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Assessment of health services provided to pilgrims by Saudi Boy Scouts and their exposure to health risks during these activities in Hajj 1429H.

This study was conducted to describe the health services provided by Saudi Boy Scouts and to identify the health risks to which they may be exposed during these activities. The study objectives were to assess the health services provided to pilgrims by Saudi boy scouts in Makkah during Hajj 1429 H, assess the training and protective measures of the scouts, assess their exposure to health risks as part of their activities in Mina, and evaluate the relationship of demographic factors and experience on these health risks and protective measures.
A self-administered questionnaire based cross-sectional study was conducted. A sample size of 330 was calculated with 5% precision at 95% confidence level from a total population of 2264 Boy Scouts.
A total of 324 scouts participated in the study. Among respondents, 58.2% were under 20 years of age, 57.4% were participating for the first time. Among the studied sample, 84.6% had attended courses in first aid, 35.2% in cardiopulmonary resuscitation, 26% in disaster management, 26.5% in personal safety, and 11.3% had not attended any health related courses. Slightly over half of the participants (56.2%) had received a medical checkup prior to joining the Hajj duty. Out of 309, only 34.3% had a valid meningococcal vaccination, and 12.8% had received influenza vaccine.
The majority of scouts (92.6%) participated in directing the pilgrims in finding their way, 30.6% in guiding sick pilgrims to their camps after their recovery, 23.5% in guiding patients within various health facilities, and 21.9% in assisting medical staff in emergency situations. Table 1 describes the state of knowledge of participating scouts regarding First-Aid.
Out of 324 scouts, 37.7% had faced acute medical emergencies among pilgrims.
During their activity 34% had faced overcrowded situations without a face-mask, 4.6% had sustained injury by a sharp object, 4.6% had been exposed to body fluids, stool or urine of a patient, 4% had been exposed to blood and 0.6% had sustained a needle injury in a medical facility.

Editorial note:

The actual service of Saudi Boys Scouts Association (SBSA) began in 1382 H, formed by a group of concerned people, when a total of 150 scouts from Jeddah and Makkah participated. Initially there were participations from other Arabic and Islamic countries, and then SBSA limited participation to Saudi scouts only. The number of scouts increased, over the years, to more than 2,000 from all over the Kingdom, with service camps gaining great interest and support from the government of Saudi Arabia.

During Hajj, a large number of the activities performed by scouts’ are related to health. Under the umbrella of the Ministry of Health, they participate directly in serving sick hajjis as a first line health provider, by directing sick pilgrims within various health facilities, guiding them to their camps after their recovery, providing first aid, helping the medical providers and transferring/evacuating the patients, when necessary.
Scouts also participate in other services during hajj that contribute to maintaining health and preventing diseases, under supervision of Ministry of Hajj and Municipality, such as guiding Hajjis in order to reduce their exposure to exhaustion, tiredness, physical and emotional stress, which leads to increased mortality and morbidity.1,2 This service is especially useful because of the large numbers of elderly people performing Hajj.
During conduction of their activities, scouts are exposed to various risk factors at least equal to pilgrims, if not more. Everyone in Hajj has an extra risk of contracting infectious diseases such as Meningitis for example.3 In addition, the condition in the camps when living is limited to basic amenities thus rendering the scouts susceptible to environmental, food and waterborne infection.4
The study highlights the organized efforts of Saudi Boys Scouts Association during Hajj that depends totally on the volunteer work of young scouts. The majority of scouts was of a young age, when they are willing to learn and participate actively with proper guidance and support, but, on other hand, makes them more vulnerable to risks or difficulties during Hajj.
Unfortunately, the study revealed that the training of scouts participating in Hajj was suboptimal. As with any health care provider, there is concern about the spread of blood-borne pathogens such as Hepatitis B and Human immunodeficiency virus through direct exposure to blood or needle stick injury, especially among young first aid providers.5
Boy scouts have a major contribution in guidance of pilgrims, assisting health care providers and providing first-aid during Hajj. It was recommended to facilitate boy scouts in conducting their activities efficiently and safely during Hajj by improving the frequency and quality of training courses in first aid and cardiopulmonary resuscitation. These courses should be made mandatory for all the scouts attending Hajj duty. Existing training requires more focus on health education for personal safety measures, such as importance of regular use of face-mask, timing of meningococcal vaccination, avoidance
of exposure to blood or other body fluids of patients and communication skills.

1. Landry P, Slama S.V. Pilgrimage and other mass gatherings: epidemiology and prevention. Rev Med Suisse. 2008 May 14; 4(157):1192-5.

2. Ahmed QA, Arabi YM, Memish ZA. Health risks at the Hajj. Lancet. 2006 25;367(9515):1008-15.

3. Balkhy HB. Memish ZA. Meningococcal carriage among local inhabitants during the pilgrimage journal of antimicrobial agent.2003; 21(2):107-111.

4. Shafi S, Memish ZA, Gatrad AR, Sheikh A. Hajj 2006: communicable disease and other health risks and current official guidance for pilgrims. Euro Surveill. 2005 Dec 15; 10(12): PP E051215.2.

