Health Status of Non-organized Hajjees (Muftaresheen) during 1420 H, Hajj Season

Hajjees may be divided into two groups; the first, representing the majority, consists of those who join organized Hajj groups (Hamla), and the second consists of those who do not join them. This group resides on the street, and are therefore given the name "Muftaresheen". We conducted this study to investigate this group, aiming to identify their demographic characteristics and health problems, and to assess their behavioral risk factors.

There are five major areas where most Muftaresheen reside in Mina; around Jamarat, on Pedestrian Street, around Masjed Alkhif, around Mina General Hospital, and underneath bridges. A sample size of 500 was determined using the proportional allocation method. The sample was recruited from these five areas. A self-administrated questionnaire translated into three languages; Arabic, Urdo and English, was used.

Out of 412 respondents; 65% were under 40 years, 62% were domestic, 95% were non-Saudis; Pakistanis comprised 23% of the total, Egyptians 21%, and Sudanese 12%. Forty-seven percent had stayed in Makkah less than one week before starting Hajj, 60% were performing Hajj for the first time, and 62% explained that the reason for not joining Hamla was financial.

With regards to vaccination against meningococcal meningitis, 82% stated that they had received the vaccine. More than two thirds (72%) had received health education regarding risk behavior during Hajj (Table 1), and 57% got it in Saudi Arabia. About 60% of Hajjees were drinking bottled and plastic-bag water, 40% bought their food from street vendors and 27% kept leftover food more than 2 hours. Ninety two percent used public toilets, and the distance between them and the toilets was 100-300 in. Sixty eight percent were sleeping less than 6 hours per day due to different reasons.

Forty five percent complained of one symptom or more; 18% had runny nose, 14.6% headache, 14% cough and 12% sore throat. Among symptomatic hajjees, 56% received medication. Three percent had diabetes mellitus, and 3% had hypertension.

Thirty-two percent were not comfortable with performing Hajj in this way; 42% attributed the reason to overcrowding, 14% to bad climate, 14% to difficulties in obtaining food and 30% to bad odor.

The majority of the Muftaresheen were males under 40 years of age, which may be attributed to the fact that being a muftaresh, living on the street, and facing many difficulties requires physical fitness. Although the Muftaresheen belonged to different nationalities, certain nationalities were more common, which, most probably, reflects the large number of people of these nationalities residing in Saudi Arabia, since most muftaresheen were domestic Hajjees. Saudis comprised 5% only, indicating that this problem is mainly among non-Saudis.

The overall meningococcal vaccination coverage is consistent with previous studies.[1] This incomplete coverage raises the importance of exerting continuous efforts to maintain a high vaccination coverage to prevent meningococcal meningitis outbreaks.

Health education remains the backbone for prevention of most Hajj associated diseases. The present study showed that about one third of the Muftaresheen had not received any education regarding Hajj-related health problems. This raises the importance of exposing Hajjees to health education concerning different Hajj related problems. Furthermore, 44% of symptomatic Hajjees did not seek treatment, which may also be due to lack of health education regarding utilization of the free medical services offered

Over one third bought their food from street vendors, which is higher than previous reports on organized Hajj groups. [2] Street food vendors can be a potentially serious hazard, due to the difficulty of adequate supervision by local authorities during the busy Hajj season.[3] On the other hand, Hajjees in the present study faced little problem regarding drinking healthy water and accessibility to public toilets. About two-thirds of the participants were comfortable with performing Hajj as Muftaresheen, despite the fact that they reported sleeping under six hours per day because of the light and noise.

The access of muftaresheen to excellent free governmental services, safe portable water supply and proper management of excreta disposal, in addition to relatively acceptable shelter, may continue encouraging them to choose residing on the street. A strong effort should be exerted to stop this problem by intensifying health education on the hazards of staying on the streets, application of strict regulations regarding joining organized Hajj groups, and decreasing the cost of joining organized Hajj groups for the benefit of intermediate and low income Hajjees.