Effect of Health Education Advice on Saudi Hajjis, Hajj 1423 H (2003 G)

The pilgrimage to Makkah (Hajj) is an annual congregation of more than 2 million Muslims with different nationalities, languages, life styles, levels of education, and health status. The Ministry of Health (MOH) annually invests a large amount of resources in advising the hajjis in preventing diseases and promoting positive health. The health education program implemented by MOH during Hajj focuses on a number of key issues while using multiple methodologies. Although the program targets all Hajjis, Saudi hajjis constitute an important target group. This study was conducted to assess the effect of health education program on the knowledge and practices of Saudi hajjis in Hajj 1423, in order to provide information for evidence-based planning of health education programs.

A cross-sectional survey was conducted among Saudi Hajjis using a self-administered questionnaire. Sampling was done by using a three stage random cluster technique based on geographical mapping. The whole area of Mina occupied by Hajjis is divided into camps by the Ministry of Hajj, and defined camps are allocated to Domestic Hajjis. After obtaining the list of these camps, 10 such units were randomly selected. Each sampled unit was divided into 9 approximately equal squares, and out of them 2 squares were selected randomly by using random number tables. In each of the selected squares one tent was selected randomly as a starting tent, and 30 Hajjis from the square were included in the study, irrespective of gender. However, due to some non-response, logistic problems and incomplete forms, the results of 451 hajjis are being presented.

Out of 451 Hajjis, 69.4% were males, 52.5% were performing Hajj for the first time and 96.5% came with organized Hajj groups. Of all hajjis 92.2% got the advice to take the meningitis vaccine, among them 95.2% did. However, 49.6% of the hajjis were vaccinated less than 10 days before reaching Hajj area. Of the total 52.8% got the advice not to buy food from street vendors, among them 91.6% did not; 79.8% got the advice to wash vegetable before eating among them 94.7% did; and 79.4% got the advice to wash hands before eating among them 96.1% did. Among all Hajjis 59% got the advice to use transportation means while traveling, among them 97% did; 48.1% got the advice to use umbrellas among them 47.9% did; 20.0% got the advice to use identification wristbands, among them 4.4% did; and 69.9% got the advice to drink more than 2 liters daily among them 92.7% did. Of the total, 53.4% got the advice not to use used razor blades, among them 95.9% did not; and 45.5% got the advice not to lend the used razor blades, among them 98.5% did not. Of all Hajjis 47.5% got the advice not to smoke during Hajj, among them 93% did not; and 49.7% got the advice to wear facemasks, among them 64.3% did. As given in table 1, among the 13 advices and their corresponding practices observed, 8 were statistically significant. The advice had a statistically significant association with practice for meningitis vaccination, influenza vaccination, washing vegetables before eating, washing hands before eating, using umbrellas, consuming plenty of fluids, wearing identification wristbands, and using the facemask. As shown in table 2, the TV was the most common source of advice for ten messages, and second most common for three other advices.

Health education remains the backbone for prevention of most hajj associated health problems. Well-designed health education programs are probably the best tools that can be used to rectify undesirable behaviors among Hajjis.[1] It is evident from the study that a large proportion of the participating hajjis had received some kind of message regarding the health related behaviors studied, with the exception of influenza vaccine and wearing identification wrist bands. Similarly, the practice for most of the healthy behaviors was also fairly high except for the same issues along with using umbrellas and facemasks. Interestingly, many more hajjis claimed to observe healthy practices than those claiming to have received the advice for most of the issues studied.

Some of the practices like using umbrellas or using transportation might have been effected by the peer practices during hajj, instead of individual level of being exposed to health messages. Despite all that, receiving health message is generally found to be positively associated with the practices observed.

Still, certain lacunae can be identified in the health education messages apparently well disseminated and acted upon. Meningococcal disease (MCD) is a serious disease, which has a case-fatality rate of about 15% among Hajjis.[3] In recent years a number of outbreaks have been reported, in Makkah or across the world, associated with Hajj.[4] To prevent recurrence of such outbreaks, in addition to other preventive measures, high meningococcal vaccine (MCV) coverage rates have to be maintained. In conformation to earlier studies,[5,6] this study showed that MCV coverage among Saudi hajjis was about 89.4%. Keeping in view the immunogenicity pattern of meningitis vaccine, all hajjis should have been vaccinated at least 10 days before arrival to Makkah for hajj.[7] In this respect, the effective vaccination coverage is very low be. cause almost half the Hajjis (49.6%) had been vaccinated under 10 days before their arrival to Makkah, a finding consistent with an earlier study, indicating poor awareness of hajjis regarding proper timing for vaccination due to absence of this component in the health education messages.[5]

The mass media, represented by TV, was the most frequently utilized source of advice for all health education advices except for that of vaccination, using facemasks, and smoking. Interestingly, it was not among the most effective sources of advice, which may be explained by the fact that mass media is not as effective as might be expected in case of behavioral changes. In fact, one of the most confident assertions emerging from communication of innovations theory is that interpersonal channels of communication are more effective than mass media when it comes to persuading communities to change their practices.[8,9] The present study showed that lectures and physicians as resource of health advice among Hajjis are highly effective, despite the fact that they were not among the most frequent sources of advice.