Beyond borders: Exploring the mental, emotional, and spiritual significance of Hajj.

For Muslims all across the world, the desire to participate in the religious rites of the Hajj (pilgrimage to Mecca) which stands as one of the five pillars of Islam is a heartfelt longing. It stands for the pinnacle of devotion and spiritual gratification, luring followers to the most sacred city in Islam for a life-changing journey of faith, comradery, and submission to Allah. Muslims hold Mecca in the highest regard; it is a source of endless inspiration and devotion throughout their lives, as seen by their desire to undertake the Hajj and Umrah. The pilgrimage encompasses a series of synchronized rituals and acts of worship, each holding its unique spiritual meaning, and serve as a powerful testament to the universal nature of Islamic teachings. These rituals have a significant impact on Muslims' mental and spiritual well-being. Hajj elicits a spectrum of feelings; creates unity, humility, and thankfulness; and encourages self-reflection as well as personal development. It also instills a sense of spiritual fulfillment. Hajj transcends personal boundaries, strengthening a pilgrim's sense of connection to the larger Muslim community that rejuvenates their hearts and souls toward the teaching of Islam. Hence, it is imperative to explore in depth this transformative journey, illuminating the mental, emotional, and spiritual dimensions that bind Muslims across the globe.

Identity enactment as a social accomplishment: Shared identity and the provision of mutual support amongst pilgrims undertaking the Hajj.

Experimental and survey research shows that a common group membership can result in increased levels of social support. Here we complement such research with qualitative data concerning the forms and function of such support. Specifically, we explore the mutual support reported by pilgrims undertaking the Hajj. This requires participants enact a series of identity-related beliefs and values (including specific rituals) in conditions that are practically and psychologically challenging. Using data obtained through semi-structured interviews (N = 33), we investigate how participants' shared identity facilitated their behavioural enactment of these identity-defining beliefs and values. We focus on how their shared understanding of their beliefs and values as Hajj pilgrims allowed various forms of support (psychological, material, informational, and behavioural) which helped participants translate their identity-related ideals into behaviour. Our analysis implies that a shared identity provides a frame of reference with which group members can recognize each other's identity-related concerns and what they need in order to enact their identity. In turn, it implies that in situations where there are practical and psychological constraints on behaviour, action in terms of one's social identity can be conceptualized as a joint accomplishment in which the mutual support of group members is key.

Triggers, Risk Factors, and the Prevalence of Syncope Among Domestic Hajj Pilgrims, 2023: A Cross-Sectional Study.

BACKGROUND: Syncope and other transient loss of consciousness episodes in crowded and unfamiliar environments may lead to major health hazards. Despite numerous publications, data on syncope among Hajj pilgrims in Makkah is lacking. OBJECTIVES: To identify the triggers, risk factors, and prevalence of syncope and other transient loss of consciousness episodes among domestic pilgrims. METHODOLOGY: This cross-sectional study included a convenient sample of domestic pilgrims who performed Hajj in July 2023 using an online Google Forms questionnaire (Alphabet Inc., Mountain View, CA). RESULTS: Out of 388 participants, 69 (18.1%) reported a history of syncope during the Hajj pilgrimage. Among these, 57 (82.6%) reported complete loss of consciousness, and 56 (81.2%) noted warning symptoms preceding the episode. The syncopal attack occurred once in 49 respondents (71%). Several triggers for syncope were identified, with sudden standing from a sitting position being the most prevalent (100%). Additional co-triggers were crowding (n=43; 62.3%), stressful conditions (n=30; 43.2%), prolonged standing (n=21; 30.4%), and walking (n=11; 15.9%). Traumatic injuries were reported in 33 (47.8%) as a result of syncope. Standing for long periods of time on the day of Arafat (Arafat standing) emerged as the most common triggering situation (n=48; 69.6%). There were multiple medical factors contributing to syncopal episodes; the most common medical explanations were heat exhaustion (n=48; 69.6%), dehydration (n=24; 34.8%), over-exertion (n=48; 69.6%), low blood sugar (n=10; 14.5%), and low blood pressure (n=17; 24.6%). Significant predictors were the presence of cardiac disease (odd ratio (OR) 7.6, 95% confidence interval (CI) 2.71-21.45, p<0.001), anemia (OR 2.5, 95% CI 1.01-6.09, p=0.049), previous syncope (OR 2.5, 95% CI 1.02-6.27, p=0.049, and family history of syncope (OR 10.1, 95% CI 2.08-49.32, p=0.004). CONCLUSION: Syncope during the domestic Hajj pilgrimage is frequent, especially on the day of Arafat, and carries the risk of traumatic injury. People with previous episodes of syncope and comorbidities, especially cardiac patients and those who have a family history of syncope, are particularly prone to this risk. Healthcare should focus on at-risk patients, particularly on critical pilgrimage days, and increase pilgrims' awareness about triggers of syncope including sudden and prolonged standing, exertion, and heat exposure.

