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Risk factors of direct heat-related hospitalization in Mina during 1437 hajj.


Heat is accounted a serious hazard during Muslim`s Pilgrimage (hajj) especially when hajj coincides with summer season. Heat illnesses -including heat exhaustion and heat stroke showed hasty increment during the 1437 (2015) hajj Heat illnesses and contributed for 24% of total hospital admissions with the highest rate in Mina area. Although heat illnesses are commonly occurring during Hajj, there is a dearth of evidence targeting these illnesses. Our study aims to identify risk factors for the increased morbidity during 2016 hajj season.


A non-matched case control study of risk factors was conducted. All participants (n=93) were interviewed to collect the data about demographics, behaviors during and before hajj, living conditions and health status. Medical records were utilized to gather the data on cases` hospital admission. Cases (n=31) were hospital admissions due to heat-related diagnoses during the 4 days of usual pilgrims` presence in Mina for rites performance. Controls (n=62) were randomly selected from the healthy pilgrims accompanying patients in the emergency room of the same hospital.


Age (OR=1.14; p 0.001) and female gender (OR=4.6; p 0.042) were the factors which might contribute to the higher heat-related morbidity and hospitalization. On the other hand, religious flexibility regarding rituals` timing and performance (OR=0.10; p 0.002) and sleeping more than 4 hours daily during Hajj (OR=0.10; p 0.004) were among the protective factors found. Many modifiable risk factors were associated with heat-related hospitalization using bivariate analysis.


Although our study is unmatched but, we found that elderly and female pilgrims require special attention to prevent the development of heat illnesses among them. Encouraging pilgrims to rest and sleep well during Hajj is advantageous to prevent the development of severe heat illnesses requiring hospitalization. The religious leader might need to discuss and collectively agree on an Islamic rule (fatwa) about religious flexibility during Hajj taking into account the timing for ritual performance.