The Role of Using Masks to Reduse Acute
THE ROLE OF USING MASKS TO REDUCE ACUTE
UPPER RESPIRATORY TRACT INFECTIONS IN PILGRIMS
UMAR ZEIN
Medical Faculty
Department of Internal Medicine
Sumatera Utara University
ABSTRACT :
Annually, about 200.000 Indonesian Muslims come to two Holy Cities, Mecca and
Medina to perform the ritual Hajj; the people are divided into groups, 400 – 500
persons per flight. Until the ritual activities are finished, common symptoms like
coughing occured as an acute Upper Respiratory Tract Infection (URTI).
The aim of the study is to define the important reason of using mask to prevent
acute URTI.
Materials and methods:
We have observed 447 pilgrims in group number 15 to Medan in the year 2002.
Questionnaires have been given to the people to find out about the use of face
masks during the daily activities , and the symptoms were registered. The acute
URTI’s were diagnosed by clinical and
physical examination. We conducted a
Cohort study and Statistical analysis by Mantel-Haenszel Weight Relative Risk using
EPIInfo-6 software computer (CI = 95%).
Results :
Age range : (14 – 89) years, mean age was : 52.41 ± 12.38 year, Male : Female = 1
: 1,7. Mostly Pilgrims > 60 years old were 33%. The most common symptoms were
cough (55%), followed by cold (14%), and fever (12%) . We found out that the
overall RR , for people > 60 years , and < 60 years were 3.36 ; 1.99 ; and 4.48,
respectively (p < 0.000). Mantel-Haenzel Weight RR in case of disease in exposed
people was : 3.10 (Confidence limit : 2.65 < MHRR < 3.82 ; p < 0.000).
Conclusion :
The risk to get an URTI in pilgrims who were not using a face-mask during Hajj
activities is 3 times higher than in those using face masks.
Key Word : Pilgrims – using masks – cough – URTI
The Role of Using Mask to Reduce Upper Respiratory Tract Infections in
Pilgrims
Umar Zein
Division of Tropical Diseases and Infections
Department of Internal Medicine, Medical Faculty of Sumatera Utara University
Medan – Indonesia
Introduction :
Hajj literally means to travel (i.e., towards God) and it also means to make an effort,
to dominate something (yourself). Conventionally this term is translated as
pilgrimage, although it is far from the exact significance of the word Hajj. This is the
fifth of the religious duties in Muslims people. It is obligatory to every adult, to go to
Mecca once in a lifetime in order to perform a great effort for Hajj as a capable
person.1
Annually, some 2.5 million muslim people from all over the world perform the Hajj, a
figure that continues to grow. Although it is a duty for every muslim, many,
particularly those residing in the West, including Indonesia, will travel more
frequently.2 Every year around 200,000 Indonesian Muslims come to two Holy Cities
Mecca and Medina to perform the ritual Hajj; the are divided into groups, 400 to
500 persons per aeroplane. One physician and two nurses accompany these groups
and are responsible for checking the health condition of pilgrims and to treat them in
case of illness.
During 37 days the pilgrims have to perform the ritual activities in many places, such
as Mecca, Arafat, Muzdalifa, Mina, Medina, and Jedda. The primary activity are
physical activities. For instance, you have to walk from the house to the mosque in
order to pray five times a day, walk around The Ka’bah seven times to perform the
Tawwaf, walk and run between Safa and Marwa Hills seven times to perform the Sa’i,
walk from the camp in Mina to Jamarat three or four times, and pray.
During this stay in Saudi Arabia until the end of the ritual activities, the most
common symptoms of pilgrims were coughing due to an Acute Upper Respiratory
Tract Infection (URTI). The probable reason may be the exposure to people from
various parts of the world, overcrowding, high dust levels, and changes in climate
and humidity.
To reduce air-borne transmission of acute URTI, The Indonesian Hajj Committee and
the Indonesian Health Department have suggested to use mouth and nose masks
during Hajj.
Some of the pilgrims were using the mask for the whole period, some for only a few
days, while the rest did not use it at all. These masks were provided by the Hajj
Committee to pilgrims free of charge.
