Investigating health risk perceptions during the Hajj: Pre-Travel advice and adherence to preventative health measures.

Background: Every year, over 2 million people gather together to observe the Hajj pilgrimage in Mecca. This presents a public health risk to both Saudi and the pilgrims' country of origin. The aim of this study was to evaluate the risk perception and the source of health advice by the pilgrims. Methods: We conducted a cross-sectional survey among internal and external pilgrims performing the Hajj. The survey evaluates the general safety and preventative measures applied, factors influencing public health safety at Hajj, source of pre-travel health advice, recommended preventative health measures, and the effective preventative measures. Results: A total of 280 pilgrims from 28 different countries were approached of which 233 completed the survey with response rate of 83%. The majority (219 [94%]) of the respondents considered the Hajj as safe while 205 (88%) sought pretravel health advice. The most popular source of pre-travel health advice among the pilgrims were from medical professionals (83 [25.6%]) and other pilgrims (44 [18.9%]). Diversity and carelessness were believed to be the main factors influencing public health safety in the Hajj by 184 (79%) and 181 (78%) of the respondents respectively. Yellow fever (117 [50%]) and wearing of face masks (56 [24%]) were the most and least adopted recommended public health measures respectively while most pilgrims believed handwashing (137 [59%]) and wearing of face mask (119 [51%]) are the most effective preventative health measures. Conclusion: Our study shows a reduced perception by pilgrims of the health risk of the Hajj and highlights the need to improve how information is channelled to prospective pilgrims about preventative health measures. The discordance between recommended preventative health measures and adherences by pilgrims shows a need for a comprehensive enforcement program underpinned by the Saudi Ministry of Health (MoH). [ABSTRACT FROM AUTHOR]