The utilization of primary health care services at Mina during Hajj, 1998

The annual pilgrimage to Makkah (Hajj) is a unique gathering of Muslims from all over the world. Pilgrims (Hajjees) vary considerably in their sociodemographic characteristics, health-related behaviors and their underlying health status. As a result, they vary in their medical needs.

In addition to the institution of numerous preventive public health measures, the Saudi Arabian health authorities provide free medical services for all religious visitors, including dispensed medicines and cost of hospitalization [1, 2, 3]. Despite these arrangements for organization and management of the Hajj event, there is an increasing need for better understanding of the medical needs of Hajjees during Hajj. Such information is needed for planning new medical programs and evaluation of ongoing medical services.

The objectives of this study were to identify the pattern of the workload at the primary health care centers (PHCCs) in Mina, and the age-, sex-, and nationality distribution of the common illnesses among Hajjees treated at these PHCCs.

PHCCs provide pure ambulatory, curative services 24 hours a day from 7 Dhul Hijja through 12 Dhul Hijja (April 4-9). There are about 20-35 health workers assigned to each center. A systematic random sample was selected from the records of patients who visited 15 of the 22 PHCCs and 1 of the 3 hospitals serving Hajjees in Mina. The nationalities of Hajjees were divided into 8 groups according to the administrative organization of the Ministry of Hajj. Illnesses were also regrouped into 8 groups according to the systems affected.

Of 1,323 records reviewed of more than 44 nationalities, the male to female sex ratio of PHCCs users was 2:1. About 10-12% of all patients across different nationalities were 65 years or older except Hajjees from Gulf Cooperative Council countries (GCC) (1.8%) and Iran (17.3%). The workload at the PHCCs in Mina increased steadily and progressively, reaching its peak on 12 Dhul Hijja (Figure 1). The workload showed consistent daily bimodal pattern; the busiest periods were between 6-10 AM and 7-10 PM . However, the workload was relatively low in the morning of 10 Dhul Hijja and the evening of 12 Dhul Hijja. Moreover, on 12 Dhul Hijja, the workload started about 2 hours earlier.

The leading causes of morbidity among Hajjees diagnosed at the PHCCs in Mina were respiratory diseases (48.6% of all illnesses), gastrointestinal illnesses (10.7%), skin diseases (7.6%) and diseases of the muscles and joints (7.4%). Heat exhaustion, cut wounds, and chronic illnesses, such as diabetes mellitus and hypertension, constituted less than 2% each (Table 1). Acute respiratory infection (ARI) spread in waves from one nationality group to another, and by 12 Dhul Hijja all nationality groups were affected.

The workload at the PHCCs varied. Of all the PHCCs, those located close to Al-Jamarat area were the busiest. A similar observation was noted by another survey conducted in 1992, although the workload at the other PHCCs in that year did not agree completely with our study [1]. Some nationalities utilized PHCC services in Mina more than others. This could be attributed to the relatively large numbers of Hajjees from these nationalities such as those from Southeast Asia. Unfortunately, lack of data needed for denominators made it difficult to calculate useful rates on utilization of the PHCCs during Hajj.

The hourly variations in the workload at the PHCCs could help decision-makers in redistribution of the health manpower between and within the PHCCs to design a more efficient schedule for general practitioners and other medical staff within the PHCCs. The remarkably wearisome physical effort a Hajjee would undergo could probably explain the increased utilization of PHCC services. Occurrence of illnesses could reflect some undesirable risk behaviors among certain nationality groups.

The movements of Hajjees on foot on 9 Dhul Hijja makes illnesses such as heat exhaustion and skin morbidity conditions more predominantly seen on 10 Dhul Hijja, whereas, gastrointestinal illnesses (GIT) that require a relatively longer incubation period, are mainly seen on 11 and 12 Dhul Hijja [4]. Occurrence of more GIT illnesses could reflect some undesirable risk behaviors among certain nationality groups such as reliance on street venders for meals, especially at Arafat, or poor storage of leftover foods in Mina or Arafat [4]. The spread of Al21 in waves from one nationality group to another seemed to be related to the geographical location of the camps of Hajjees.