Ng YW, Hassim IN. Needle stick injury among medical personnel in Accident and Emergency Department of two teaching hospitals. Med J Malaysia. 2007;62(1):9-12
Table 1: Knowledge of participating scouts regarding First-Aid, Hajj 1429 H.
First-Aid Knowledge variables
Dealing with collapsed person:
Check the response
Call for help
Open the air way
I don't know
Ratio of chest compression to mouth-mouth breathing in CPR:
I don't know
Dealing with a victim with bleeding extremities:
Carry the patient to the hospital
Apply pressure on the wound
Apply tourniquet
I don't know
Dealing with a victim with epileptic fits:
Restrain the patient
Put the patient in left lateral position
Watch till the fit finish
I don't know
تقييم الخدمات الصحية المقدمة من قبل الكشافة السعودية والمخاطر الصحية التي يتعرضون لها في موسم الحج لعام 1429هـ.

عدد كبير من أنشطة الكشافة خلال مواسم الحج تتعلق بالصحة. هدفت هذه الدراسة إلى إلقاء الضوء على هذه الخدمات بالإضافة لدراسة نوعية المخاطر التي قد يتعرض لها الكشافة أثناء تأديتهم لها، وما إذ كانت خصائصهم الشخصية، خبراتهم، وطرق تدريبهم تشكل أي تأثير على مستوى الخدمات المقدمة أو نسبة الخطر التي يتعرضون لها. تم إجراء دراسة مقطعية في منى بتاريخ 10-11- 12 من ذي الحجة لعام 1429هـ .

تراوحت أعمار الكشافة ما بين 15 إلى 42 سنة (متوسط 19 ± 2.5). وكان غالبيتهم 181 (55.9٪) في المرحلة الثانوية، 138 (42.5 ٪) في الكلية، ونسبة ضئيلة في المرحلة المتوسطة 5 (1.6٪). من بين324 كشاف مشارك، 176 (54.3٪) حمل رتبة كشاف، 147 (45.3٪) رتبة جوال و واحد قائد عشيرة (0.4٪). 186 (57.3٪) كانوا يشاركون للمرة الأولى، 66 (20.5٪) للمرة الثانية، و 72 (22.2٪) للمرة الثالثة أو أكثر. الغالبية 274 (84.6٪) قد تلقوا دورات تدريبية في الإسعافات الأولية، 86 (26.5٪) في السلامة الشخصية،84 (26٪) في التصرف أثناء الأزمات، 114 (35.3٪) في الإنعاش القلبي الرئوي، و 36 (11.2٪) لم يتلقوا أي دورات. بالنسبة لمعرفتهم العامة بالإسعافات الأولية 19.9% منهم تحصلوا على درجة عالية. وقد أثبتت الدراسة أن درجة معرفة الكشافة تتأثر بالدورات التدريبية في الإسعافات الأولية 0.001 P=والإنعاش القلبي والرئوي 0.006 p=

أما بخصوص الإجراءات الوقائية المتخذة وجدت الدراسة أن 146 (45.1٪) من الكشافة لم يخضعوا لفحص طبي قبل انضمامهم للحج وأن من بينهم (8.6٪) مصاب بالربو، و 5 (1.5٪) مصاب بالسكري، 4 (%1.2) كانوا يعانون من ارتفاع ضغط الدم وبنسب مماثلة 3(0.9 ٪) لكل من فقر الدم المنجلي، فقر الدم والأكزيما.

أوضحت الدراسة أن 43.3% فقط تلقوا تطعيم الحمى الشوكية في التوقيت المناسب، و 12.8% فقط كانوا قد تلقوا تطعيم الأنفلونزا خلال أقل من ستة أشهر.

بخصوص الخدمات المقدمة من قبل الكشافة، فغالبيتهم 300 (92.6٪) قاموا بإرشاد الحجاج التائهين،99 (30.6٪) قاموا مصاحبة المرضى من الحجاج إلى مخيماتهم بعد شفائهم، 76 (23.5٪) قاموا بإرشاد وتوجيه المرضى في المرافق الصحية و 70 (21.6 ٪) شاركوا في منع الازدحام أمام المرافق الصحية. 120 (٪37.7) سبق لهم مواجهة حالات مرضية بين الحجاج، تنوعت من المشاكل الصحية البسيطة 53 (٪43.4)، فقدان الوعي 48 (39.3٪)، إصابات شديدة 35 (٪28.7) وأزمات قلبية 22 (٪18).

أثناء تأديتهم لعملهم،62.7% التزموا بارتداء كمامة الوجه غالبية الوقت، 110 (34%) وجدوا أنفسهم عرضة للزحام الشديد ولم يكونوا مرتدين للكمامة، 15 (4.6٪) أصيبوا بأدوات حادة ، 13 (4٪) تعرضوا لدم مريض أو شخص آخر، 15 (4.6٪) تعرضوا لبراز أو البول مريض أو شخص أخر، و 2 (0.6 ٪) أصيبوا بوخز الإبر في منشأة طبية.

خلال موسم الحج أصيب 72 (22.2٪) من الكشافة بنزلات البرد، 36 (11.1%) بالآم أسفل الظهر، و 33 (10.2٪) أصيبوا بشد عضلي.

أوضحت الدراسة الحاجة لتكثيف الدورات الصحية و رفع مستوى التحصين ضد الحمى الشوكية و الانفلونزا، والالتزام بالفحص الطبي قبل الانضمام للحج.