Recommendations for management of diabetes and its complications during Hajj (Muslim Pilgrimage) - 2024 update.

Hajj is an obligatory duty for all healthy adult Muslims once in the lifetime subjected to the ability. Considering the 10.5 % global prevalence of diabetes coupled with the numbers of Muslims performing the Hajj, ∼ 1.8 million in 2023, it is estimated that Muslims with diabetes performing Hajj may exceed 340,000 this year. During Hajj the pattern and amount of their meal, fluid intake and physical activity are markedly altered. Many people with diabetes insist on doing the Hajj duty, thereby creating a medical challenge for themselves and their health care providers. It is therefore important that medical professionals be aware of the potential risks that may be associated with Hajj. People with diabetes may face many health hazards during Hajj including but not limited to the killer triad which might occur during Hajj: Hypoglycemia, Foot injury and Infections. Many precautions should be taken to prevent and treat these potentially serious complications. Risk stratification, medication adjustments, proper clinical assessment, and education before doing Hajj are crucial.

The Prevalence of Musculoskeletal Injuries Among Pilgrims During the 2023 Hajj Season: A Cross-Sectional Study.

Background Hajj, the annual Islamic pilgrimage, brings together over two million pilgrims in the city of Makkah to participate in a series of rituals. Given the physically demanding nature of the Hajj, pilgrims are susceptible to musculoskeletal (MSK) injuries and exhaustion. MSK pain and injuries are frequent occurrences among pilgrims, necessitating an assessment of the scope of this issue. Therefore, the primary objective of this study was to determine the prevalence of MSK injuries among pilgrims during the 2023 Hajj season. Methods This is a cross-sectional questionnaire-based study that was conducted in the city of Makkah, Saudi Arabia, during the 2023 Hajj season. Results A total of 463 pilgrims were included in the analysis. The most frequently reported types of injuries were muscular injuries (169, 45.4%), primarily characterized by pain (99, 58.6%), muscle spasms (55, 32.5%), and muscle tears (eight, 4.7%). The second most commonly reported MSK injury was bony injuries (97, 26.1%), which included fractures, followed by 79 cases (21.2%) of joint injuries, predominantly featuring pain (69, 87.3%) and joint prolapse (10, 12.7%). Notably, 27 pilgrims (7.3%) suffered from ligament injuries, including tears. Regarding the mechanisms or causes of these MSK injuries, the most frequently reported factors were fatigue (206, 55.4%), falls (76, 20.4%), crowding (34, 9.1%), accidents (30, 8.1%), and the use of wheelchairs (14, 3.8%). Additionally, it is noteworthy that muscular injuries were more prevalent among all age groups, particularly among young-aged pilgrims, while joint injuries were more common among elderly pilgrims. Conclusion MSK injuries are prevalent among pilgrims, with muscular injuries being the most frequently encountered. This underscores a noteworthy public health concern that necessitates attention from the Ministry of Health of Saudi Arabia.

Muslim pilgrims' knowledge, attitudes, and practices regarding complementary and alternative medicine (CAM); a study conducted during Hajj season.

