{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:26:29Z","timestamp":1790623589848,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:00:00Z","timestamp":1617148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The Hajj mass gathering annually attracts over two million Muslim pilgrims worldwide to the Kingdom of Saudi Arabia (KSA). We aimed to establish demographics and health profiles for the South African pilgrims performing the 2017 Hajj. Methods: This is a longitudinal survey-based study conducted on 1138 adult South African pilgrims in two phases (during and post-Hajj). Data on demographics, vaccination status, underlying health conditions, pre-Hajj training, health promotion, travel history, and health issues during and post-Hajj were collected using pre-designed questionnaires. Results: Participants had a mean age of 49.2 years (SD = 13.3; range 18\u201381), with a male: female ratio of 1.2:1. The majority of pilgrims were married (88.2%), of Indian\/Asian background (73%), and literate (&gt;99%). Nearly all pilgrims were vaccinated against meningococcal disease and yellow fever, but only 23.7% were vaccinated against Influenza. Hypertension, diabetes, and elevated cholesterol levels were the most common underlying health conditions reported by 22.6%, 13.2%, and 11.5% of pilgrims, respectively. One month after return to South Africa, nearly 65% of pilgrims reported illness during Hajj, while 40% reported falling ill post event upon return to South Africa. Nevertheless, only a few were admitted to hospitals (12 during Hajj and 15 post-Hajj). Among ill pilgrims, respiratory symptoms were the most commonly experienced symptoms during (70.2%) and post-Hajj (82.2%). Other symptoms such as walking-related symptoms include symptoms directly related or mainly caused by walking (e.g., leg pain, sore feet, blisters on the feet), dehydration, and gastrointestinal tract symptoms reported during Hajj. Medication to treat respiratory symptoms and antibiotics were the most commonly used medications during and post-Hajj. Having an underlying health condition was an independent predictor of falling ill during or post Hajj. Conclusion: Our study indicates that a sizable proportion of South African pilgrims are elderly with underlying health conditions and most contract respiratory tract infections during and post Hajj. Our study highlights the need for systematic collection of prospective pilgrims\u2019 demographics and health data and more attention to post-Hajj health follow-ups of pilgrims.<\/jats:p>","DOI":"10.3390\/ijerph18073607","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T00:13:10Z","timestamp":1617149590000},"page":"3607","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A Longitudinal Study Regarding the Health Profile of the 2017 South African Hajj Pilgrims"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6283-2000","authenticated-orcid":false,"given":"Abdulaziz","family":"Mushi","sequence":"first","affiliation":[{"name":"The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8762-5403","authenticated-orcid":false,"given":"Yara","family":"Yassin","sequence":"additional","affiliation":[{"name":"The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5075-7392","authenticated-orcid":false,"given":"Anas","family":"Khan","sequence":"additional","affiliation":[{"name":"The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia"},{"name":"Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badriah","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Parker","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town 7925, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8076-0453","authenticated-orcid":false,"given":"Ozayr","family":"Mahomed","sequence":"additional","affiliation":[{"name":"Department of Public Health Medicine, University of KwaZulu Natal, Durban 4051, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saber","family":"Yezli","sequence":"additional","affiliation":[{"name":"The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh 12341, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"868","DOI":"10.15537\/smj.2017.8.20124","article-title":"Umrah. An Opportunity for Mass Gatherings Health Research","volume":"38","author":"Yezli","year":"2017","journal-title":"Saudi Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/S0140-6736(06)68429-8","article-title":"Health Risks at the Hajj","volume":"367","author":"Ahmed","year":"2006","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ijid.2016.04.007","article-title":"Meningococcal