How to Reduce Cardiovascular Mortality and Morbidity among Hajj Pilgrims: A Multiphasic Screening, Intervention and Assessment

Abstract

Each year, thousands of pilgrims travel to Saudi Arabia to perform Hajj ceremonies. Complete and correct performance of the obligatory rites, usually in hot weather and often in the midst of a huge crowd, is sometimes difficult even for healthy subjects. It is considerably more difficult for patients with cardiovascular disorders, because of their potential underlying disabilities. These considerations prompted the Hajj Medical Group in Isfahan to design guidelines to screen potential pilgrims with cardiovascular disorders. The main objectives were: 1) to screen cardiovascular disorders among subjects older than 50 years before Hajj; 2) to adopt appropriate intervention measures; and 3) to assess the outcome of the intervention measures. The objective was the prevention of increasing mortality and morbidity among pilgrims during the pilgrimage. We had the opportunity to conduct the medical evaluation of all the applicants in standard situations based on the protocol, so that the methods could be used by any health policymakers among the nations whose citizens perform the pilgrimage. Patients and Methods This study consisted of two phases. The first phase, in which the pilgrims were screened, was a cross-sectiona l study conducted in 1993. The second phase was a cohort study in which a number of patients with cardiovascular disorders were selected randomly before, and followed up after the ceremony to evaluate morbidity and mortality. The target population included all applicants of Isfahan City aged 50 or more, who wanted to participate in the Hajj ceremonies in 1993. There was a 100% participation rate in the screening program. All the pilgrims were referred to Al-Zahra General Medical Hospital for screening.