الفهرس 
ACKNOWLEDGEMENT
Heaith risks at hajj and umrahOnly 14 pages are availabe for public view
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Abstract
Every year more than 10 million pilgrims from 184 countries arrive at Makkah for the Hajj or the Umrah. Intense congestion, shared accommodation, air pollution, and compromised hygiene all contribute to the transmission of infections at Hajj, most notably acute respiratory infections (ARIs).
To date, few studies have assessed the health seeking behaviour of Umrah pilgrims, and almost none in Egypt. As there is a public health need to identify strategies targeting the Hajj and Umrah pilgrims for travel health promotion, we aimed in this study to assess the health seeking practices and their determinants among Umrah pilgrims departing from Assiut international Airport.
This cross-sectional study was conducted in the departure lounge at Assiut International Airport. Data collection started at 6th of June 2016 (1st of Ramadan 1437) till the end of Ramadan at 5th of July, then stopped till March 2017 and resumed thereafter till the end of April 2017. A total number of 300 Umrah pilgrims were invited to participate in the study through face-to-face interviews using a semi-structured questionnaire.
The questionnaire included the following items:
a) Participant demographics (age, sex, residence, marital status, educational level, occupation, smoking and whether they have a chronic illness).
b) Travel characteristics of the study participants (travel companions and trip planner).
c) Pre-travel health-related knowledge of Umrah Pilgrims.
d) Pre-travel attitudes of Umrah Pilgrims about the health practices during Umrah.
e) Pre-travel health seeking practices (seeking health information, vaccination and clinical consultation).
f) History of previous Hajj/Umrah (Pre-travel health seeking practices during previous Hajj/Umrah, health practices and experienced health problems).
Socio-demographic characteristics:
Regarding the socio-demographic characteristics of the study participants, more than 50% of them above 50 years (Their mean age was 48.9 ±14.3), most of them were males (66.7%) and married (72%). 44.7% of them were smokers, 31.3% of studied pilgrims had secondary education, 24.7% had university education while 28% were illiterates or knew only to read and write.
Also, 46 % of the study participants were from rural areas while 54% were urban residents. 35% of the study pilgrims had chronic diseases, the most commonly mentioned diseases were hypertension (64.8%) and diabetes mellitus (47.6%).
Hajj/ Umrah related health knowledge of the study pilgrims:
There was low-risk perception among the study pilgrims as only one-third of them expected the exposure to a health risk during Umrah.
Regarding the level of knowledge of the study participants, they had an average level of knowledge regarding some communicable diseases such as; respiratory, gastrointestinal and skin infections related to Umrah and regarding some non-communicable health problems such as; sunstroke, constipation and low back pain.
However, they had poor level of knowledge regarding recent infections; MERS-CoV and Zika virus and diseases which can be transmitted by unsafe shaving and Hajj bag.
The attitude of the pilgrims about pre-travel health practices:
The majority of the study pilgrims had positive attitude regarding the pre-travel health seeking practices and were found to have a total attitude score percent of 71.9 %.
A great proportion of the study participants believed in importance of pre-travel vaccination (60%) and that pre-travel vaccination gives protection against infection (60.3%). Moreover, 60.3% disagreed about not getting the required vaccines for fear of side effects and 61.3% disagreed that vaccination is not important for the elderly. However, just less than half of the study participants thought that vaccination is just a pre-travel routine or were neutral about this statement.
Moreover, almost half of the study participants believed that only elderly should visit a physician before travel, agreed that they should seek pre-travel health information and believed in the importance of pre-travel clinical examination. However, it was found that the majority of them believed in the importance of using a face mask (77%) and washing hands frequently (86.3 %) to avoid respiratory infections.
Pre-travel health practices of the pilgrims:
Regarding pre travel seeking of health information among studied pilgrims, only 33.3% of them believed in the importance of seeking pre-travel health information, while only 24% actually sought health-related information.
Their main sources of pre travel health information were private clinics (63.9%) and the internet (27.8 %) and the most frequently health-related information was the regulation of drug doses during Umrah (63.9%) followed by the required vaccination (19.4 %).
The main cause of reluctance of seeking pre-travel health-related information was lack of knowledge about the existence of health risks during Umrah (53.1%).
Regarding pre-travel vaccinations, only 56.3% of the study participants were vaccinated before travelling to Umrah and 72.2% of them believed in the importance of pre-travel vaccination. The lack of knowledge about the existence of any required vaccine was the main cause of not having the required pre-travel vaccines (66.4%).
Regarding pre-travel visiting a physician, (26.7%) of the study pilgrims visited a physician before travel for Umrah, mainly for organizing treatment doses of chronic disease (57.4%).
Factors affecting seeking pre-travel health practices:
By Logistic regression analysis, the most important predictors of seeking pre-travel health practices among the study pilgrims were the positive attitude of pilgrims about health seeking behavior, their perception of the risk of health hazards during Umrah and having a chronic disease.
It was found that having a chronic disease (B=2.70, p value <0.001), higher scores of positive attitude of pilgrims about health seeking behavior (B= 0.37, p value <0.001) and the pilgrims’ perception of health risk (B= 1.32, p value <0.01) were the significant predictors of pre-travel seeking of health information.
Regarding pre-travel vaccination, urban residence (B= 1.11, p value <0.001), higher scores of positive attitude about health seeking behavior (B= 0.22, p value <0.001) and their perception of risk were the significant predictors.
However, having a chronic disease (B= 4.27, p value <0.001) and the attitude of the Umrah pilgrims about health seeking behavior (B= 0.30, p value <0.001) were the only significant predictor of visiting a physician before travelling to Umrah.
Based upon these findings, the study recommends enhancing the awareness among Hajj pilgrims about the importance of seeking professional pre-travel health advice and about the routine and recommended vaccines, and suggests that communicating the risk of exposure to travel-related infectious diseases to pilgrims would support the adherence to healthy practices.
The study also recommends the establishment of affordable and accessible travel clinic in Egypt, with training of the general practitioners in the public health sector by specialized organizations about the essential travel health information about Hajj and the preventive measures recommended by Saudi MOH.