Disease during the Hajj and Umrah Mass Gatherings","volume":"47","author":"Yezli","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.4269\/ajtmh.17-0271","article-title":"Undiagnosed Active Pulmonary Tuberculosis among Pilgrims during the 2015 Hajj Mass Gathering: A Prospective Cross-Sectional Study","volume":"97","author":"Yezli","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/S0140-6736(14)60381-0","article-title":"Hajj: Infectious Disease Surveillance and Control","volume":"383","author":"Memish","year":"2014","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.tjem.2015.02.001","article-title":"Health Response to Hajj Mass Gathering from Emergency Perspective, Narrative Review","volume":"15","author":"Shujaa","year":"2015","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_7","unstructured":"Ezat, S., Puteh, W., al Salem, A., Radwan, N.A., Dahliah, S., and Zannah, A. (2019). The Causes of Malaysian and Indonesian Pilgrims\u2019 Hospitalization during the Hajj Season 1440 (2019) in Mena and Arafat Hospitals. Saudi J. Biomed. Res. Abbreviated Key Title Saudi J. Biomed. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jiph.2017.06.004","article-title":"Morbidity and Mortality amongst Indian Hajj Pilgrims: A 3-Year Experience of Indian Hajj Medical Mission in Mass-Gathering Medicine","volume":"11","author":"Khan","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/jtm\/tay070","article-title":"Strengthening Health Security at the Hajj Mass Gatherings: A Harmonised Hajj Health Information System","volume":"25","author":"Yezli","year":"2018","journal-title":"J. Travel Med."},{"key":"ref_10","unstructured":"(2020, September 10). Statistic South Africa Community Survey 2016 IN BRIEF, Available online: http:\/\/www.statssa.gov.za\/wp-content\/uploads\/2016\/03\/CS-FW-ID.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.4103\/1817-1737.49412","article-title":"Respiratory Tract Infection during Hajj","volume":"4","author":"Alzeer","year":"2009","journal-title":"Ann. Thorac. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Aleeban, M., and Mackey, T.K. (2016). Global Health and Visa Policy Reform to Address Dangers of Hajj during Summer Seasons. Front. Public Health, 4.","DOI":"10.3389\/fpubh.2016.00280"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2991\/jegh.k.181231.001","article-title":"Indonesian Hajj Cohorts and Mortality in Saudi Arabia From","volume":"9","author":"Pane","year":"2004","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_14","first-page":"1073","article-title":"Pattern of Admission to Hospitals during Muslim Pilgrimage (Hajj) Sleep Disorders View Project Liver Fibrosis View Project","volume":"24","author":"Akbar","year":"2003","journal-title":"Saudi Med. J."},{"key":"ref_15","first-page":"1373","article-title":"Pattern of Medical Diseases and Determinants of Prognosis of Hospitalization during 2005 Muslim Pilgrimage (Hajj) in a Tertiary Care Hospital. A Prospective Cohort Study","volume":"27","author":"Khan","year":"2006","journal-title":"Saudi Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jsha.2012.02.004","article-title":"Cardiovascular Disease in Hajj Pilgrims","volume":"24","year":"2012","journal-title":"J. Saudi Heart Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S0140-6736(16)00505-5","article-title":"The Hajj Health Requirements: Time for a Serious Review?","volume":"387","author":"Yezli","year":"2016","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jegh.2014.12.007","article-title":"Foot Ailments during Hajj: A Short Report","volume":"5","author":"Sridhar","year":"2015","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5395\/rde.2017.42.2.152","article-title":"Statistical Notes for Clinical Researchers: Chi-Squared Test and Fisher\u2019s Exact Test","volume":"42","author":"Kim","year":"2017","journal-title":"Restor. Dent. Endod."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1126\/science.1183210","article-title":"Pandemic H1N1 and the 2009 Hajj","volume":"326","author":"Ebrahim","year":"2009","journal-title":"Science"},{"key":"ref_21","unstructured":"General Authority for Statistics (Saudi Arabia) (2020, February 13). Hajj Statistics 2017, Available online: https:\/\/www.stats.gov.sa\/sites\/default\/files\/haj_1438.pdf."