12
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36.4
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0.003
|
|
No
|
60
|
88.2
|
21
|
63.6
|
|
|
Total
|
68
|
100
|
33
|
100
|
|