Complementary and alternative medicine (CAM) has attracted much interest, and its prevalence in both developed and developing countries has increased. During the Hajj season, millions of Muslims from many different countries travel to Makkah for the pilgrimage. In dealing with health issues during the holy season, many pilgrims prefer to self-medicate with traditional remedies instead of visiting medical practitioners, which could affect the efforts of state healthcare organizations to maintain overall public health during this mass gathering. This study aims to gauge the prevalence of CAM use during Hajj, and to assess pilgrims' beliefs and knowledge of CAM therapies, with particular reference to products available in Makkah. A cross-sectional survey was conducted in several camps and hotels occupied by Hajj pilgrims in Makkah, during Hajj 2023. CAM modalities were used by 68.8 % of the study participants during the Hajj season. There were almost equal numbers of men (53.7 %) and women (46.3 %) participants, with 88 % of the CAM users being non-Saudi and only 12 % Saudi. The majority of the CAM users belonged to two age groups, the 31-40 year group (29.9 %) and the 41-50 year group (34.5 %). The most frequent self-practice therapies were religious prayer/rituals (30.2 %), and the most popular practitioner therapies was herbal treatments (12.3 %). The most common source of CAM-related information was family/friends (29.2 %), for improving well-being reason (25.8 %). More than half of the participants (56.8 %) strongly believed that CAM therapies have the potential to cure disease, although they were unaware of possible interactions between CAM and conventional drugs (76.7 %). More than half of the participants (57.8 %) did not disclose their CAM usage to healthcare practitioners. Half of the sample said they used CAMs during Hajj because of the common belief that therapeutic products from the holy city of Makkah, such as Zamzam water, are more effective. In conclusion, CAM therapies are commonly used by Hajj pilgrims as they are presumed to be natural and therefore safe, raising concerns about the potential risks of relying on CAM without adequate consultation with healthcare providers or awareness of potential interactions between prescription drugs and CAM treatments.

Genetic diversity and molecular analysis of human influenza virus among pilgrims during Hajj.

The risk of transmission of respiratory tract infections is considerably enhanced at mass gathering (MG) religious events. Hajj is an annual Islamic MG event with approximately 3 million Muslim pilgrims from over 180 countries concentrated in Makkah, Saudi Arabia. This study aimed to investigate the genetic diversity of influenza viruses circulating among pilgrims during the Hajj pilgrimage. We performed a cross-sectional analytical study where nasopharyngeal swabs (NPs) from pilgrims with respiratory tract illnesses presenting to healthcare facilities during the 2019 Hajj were screened for influenza viruses. Influenza A subtypes and influenza B lineages were determined by multiplex RT-PCR for positive influenza samples. The phylogenetic analysis was carried out for the hemagglutination (HA) gene. Out of 185 nasopharyngeal samples, 54 were positive for the human influenza virus. Of these, 27 were influenza A H1N1 and 19 H3N2, 4 were untypable influenza A, and 4 were influenza B. Phylogenetic analysis revealed that the H1N1 and H3N2 strains differentiated into different and independent genetic groups and formed close clusters with selected strains of influenza viruses from various locations. To conclude, this study demonstrates a high genetic diversity of circulating influenza A subtypes among pilgrims during the Hajj Season. There is a need for further larger studies to investigate in-depth the genetic characteristics of influenza viruses and other respiratory viruses during Hajj seasons.

Exploring the experiences, motivations, and skillsets of nurse volunteers during Hajj: implications for enhancing volunteer programs.

BACKGROUND: The annual Islamic pilgrimage of Hajj attracts millions of pilgrims from around the world, necessitating the involvement of healthcare professionals, including nurse volunteers, to ensure the safety and well-being of attendees. This study aims to explore the experiences, motivations, and skillsets of nurse volunteers during the Hajj pilgrimage, focusing on the personal, professional, and spiritual dimensions of volunteering, and providing insights to enhance volunteer programs. METHODS: The demographic data shows that the majority of nurse volunteers during Hajj 2022 fell in the 30-39 age group and were predominantly women. The study provides insights into the interest, experience, and motives for volunteering, with spiritual motives cited as a primary driver. An overview of volunteer hours, perceived benefits, and pre-existing skills reveals diverse commitments and skillsets among the volunteers. RESULTS: Nurse volunteers during Hajj 2022 show diverse age and gender composition, strong commitment, spiritual motives, varied engagement, and professional skills. Team dynamics, skills development, and positive experiences are crucial. A potential gap exists in preparatory education. Significant associations are found between age, volunteer hours, training, skill practice, and gender. CONCLUSION: This study highlights the multifaceted benefits of volunteering during Hajj and underscores the need for decision-makers to devise strategies that cater to diverse needs, foster collaboration, and enhance the preparedness of nurse volunteers. Further research is suggested to examine the long-term impact of volunteering during Hajj on nurses' professional development and personal well-being and to evaluate the effectiveness of various recruitment strategies, training programs, and support initiatives.

Epidemiology of Hajj pilgrimage mortality: Analysis for potential intervention.

