Abstract
AIM: The Hajj pilgrimage, the world's largest annual mass gathering, is held in the Kingdom of Saudi Arabia (KSA). The Saudi Arabian Ministry of Health (MoH) issues entry visa requirements and recommendations for Hajj pilgrims visiting the country. Vaccinations, health checks, and specific immunizations are all recommended either at or before entering KSA.
 
 We assessed Hajj pilgrims’ knowledge, attitude and practices regarding preventive, curative, hygienic and health promoting measures. 
 
 SUBJECTS AND METHODS: We administered a questionnaire to a cross-section of Hajj pilgrims(2018 G)traveling through Prince Mohammad bin Abdulaziz International Airport in Al-Madina, KSA. Variables collected included demographics, Hajj health preparations, and knowledge and attitudes towards travel-related health behaviors. 
 
 RESULTS: Of 101 respondents, 20% were Saudi and 64%were male. Regarding travel profile, 75% were attending hajj for the first time. About half (52%) stayed in KSA for more than 2 weeks.  Knowledge regarding travel heath of respondents was high: 82% scored as excellent and 11% scored as good. Positive attitude toward travel medicine was reported by 60% of participants; 56% of them sought pre-travel advice.  Regarding health protection behaviors, 79%reported using protective measures against respiratory infections, 70%for insects, 95%for food and waterborne Diseases, 99%against heat-related conditions and 100%for injuries.
 
 CONCLUSION: Despite the health criteria for obtaining Hajj visas and the documented health risks associated with attending Hajj, we discovered that less than half of participants received pre-travel advice. To ensure that Hajj pilgrims have a secure and healthy experience in the Kingdom, we recognized the need for continued education and promotion of health preventive measures. This research could be used to help countries establish Hajj health systems, which would be immensely helpful and would go a long way toward reducing Hajj mortality and morbidity, as well as associated burdens.
Highlights
A mass gathering is defined by WHO as a planned or spontaneous event that gathers substantial numbers of attendees who might strain the health planning and response capacities of the host community, city, or country [1].Mass gathering sporting and religious events pose important public health challenges, including the transmission of infectious diseases, exacerbation of non-communicable diseases, and disorders related to climate change [2]
We found that less than half of participants obtained pre-travel advice, despite the health requirements for obtaining Hajj visas and the known health risks associated with attending Hajj
We identified a need for continued education and promotion of health prevention measures to ensure that Hajj pilgrims are able to have a safe and healthy experience in the Kingdom
Summary
A mass gathering is defined by WHO as a planned or spontaneous event that gathers substantial numbers of attendees who might strain the health planning and response capacities of the host community, city, or country [1].Mass gathering sporting and religious events pose important public health challenges, including the transmission of infectious diseases, exacerbation of non-communicable diseases, and disorders related to climate change [2]. The Kingdom of Saudi Arabia (KSA) hosts the Hajj pilgrimage, which is the largest mass gathering in the world held on a recurrent annual basis [3]. The Ministry of Health (MoH) of the Kingdom of Saudi Arabia issues the requirements and recommendations for entry visas relevant to pilgrims and seasonal workers who intend to visit KSA during forthcoming Hajj season. The Ministry of Health (MoH) of KSA issues requirements and recommendations for entry visas relevant to travelers visiting KSA during Hajj. These recommendations include vaccinations, health checks, and specific immunizations either at or prior to entry into KSA. We assessed Hajj pilgrims’ knowledge, attitude and practices regarding preventive, curative, hygienic and health promoting measures
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