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Behavioral Risk Factors for Diseases during Pilgrimage to Makkah (Hajj), 1417 H (1997).


Multitudes of diverse nationalities perform the annual Islamic Pilgrimage to Makkah, (Hajj) every year. To reduce serious Hajj-related illnesses the Ministry of Health has developed a number of programs to reduce risky behavior of pilgrims. In 1997 we assessed behavioral risk factors (BRF) for several important diseases and conditions to assess current interventions, to design additional intervention programs, and to serve as base-line for future similar monitory BRF surveys.


Mina, a holy place where all pilgrims camp for at least three days, was divided into four zones, and all zones were subdivided into 475 equal areas. We randomly selected 44 clusters proportionate to number of areas in each zone using a two-stage cluster sampling. Selected behaviors predisposing to the major Hajj-related illnesses, and the socio-demographic factors influencing them were probed using a self-administered standard questionnaire that was translated into ten different languages.


Out of 1101 respondents (37 nationalities); 63% were performing Hajj for the first time. 74% joined organized Hajj missions, 27% were residents of Saudi Arabia. 584 (57%) wore identifying wristbands, 90% (95% CI 88%-91 %) had the required vaccination for prevention of meningococcal meningitis. Risky behavior for food poisoning included bringing foods from their home countries (39%), and eating food from street vendors (22%). However, 1.6% (95% CI 0.9-2.6) had no meal during the 24 hours preceding the survey. Heat stroke prevention included using umbrellas (51%). Of all Hajjees 7-9% moved between holy places (three journeys within 24 hours, a total of 30 kilometers) on foot, and 22% lost their way in Mina for a median of 3 hours; drank a mean ((+ SD) of 2670 + 58.2 ml of fluids, and slept for a median of 6 hours per day. After completing Hajj rites, 36% (33%-39%) shaved their heads with razor blades and 21% (17%-26%) put themselves at risk of blood-borne disease by re-using razor blades used by other Hajjees. In addition, 23% (19%-24%) had cut wounds in their feet. Hajjees put themselves at risk of injury by hanging on the back of buses (6.4%, 95% CI 4.9%-8.2%), and 13% (11%-15%) were severely hit with pebbles thrown at the Jamarat. BRF were more common among domestic Hajjees.


Scarcity of data has restricted the scope of public health programs aimed at reduction of BRF among religious visitors, especially domestic Hajjees. Such programs require continuous revision and evaluation.