BACKGROUND: The Saudi Vision 2030 predicts the attendance of 30 million pilgrims each year by 2030. Cost-effective healthcare services during the Hajj are important to manage this increase in the number of pilgrims. Little is known about the impact of the existing chronic diseases on morbidity and mortality during the Hajj. Furthermore, the quality of services provided by Hajj hospitals warrants further study. This study aims to describe patterns of inpatient, all-cause mortality during the Hajj and the relationship between mortality and preexisting chronic diseases as well as the services provided in Hajj hospitals. METHODS: The population included pilgrims who were admitted to Hajj hospitals in Makkah and sacred sites between 2012 and 2017, excluding 2015. A retrospective, matched, case-control study design was utilized. 2237 cases of mortality were matched to 4474 control cases based on age and gender. The data were extracted from hospital admissions offices and medical records. Hierarchical, logistic regression models were used to examine the medical services. The effect measure modification of the copresence of more than one chronic disease was also examined. RESULTS: The rate of inpatient all-cause mortality was higher in Makkah hospitals compared to sacred site hospitals. Inpatient, all-cause mortality was significantly associated with diabetes, hypertension, and cardiovascular diseases. Effect measure modification was present between diabetes and cardiovascular diseases, hypertension, and cardiovascular diseases, but not between diabetes and hypertension. Patients who received medical services were more likely to die during their hospital stay compared to patients not receiving services. CONCLUSION: The current focus on public health issues during the Hajj should be equally distributed between communicable and non-communicable diseases. Although advanced services are provided by Hajj hospitals, interventions to address the increased risks, including mortality, faced by pilgrims with preexisting, chronic diseases should be further investigated and considered.

The role of identity-related beliefs in the appraisal and management of crowding: Insights from the Hajj.

In crowds, to the degree one identifies with other crowd members one likely experiences a sense of common purpose, social connection and mutual support. Such is the psychological significance of these correlates of a shared identity that even others' close physical proximity can be pleasurable. However, such pleasure in others' proximity cannot be assumed: physical crowding can bring practical challenges and so potentially disturb the positive experience of crowd membership. In the research reported here, we explore crowd members' reports of such challenges and the ways in which these were interpreted and managed through reference to the beliefs and values associated with crowd members' shared identity. Our data arise from semi-structured interviews (N = 33) with British Muslims after participating in the Hajj pilgrimage in Saudi Arabia. Exploring these data sheds light on the ways in which identity-related beliefs and values can contribute to the maintenance of order and harmony even in situations where crowding could undermine the positive experience of others' proximity. Accordingly, our analysis advances our understanding of the self-organization and self-policing of crowds.

Respiratory viral infections during Hajj seasons.

Respiratory viral infections pose a public health concern during mass gathering (MG) events. Sustainable and continuous surveillance of respiratory viruses remains a priority to early identify and prevent potential outbreaks. This article reviews recent literature addressed the prevalence and diversity of circulating respiratory viruses during Hajj pilgrimage, one of the largest planned religious MG events held annually in Saudi Arabia. The variation between studies with respect to study design, sample size, time of sample collection (pre-, during, and pos-Hajj), type of participants (e.g., symptomatic vs. a symptomatic pilgrims), and laboratory procedure was highlighted. The majority of these studies were conducted on the 2019 Hajj season or earlier, prior to the emergence of COVID-19 which had significant impact on the past three Hajj seasons (2020, 2021, and 2022). A summary about key aspects related to organization of Hajj during COVID-19 pandemic and the implementation of exceptional infection control strategies is provided.

Antimicrobial utilization in Hajj 2022: An evaluation of quality indicators.

BACKGROUND: The mass gathering in Hajj (Islamic pilgrimage) makes the spread of infectious diseases inevitable. Antibiotics are frequently prescribed during this season. We aimed to measure antimicrobial utilization during the 2022 Hajj and evaluate the practice using quality indicators. METHODS: Antimicrobial utilization by Hajj medical facilities (77 primary clinics and 7 hospitals) was measured using the anatomic therapeutic classification defined daily dose (DDD) and DDD/1,000-inhabitant/day (DID), where inhabitants were the Hajj 2022 pilgrims (n = 899,353). Quality indicators included percentages of consumption of different antibiotic classes of the total consumption of antibacterials for systemic use in DID. RESULTS: During Hajj, there was 87,173 outpatient visits and 740 hospitalizations (215 critically ill). Amoxicillin was the most prescribed antibiotic (DID=11.708) followed by azithromycin (DID=7.395). Penicillins fell in the second quartile (i.e., highly prescribed) with a quality indicator value (J01_CE%) of 48.149. The consumption of other antibacterials, including fluoroquinolones, fell in the first quartile (<25%). The overall ratio of broad- to narrow-spectrum antibiotic prescribing (J01_B/N) was 1.49. CONCLUSION: Although the prescribing of ß-lactams over fluoroquinolones indicates a good practice, clinicians should be reminded that most infections spreading in mass gatherings are viral; hence, do not require antibiotics. Implementation of antimicrobial stewardship is recommended to improve antimicrobial utilization.