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"650.e5","DOI":"10.1016\/j.cmi.2015.03.020","article-title":"Molecular Dynamics of Staphylococcus Aureus Nasal Carriage in Hajj Pilgrims","volume":"21","author":"Verhoeven","year":"2015","journal-title":"Clinical Microbiology and Infection"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-7357-1","article-title":"A Cross-Sectional Study on Factors Associated with Hypertension and Genetic Polymorphisms of Renin-Angiotensin-Aldosterone System in Chinese Hui Pilgrims to Hajj","volume":"19","author":"Zhang","year":"2019","journal-title":"BMC Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.tmaid.2015.09.008","article-title":"The Inevitable Hajj Cough: Surveillance Data in French Pilgrims, 2012\u20132014","volume":"13","author":"Gautret","year":"2015","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_25","first-page":"14","article-title":"The Hajj: A Constant Travel Destination amidst Changing Times","volume":"25","author":"Parker","year":"2010","journal-title":"South. Afr. J. Epidemiol. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Yezli, S., Mushi, A., Yassin, Y., Maashi, F., and Khan, A. (2019). Knowledge, Attitude and Practice of Pilgrims Regarding Heat-Related Illnesses during the 2017 Hajj Mass Gathering. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16173215"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Pane, M., Imari, S., Alwi, Q., Nyoman Kandun, I., Cook, A.R., and Samaan, G. (2013). Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0073243"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.jiph.2019.04.007","article-title":"Saudi Hajj Pilgrims\u2019 Preparation and Uptake of Health Preventive Measures during Hajj 2017","volume":"12","author":"Alqahtani","year":"2019","journal-title":"J. Infect. Public Health"},{"key":"ref_29","unstructured":"(2020, September 10). UNU-WIDER Morn\u00e9 Oosthuizen UNU-WIDER: Research Brief: Racial Inequality and Demographic Change in South Africa. Available online: https:\/\/www.wider.unu.edu\/publication\/racial-inequality-and-demographic-change-south-africa."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Yezli, S., Mushi, A., Almuzaini, Y., Balkhi, B., Yassin, Y., and Khan, A. (2021). Prevalence of Diabetes and Hypertension among Hajj Pilgrims: A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18031155"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-019-54370-0","article-title":"Respiratory Tract Infections among French Hajj Pilgrims from 2014 to 2017","volume":"9","author":"Hoang","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2174\/1871526514666140713154727","article-title":"Pneumococcal Vaccine Uptake Among Australian Hajj Pilgrims in 2011-13","volume":"14","author":"Tashani","year":"2014","journal-title":"Infect. Disord. Drug Targets"},{"key":"ref_33","first-page":"179","article-title":"Trend of Diseases among Iranian Pilgrims during Five Consecutive Years Based on a Syndromic Surveillance System in Hajj","volume":"27","author":"Razavi","year":"2013","journal-title":"Med J. Islamic Repub. Iran"},{"key":"ref_34","unstructured":"(2020, September 10). World Health Organization GHO|by Category|Raised Blood Pressure (SBP \u2265 140 OR DBP \u2265 90), Age-Standardized (%)\u2014Estimates by Country [Internet]. Available online: https:\/\/www.who.int\/diabetes\/country-profiles\/zaf_en.pdf?ua=1."},{"key":"ref_35","first-page":"101","article-title":"Causes of Admission to Intensive Care Units in the Hajj Period of the Islamic Year 1424 (2004)","volume":"27","author":"Madani","year":"2007","journal-title":"Ann. Saudi Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijid.2015.12.010","article-title":"Prevention of Meningococcal Disease during the Hajj and Umrah Mass Gatherings: Past and Current Measures and Future Prospects","volume":"47","author":"Yezli","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_37","unstructured":"Saudi Arabia Ministry of Health (2020, September 10). 1441H.-Hajj Season\u2014Health Regulations, Available online: https:\/\/www.moh.gov.sa\/en\/Hajj\/Pages\/HealthRegulations.aspx."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.tmaid.2018.12.002","article-title":"Clinical Respiratory Infections and Pneumonia during the Hajj Pilgrimage: A Systematic Review","volume":"28","author":"Benkouiten","year":"2019","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_39","first-page":"1701","article-title":"The Dynamics and Interactions of Respiratory Pathogen Carriage among French Pilgrims during the 2018 Hajj","volume":"8","author":"Hoang","year":"2019","journal-title":"Taylor Francis"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S1473-3099(09)70069-6","article-title":"Incubation Periods of Acute Respiratory Viral Infections: A Systematic Review","volume":"9","author":"Lessler","year":"2009","journal-title":"Lancet Infect. Dis."