Wristband wearing among pilgrims in Mina during Hajj 1415 H

Each year more than two million Muslims from countries throughout the world arrive in Makkah, Saudi Arabia (SA) to perform Hajj. These pilgrims speak diverse languages. They are often older adults who have a variety of underlying health conditions. The congestion and mass movement may place additional stress on these adults during the pilgrimage. Emergency medical intervention becomes complicated when medical history is difficult to extract due to medical conditions or language barriers. Moreover, in the case of death, it is difficult for the Ministry of Health (MOH) to return an unidentified body to the country of origin. To relieve these difficulties MOH introduced identification wristbands (WB) to be used during every Hajj season.

Standard WB developed by MOH contain information about personal identification: name, nationality, a computer number is assigned, as well as five underlying health conditions, (Diabetes, Epilepsy, Hemophilia, under Cortisone treatment, and Sensitivity to penicillin). WB are distributed to everyone wishing to perform Hajj from SA through Primary Health Care Centers (PHCC) throughout SA. Pilgrims from outside SA obtained WB from either the Experimental National Establishment for Pilgrims (ENEP) or from their original countries.

To ascertain where WB were obtained and what information they contained, we did single stage cluster sampling of 400 pilgrims in 40 camps in Mina. Each pilgrim was checked for WB and given a standard questionnaire.

Seventy-three percent (C1=68% to 77%) of pilgrims wore WB of any type. The majority (63%, CI= 58% to 69%) obtained the WB in SA from any of the WB sources. Only 21% (C1=16% to 26%)of pilgrims wore WB which contained all information required by MOH.

All pilgrims from SA obtained their WB from PHCC. Of pilgrims from SA, 9% (CI=4% to 14%) of Saudi citizens and 13% (CI=6% to 19%) of non-Saudis were wearing WB. These WB were obtained from PHCC. None of the pilgrims from the Gulf Region wore WB, however 92% (89% to 95%) of the pilgrims from outside SA wore them.

Of those wearing WB, 51% (CI=45% to 57%) stated that they would be able to replace the WB if lost. Replacements come through the ENEP (60%), the original countries' missions (26%), medical groups (7%), and PHCC (8%). ENEP was the primary source of information about the importance of wearing WB (54%) (Table 1).

We selected 31 physicians for interview from two hospitals and six PHCC in Makkah through a simple random sampling to learn what they knew about WB and how the WB were distributed. The quantities of WB distributed during Hajj 1415 varied from 10 to 680 per health unit with a mean of 142 (standard error = 65). In hospitals, WB were distributed only to admitted patients. In the PHCC, 42% were distributed because of the patient's condition, 33% for pilgrims and 25% on request.

The percentage of physicians who knew what the headline content of the WB was, is as follows° name 97%, nationality 90%, computer number 77%, health status 64%. The percentage of physicians who knew the meaning of health status abbreviations for Diabetic, Epileptic, Hemophilic, Cortisone, and Sensitivity to penicillin was 81%, 23%, 6%, 19%, and 42% respectively. However, 84% of physicians had obtained medical conditions verbally from patients rather than the WB.

This study showed many different types of WB to be in existence. Not all the WB distributed by ENEP contained space for identification or health status. The health sectors and physicians in Makkah did not try to inform the pilgrims of the importance of wearing WB. PHCC were negligent introducing and distributing WB to pilgrims. Even hospitals in Makkah did not fill in the information completely. There was a great deal of misunderstanding about the purpose of WB, and this explains why a high percentage of pilgrims from SA and the Gulf Region were not wearing WB.

The high percentage of pilgrims wearing the WB showed pilgrims approved and understood the importance of wearing WB. It was unfortunate, however that many of these WB did not meet the criteria required by MOH. The study results suggest that it would be easy to change all types of WB used recently to the WB designed by MOH.

WB wearing can be promoted by reminding physicians in the PHCC of the importance of WB, by distributing. WB to everyone wishing to perform Hajj, and by advertising using posters and pamphlets. Advertising should begin one month before Hajj season. Public messages should be continually broadcast during the Hajj season on the importance of wearing WB. MOH must coordinate with ENEP and make sure WB contain all necessary information. Offices should be established at Saudi borders to distribute the WB.