Pre-Hajj Health-Related Advice, Makkah, 1999

During Hajj (The Islamic pilgrimage to Makkah) of 1999 (1419 H), the Saudi Arabian Field Epidemiology training Program (FETP) conducted A major survey to study knowledge and practice of Hajjees concerning Hajj related Health problems.

At Mina (a holy place near Makkah) where more than 2 million Hajjees spend at least 3 days, A map was used to divide Mina into four equal zones and the whole area was subdivided into 476 equal areas. Of those 476 equal areas, 66 clusters were randomly selected proportionate to the number of areas in each zone using a two-stage cluster sampling, 20-35 Hajjees per cluster.

A total of 1707 Hajjes from 53 nationalities were interviewed by using a self-administered questionnaire that was translated into 16 languages. Hajjees were grouped according to their nationalities as determined by the ministry of Hajj: Gulf Cooperation Council countries (GCC), Other Arab countries (ARB), South Asia (Indian subcontinent, ISC), Southeast Asia (SEA), Sub-Saharan Africa (SSA), Iran, the Former Soviet Union (FSU), the Americas, Europe and Australia.

Out of 1707 Hajjees, 79% were performing Hajj for the first time and 97% joined organized Hajj groups. Two percent were residents of Saudi Arabia, while 57% wore identifying wristbands (44% of Hajjees were advised to do so). Of the total, 24% used face masks (28% of Hajjees were advised to do so), 46% applied lubricants (34.1% of Hajjees were advised to do so), and 67.2% washed their hands frequently (54.3% of Hajjees were advised to do so). Eighty-seven percent received the acquired vaccination against meningococcal meningitis (84% of Hajjees were advised to do so). Risky behaviors for food poisoning included: bringing food from home country 35% (23.4% of Hajjees were advised to do so), and eating food from street vendors 43% (31% of Hajjees were advised to do so). Heat stroke prevention included 73% who used an umbrella (67% of Hajjees were advised to do so), 90% who drank plenty of water (72% of Hajjees were advised to do so), and 76.3% who used transportation on moving between the holy places (41.3% of Hajjees were advised to do so).

After completing the Hajj rites, 99.7% had their heads shaved with razor blades and 7% put themselves at risk of bloodborne disease by using a previously-used razor blade. Pamphlets and lectures were very effective sources of advice. There were significant associations between practice and advice regarding healthy behaviors. The percentages of healthy practice among Hajjes according to their group nationality are summarized in Table 1.

Hajjees come to Saudi Arabia from more than 140 countries around the world with varying disease profile [1]. During Hajj health education is conducted in more than ten languages [2].

The results of this study were consistent with previous reports. The incomplete meningococcal vaccine (MCV) coverage rate indicates loose application of laws that many Hajjees may be were not asked to show vaccination certificate to verify their vaccination status. It demonstrates the need for continuous effort to maintain high coverage, through the constant release of reminders emphasizing strict adherence to the visa issuance policy for religious policy.

Hajjees brought food with them probably because they wanted to save some money or enjoy their favorite food items during Hajj. The reasons for buying food from street vendors were due to low percentage of advice and difficulty of adequate supervision by local health authorities during busy and crowded Hajj days.

The unhygienic head-shaving practice during Hajj of reusing razor blades is a potential mode of transmission of bloodborne diseases among Hajjees; especially viral infectious diseases such as Hepatitis B and C, and Acquired Immunodeficiency Syndrome (AIDS) [3]. The results of this study show that most of Hajjees did not use previously used razors. This probably due to increased awareness toward the hazards of such un-hygienic head-shaving practice.

Heat exhaustion during Hajj is the leading cause of morbidity among Hajjees and accounts for 70% of all hospital admissions [4]. The low percentage of Hajjes who used umbrella may be due to the inclusion of Iranian Hajjees among the sample of the study and these Hajjees have some religious belief that the head should not be covered either directly or indirectly. The low percentage of Hajjees who wore wristbands is probably due to low percentage of advice or that some Hajjees may have believed that it might have contradicted their religious beliefs.

The low percentages of practices regarding wearing comfortable shoes , applying lubricants, and washing hands frequently might be due to the low percentages of those advised and the lack of effective health education being promoted.

There was in adequate advice regarding healthy behaviors among Hajjees, accordingly, high-risk behaviors were widely prevalent. Well-designed health education programs are probably the best tools that could be used to rectify undesirable behaviors among Hajjes [5].

In this study Health education significantly affects the practices of Hajjees. Exposure of Hajjees to intensified sessions in health education regarding different aspects of Hajj related illness could start even before Hajjees depart from their home countries.