Preference of treatment facilities among Malaysian Hajj pilgrims for acute respiratory symptoms.

A respiratory symptoms are among of the most common problems faced by Hajj pilgrims who frequently need medical attention. Respiratory diseases were the most common cause of admission to hospital, with pneumonia being the leading reason for admission in 39% of all patients.1 Over the years, approximately 25,000 Malaysian Hajj pilgrims travel to Makkah, Kingdom of Saudi Arabia. They are managed by the Malaysian Hajj Fund (Tabung Haji), a government linked company to take care of Malaysian Hajj pilgrims. They stay in the holy land for almost 40 days. Approximately two-thirds of the Hajj pilgrims go to Madinah first for 8 days. Then, they reside in Makkah for the rest of the Hajj journey. After completing the Hajj ritual, they proceed to Jeddah, and stay at Madinatul-Hujjaj of Jeddah for 2 nights awaiting their flight back to their country. Another third of the Hajj pilgrims goes directly to Makkah, and comes back via Madina. In the year 2007 Hajj season, 256 members of the Tabung Haji Malaysia medical mission went to the holy land to take care of approximately 26,000 Malaysian Hajj pilgrims. The main role of a medical mission member was to make sure the Hajj pilgrims could perform the ritual Hajj practice in optimum health conditions. This team included 4 physicians, 41 medical officers, one pharmacist, one dietician, 59 nurses, and 50 medical assistants. Other staff involved was an x-ray radiographer, a medical technologist, and a physiotherapist. Tabung Haji Malaysia provided 16 clinics in Makkah, 3 in Madinah, and one in Jeddah. They also have 3 hospitals in Makkah, namely, Hospital Aziziah (80 beds), Syishah Medical Center (98 beds), and Al-Janadriah clinic (41 beds). In Madinah, one of the clinics has a transit ward consisting of 19 beds. If the patients need further treatment in the holy land, they are referred to the Saudi Ministry of Health’s hospitals. Sixteen ambulances were available for patients’ transportation. Fifty percent of the patients received treatments due to respiratory diseases. The aim of this study is to determine the choice of health facilities among Malaysian Hajj pilgrims for acute respiratory symptoms. This study focuses on specific symptoms of acute respiratory tract manifestation such as cough (with or without sputum), sore throat, runny nose, fever, and its duration. A cross-sectional study was conducted among 2,000 Malaysian Hajj pilgrims from 23rd December 2007 to 23rd January 2008. Ethical approval was obtained from the Universiti Sains Malaysia Research and Ethics Committee. Informed consents were obtained from the participants. Survey forms were distributed at Madinatul-Hujjaj, Jeddah, and Tabung Haji Clinic, Madinah, Saudi Arabia where pilgrims stayed on transit before returning to Malaysia. The response to the survey was on voluntary basis. The inclusion criteria were Malaysian citizens that performed Hajj in the 2007M/1428H Hajj season, coming back via Madinatul-Hujjaj, Jeddah, or Madinah, Saudi Arabia, and with at least one respiratory symptom. The exclusion criteria were Hajj pilgrims who could not read or write in the Malay language. Data were entered and analyzed using the SPSS software (SPSS, Chicago, USA) version 12.0. Results were expressed in terms of the number and percentage. For continuous variable, they were categorized in groups and analyzed similar to categorical variables. A p-value of <0.05 was considered to be statistically significant. Out of 394 pilgrims that returned the completed questionnaires, 375 (95.2%) had one or more respiratory symptoms, and were included in the study. These were: 355 cough, 308 runny noses, 230 fevers, and 222 sore throat. Sixty-one (16.3%) were taking self-medication, 278 (74.1%) sought treatment from a Tabung Haji clinic; 11 (2.9%) were admitted to hospital, and 62 (16.5%) did not take any treatment for acute respiratory symptoms. Some of them sought more than one type of treatment. There were significantly more Hajj pilgrims with cough (p=0.011), runny nose (p=0.040), sore throat (p=0.012), and fever (p=0.001) attending the Tabung Haji clinic. There were also significantly more patients with cough for more than 2 weeks (p=0.037), and runny nose more than 2 weeks (p=0.002) attending the Tabung Haji clinic. There was no significant association between any respiratory symptoms with self-treatment and hospital admission (Table 1). As a field clinic, the Tabung Haji clinic could cater to respiratory symptoms among Malaysian Hajj pilgrims. The Hajj pilgrims with respiratory symptoms were significantly seeking treatment at the Tabung Haji clinic. Some of the Hajj pilgrims took medication that they brought from their country. When their conditions did not improve or worsen, they sought medical