Clinical pharmacy services in acute care setting during mass gatherings (Hajj): Insights from a task force.

BACKGROUND: Hajj is the largest mass gathering worldwide that takes place every year in Makkah, Saudi Arabia. This paper aims to provide a comprehensive guide and expectations for delivering and optimizing clinical pharmacy services during one of the largest mass gatherings in the world, Hajj pilgrimage METHODS: A task force initiated and included members of clinical pharmacists who previously participated in delivering clinical pharmacy services during the Hajj pilgrimage, members of the Saudi Society of Clinical Pharmacy (SSCP), and policymakers from different sectors and representatives from pharmaceutical care of the Ministry of Health (MOH). The members established an expert task force to conceptualize and draft the proposed suggestions highlighting the roles and responsibilities of clinical pharmacists during the annual Hajj season. RESULTS: The task force determined the following key domains 1) pharmaceutical care (administration and strategic plan, resources, formulary management); 2) pharmacists' activities (clinical pharmacy services and documentation, professional training and development, and staff credentials, and qualifications); 3) challenges and proposed solutions. The task force was divided into groups to draft each domain and provide suggested statements and insights for each section. Finally, the group members of the task force issued 15 opinion statements. CONCLUSION: Mass gatherings such as Hajj pilgrimage, represent a unique opportunity to demonstrate the value of pharmacists in advancing health care delivery within a multidisciplinary team. These suggestions and insights could guide the implementation of clinical pharmacy services in acute settings during mass gatherings (Hajj). Future studies should focus on assessing the applicability and the impact of the provided suggestions.

Exploring Hajj pilgrim satisfaction with hospitality services through expectation-confirmation theory and deep learning.

The Hajj is a religious event that attracts a significant number of Muslims from various countries who perform rituals in Mecca, Saudi Arabia. Despite the high volume of pilgrims that typically participate in the event, the number has been reduced in recent years due to the COVID-19 pandemic. The satisfaction of Hajj pilgrims with the quality of hospitality services provided during the event is a crucial factor that must be studied and understood. To achieve this goal, various psychological theories have been employed to explain the phenomenon. The advancement of big data and artificial intelligence has enabled the development of new analytical methodologies for evaluating psychological theories in the hospitality industry. In this study, we present a novel deep learning model that leverages the expectation-confirmation theory to examine the satisfaction of Hajj pilgrims with hospitality services. The model was trained and tested on data obtained from hotel review posts related to the Hajj. Based on our results, the proposed model achieved a high accuracy of 97 % in predicting the satisfaction of Hajj pilgrims. In addition, the results can be used to improve the quality of services provided to pilgrims and enhance their overall experience during the Hajj.

[The nontrivial approach or how physicians-bolsheviks treated kings. The Soviet medicine in the Arabian peninsula in 1920-1930s].

In the late 1920s, the USSR intensified its international activities in the Arabian Peninsula. The rapprochement with Arab monarchies provided opportunity to study political, economic and ethno-cultural characteristics of region by organizing transit of pilgrims to Mecca through the Soviet territory and providing medical care in first-aid posts at diplomatic missions. The Soviet physicians, in atypical situation of Arab monarchies, played important role as intermediaries between royal courts and the Soviet government, serving as agents of "soft power". The article considers causes of Moscow geopolitical interest to this region in 1920s-1930s. The distinctions of interaction between Soviet physicians and ruling circles of Hijaz and Yemen were explored. The humanitarian, cultural and geopolitical significance of these activities were examined. The article considers and explains, through optics of geopolitical approach, situational rationality that was applied by medical men when approaching treatment of royal personages despite ideological mismatch of this work with Bolshevism dogmas. The article consistently demonstrates, noting non-triviality of both locus itself and approaches to organization of medical care, how professionalism of Soviet physicians gained confidence of monarchs of Hijaz and Yemen in complicated conditions of competition with highly qualified physicians from Western Europe. It is emphasized that in conditions of Arabia, ideological attitudes had secondary importance, while such qualities as personal charisma and medical professionalism, which created solid reputation foundation for Soviet physicians, came to foreground.