},{"key":"ref_41","first-page":"346","article-title":"Infections Li\u00e9es Au Hadj","volume":"46","author":"Piednoir","year":"2016","journal-title":"M\u00e9decine et Maladies Infectieuses"},{"key":"ref_42","unstructured":"(2020, September 10). Centers for Disease Control and Prevention Food Poisoning Symptoms|Food Safety|CDC, Available online: https:\/\/www.cdc.gov\/foodsafety\/symptoms.html."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1016\/j.jsps.2020.07.014","article-title":"Medication Utilization Pattern among Outpatients during the Hajj Mass Gathering","volume":"28","author":"Yezli","year":"2020","journal-title":"Saudi Pharm. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.tmaid.2019.06.007","article-title":"Antibiotic Use for Respiratory Infections among Hajj Pilgrims: A Cohort Survey and Review of the Literature","volume":"30","author":"Hoang","year":"2019","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"101343","DOI":"10.1016\/j.tmaid.2018.10.021","article-title":"Bacterial Respiratory Carriage in French Hajj Pilgrims and the Effect of Pneumococcal Vaccine and Other Individual Preventive Measures: A Prospective Cohort Survey","volume":"31","author":"Hoang","year":"2019","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Yezli, S., Khan, A., and Bouchama, A. (2019). Summer Hajj Pilgrimage in the Era of Global Warming: A Call for Vigilance and Better Understanding of the Risks. J. Travel Med., 26.","DOI":"10.1093\/jtm\/taz069"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ijid.2016.02.005","article-title":"Exploring Barriers to and Facilitators of Preventive Measures against Infectious Diseases among Australian Hajj Pilgrims: Cross-Sectional Studies before and after Hajj","volume":"47","author":"Alqahtani","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Badahdah, A.-M., Alghabban, F., Falemban, W., Albishri, A., Rani Banik, G., Alhawassi, T., Abuelizz, H., Bakarman, M.A., Khatami, A., and Booy, R. (2019). Meningococcal Vaccine for Hajj Pilgrims: Compliance, Predictors, and Barriers. Trop. Med. Infect. Dis., 4.","DOI":"10.3390\/tropicalmed4040127"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.26719\/emhj.20.129","article-title":"Implementing the Health Early Warning System Based on Syndromic and Event-Based Surveillance at the 2019 Hajj","volume":"26","author":"Bieh","year":"2020","journal-title":"East. Mediterr. Health J."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Alotaibi, B.M., Yezli, S., bin Saeed, A.A.A., Turkestani, A., Alawam, A.H., and Bieh, K.L. (2017). Strengthening Health Security at the Hajj Mass Gatherings: Characteristics of the Infectious Diseases Surveillance Systems Operational during the 2015 Hajj. J. Travel Med., 24.","DOI":"10.1093\/jtm\/taw087"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1136\/bmjinnov-2019-000354","article-title":"Wearable Devices for Remote Vital Signs Monitoring in the Outpatient Setting: An Overview of the Field","volume":"6","author":"Soon","year":"2020","journal-title":"BMJ Innov."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1586\/17434440.2015.1050957","article-title":"Technology Platforms for Remote Monitoring of Vital Signs in the New Era of Telemedicine","volume":"12","author":"Zhao","year":"2015","journal-title":"Expert Rev. Med Devices"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"208","DOI":"10.4103\/jfcm.JFCM_295_20","article-title":"Current Status of Telehealth in Saudi Arabia during COVID-19","volume":"27","author":"Alghamdi","year":"2020","journal-title":"J. Fam. Community Med."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Jokhdar, H., Khan, A., Asiri, S., Motair, W., Assiri, A., and Alabdulaali, M. (2020). COVID-19 M Itigation Plans D Uring H Ajj 2020: A S Uccess S Tory of Z Ero C Ases. Health Secur.","DOI":"10.1089\/hs.2020.0144"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3607\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:10:34Z","timestamp":1760364634000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,31]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijerph18073607"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18073607","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,31]]}}}