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Risk Factors of Heat Exhaustion among Pilgrims to Makkah, Saudi Arabia, 1995.


Over two million Muslim pilgrims are at risk from heat-associated illnesses (HAI) when they perform the annual pilgrimage (Hajj) to Makkah in hot weather. HAI are the leading causes of hospitalization during Hajj. During the 1995 Hajj, we examined the role of some potential behavioral risk factors for heat exhaustion (HE).


A case of HE was defined as weakness, vertigo, headache, gastrointestinal symptoms, with or without faintness and collapse; and rectal temperature less than 41*C. We conducted a paired matched 1:1 case-control study, whereby controls were the same age and sex, but did not escort or know case Hajjis.


Cases of HE (mean age in years 39.4, SD ± 16.3, range = 14-78) constituted 20 different nationalities, mainly from countries in the Middle East; 51.5% were residents of Saudi Arabia. Risk factors for HE included traveling by land to Makkah instead of flying (OR=2.8, 95% CI 1.1-7.6), walking at least one of the four journeys between Holy places (OR=3.5, 95% CI 1.7-7.5), not using an umbrella (OR=8.3, 95% CI 4.1-17.1), not staying in a tent or a building in Mina (OR=2.2, 95% CI 1.1-4.1), and being at landmarks in: Mount Jabel-ar-Rahama (OR=2.5, 95% CI 1.2-5.3) or Namira Mosque (OR=3.1, 95% CI 1.2-8.7), losing their way in Mina (OR=39.3, 95% CI 5.8-652), taking light or no meals (OR=4.0, 95% CI 2.1-7.6), and early stoning of Jamarat (p<0.05). Patients drank less water than controls during their movements between Holy places (p< 0.05). Receiving free packs of ice-cold water or beverages were protective against HE (OR=0.37 95% CI 0.2-0.7). Underlying chronic illnesses, and educational level were not associated with HE.


The burden of HE during Hajj can be reduced by promoting certain health practices, such as use of umbrellas and wider distribution of free packs of ice-cold water to Hajjis. Constructional changes and organization of the Holy places to facilitate movements of Hajjis and providing shaded areas would also be beneficial.