Jumanah Alhazmi

Background: Body Mass Index (BMI), a measure based on weight and height, is a key indicator for assessing health status and the risk of chronic diseases such as hypertension, diabetes, and cancer. Both ends of the BMI distribution have been associated with greater healthcare utilization, with prior evidence in general populations suggesting a non-linear (U-shaped) association in which underweight and obese individuals use more healthcare services than those with normal weight. This relationship is particularly important during mass gatherings like the Hajj pilgrimage, where overcrowding, extreme heat, and physical exertion can amplify health risks. This study aimed to investigate how variations in BMI influence clinic visits, hospital stays, and diagnoses among pilgrims during Hajj. Methods: A cross-sectional study was conducted among 4,000 pilgrims randomly selected from the official Hajj registry during the 2024 (1445 H) season. BMI was modelled as a categorical variable (<18.5, 18.5–24.9, 25–29.9, and ≥30 kg/m²), with the normal-weight category as the reference, allowing detection of non-linear (U-shaped) associations. Outcomes were clinic visit (yes/no), hospital admission (yes/no), and primary diagnosis, all collected using a standardized data collection form. Crude and adjusted odds ratios (cOR, aOR) with 95% confidence intervals and exact p-values were estimated using multiple logistic regression, adjusting simultaneously for age, gender, education, WHO region, marital status, employment, and smoking. Results: Underweight (BMI <18.5) and obese (BMI ≥30) pilgrims reported higher rates of clinic visits (9% and 10%, respectively) and higher rates of hospital admission than normal-weight and overweight pilgrims, confirming a U-shaped association between BMI and healthcare utilization. The most frequent diagnoses were heat-related illnesses (75% of admissions among underweight, 76% among obese), followed by chronic-disease follow-up, particularly at BMI extremes. In the adjusted analyses, WHO region and employment status remained significantly associated with clinic visits, with lower odds among pilgrims from South-East Asia and higher odds among unemployed individuals with BMI <18.5. Conclusion: Both low and high BMI are linked to greater healthcare utilization during Hajj. Implementing targeted risk assessments, pre-travel health education, and culturally adapted healthcare services for BMI extremes may reduce acute healthcare demand during mass gatherings.

Background: The Hajj pilgrimage, a significant religious event, presents unique health challenges due to the large number of participants and the physical demands of the pilgrimage. Despite efforts by Saudi health authorities to provide comprehensive health services, the effectiveness of these interventions relies heavily on pilgrims’ knowledge of available services and emergency measures. Objectives: The aim of this study is to assess the level of knowledge of health services among Hajj pilgrims in Saudi Arabia during the 1445 H (2024 G) season and its associated demographic and health-related factors. Methods and Materials: This cross-sectional study was conducted during the 1445 H (2024 G) Hajj season with 1215 pilgrims, 51.7% male. Participants were randomly selected from selected pilgrimage accommodations or passing through the airport in Jeddah. Data were collected through face-to-face interviews using a structured questionnaire covering demographics, health characteristics, and knowledge of health services. Results: The study found that 62.1% of participants correctly believed that health services during Hajj were free of charge. Furthermore, 44.4% were aware of the emergency health number, with 31.5% exhibiting good knowledge. Bivariate analysis showed that younger participants had better knowledge (p < 0.001), and males were more likely than females to demonstrate partial or good knowledge (p = 0.011). Participants with university education were significantly more likely to have good knowledge, with 29.6% demonstrating good knowledge compared to 7.4% of illiterate participants (p < 0.001). Geographic region was also a factor, with 48.9% of Middle Eastern participants exhibiting good knowledge, compared to 27.1% of African and 23.6% of Asian participants (p < 0.001). However, multivariable logistic regression, revealed that only younger age (OR = 0.98, p = 0.005), university education (OR = 1.96, p = 0.024), and being from the Middle East (OR = 1.61, p = 0.009) were significant predictors of good knowledge of health services. Conclusions: The study identified significant gaps in pilgrims’ knowledge of health services during Hajj, with younger age, higher education, and Middle Eastern geographic region identified as independent predictors of better knowledge. These findings suggest the need for targeted health education initiatives, particularly for older pilgrims, those with lower educational attainment, and individuals from regions with lower awareness levels, to improve knowledge and potentially enhance health outcomes during Hajj.

Background: Foot injuries are common among Umrah pilgrims due to prolonged walking, overcrowded conditions, and inadequate preventive measures, such as inappropriate footwear or walking barefoot. Despite their potential impact on mobility and overall pilgrimage experience, these conditions remain underreported and insufficiently addressed in public health strategies. Objectives: This study aims to assess the prevalence and types of foot problems among Umrah pilgrims, examine their associations with demographic characteristics and comorbidities, analyze the utilization of medical attention for foot pain, and assess the use of preventive measures to reduce foot-related health risks during the pilgrimage. Methods: A cross-sectional study was conducted throughout the 2024 G (1445 H) Umrah season at the Grand Mosque, Makkah. The study recruited 1138 Umrah pilgrims aged 18 and older who performed the pilgrimage. A structured questionnaire was administered to collect data on demographic characteristics, chronic diseases, foot conditions, medical-attention-seeking behavior, and preventive practices. Pilgrims with pre-existing foot conditions were excluded from participation. Results: Foot diseases were reported by 46% of participants. The most common foot injuries included sprains/strains (18.7%) and muscle pain/cramps (4.9%), with the leg and forefoot being the most affected areas. Significant associations were observed between foot diseases and lower education levels (p = 0.03), chronic liver disease (p = 0.04), and cardiovascular disease (p = 0.04). Despite the high prevalence of foot-related conditions, only 9.6% sought medical attention, and 14.9% reported using preventive measures. Conclusions: The study highlights a substantial burden of foot problems among Umrah pilgrims, with limited utilization of healthcare services and preventive strategies. Targeted interventions, including educational campaigns and improved screening for high-risk individuals, are essential for enhancing foot health and ensuring a safer pilgrimage experience.