We have conducted a study to assess the health condition of all pilgrims during the
Hajj period and to understand the correlation between the occurrence of acute URTI
and using a mask regularly. The acute URTI due to airborne transmission can be an
effect or a disease.
The aim of this study is to show the benefit of using masks during Hajj to prevent
acute URTI's and to explain the correlation between exposure and effect.
Materials and method :
We have observed 447 pilgrims in group no. 15 to Medan in the year 2002 that
conducted this studied and we followed and recorded the daily complains of the
people. Especially respiratory symptoms that had been occured. Questionnaires have
been given to the people to find out about the use of face masks during the daily
activities , and the symptoms were registered. The acute URTI’s were diagnosed by
clinical symptom such as cough, fever, sore throat, hoarseness, cold and by physical
examination.
The mouth and nose masks were normally out of cotton. Each person got two masks
from Indonesia Hajj Committee before departure.
This flight group departured from Medan on February 5th and came back on March
15th 2002 (37 days).
2002 Digitized by USU digital library
3
We have conducted a Cohort study by following up the pilgrims before and after
development of signs and symptoms of acute URTI. Exposure and the use of mask
we recorded by questionnaire. This is shown in Figure 1.
One person died before the ritual activities were finished because of pneumonia.
We have found out that using masks can reduce the risk of acute URTI during ritual
Hajj. When the ritual activities were finished, the number of pilgrims was 446.
After the ritual process, we collected the data and calculated by Chi square formula
and 95% Confidence Interval for Relative Risk, and p < 0.05 for significance value.
For the strata group that divided into age group, we using statistical analyzed by
Mantel-Haenszel Weight Relative Risk.3 Calculation was done by Epi Info-6 computer
software program.
Result :
In Group no. 15 to Medan in the year 2002 there were 447 pilgrims with an age
range between 14 and 89 years, the mean age was : 52,41 ± 12,38 year, Male :
Female =
1 : 1,7. Twenty-three percent pilgrims were more than 60 years old . (Table 1).
During the study one person died.
Table 1 : Age group and sex distribution of the Pilgrims
Age Group
Male
Female
Freq.
%
< 40 years
23
52
75
16.8
40 – 50 years
51
65
116
26.0
51 – 60 years
39
69
108
24.2
> 60 years
52
96
148
33
Total
165
282
447
100
Table 2 : Kinds of high risk conditions in Pilgrims
High Risk Factors
Frequency
Percent
1. Age > 60 years
148
33.0
2. Hypertension
104
23.3
3. Dyspepsia
22
4.9
4. Obesity
11
2.4
5. Diabetes
11
2.4
6. Rheumatoid Arthritis
10
2.2
7. Chronic Liver Diseases
9
2.0
8. COPD
5
1.1
9. Post Stroke
3
0.7
10. Chronic Renal Disease
2
0.4
11. Other
6
1.3
2002 Digitized by USU digital library
4
According to the documentation of the Indonesia Hajj Committee, people older than
60 years (33%) were at the highest risk, followed by Hypertension (23.3%) and the
other chronic diseases.(Table 2).
Not using mask
( Exposed ) 230
One died
447
Pilgrims
446
Pilgrims
Using mask
(Unexposed) 216
URTI (+)
168
URTI (-)
62
URTI (+)
47
URTI (-)
169
Figure 1 : Schematic Diagram of the Cohort Study Group
Looking at the recorded complaints of pilgrims and the need of treatment, the most
common symptoms were cough (55.0%), followed by cold (14.0%), and fever
(11.6%). (Figure 2).
2002 Digitized by USU digital library
5
4.7
1.3
1.5
1.6
1.7
3.5
3.6
4.0
%
9.5
11.6
14.0
55
0
20
40
Others
Sorethroat
Itchy
Malaise
Hoarseness
Dyspepsia
Diarrhea
Headache
Myalgia
Fever
Cold
Cough
60
Figure 2 : Percentage of symptoms in Pilgrims
The Calculation of the Relative Risk in all age groups is shown in Table 3.
The overall Relative Risk is 3.36, in age group > 60 years 1.99 , in age group < 60
years 4.48, and the stratified analysis by Mantel-Haenzsel Weight RR is 3.10.
Table 3 : Relationship between Using mask and Not using mask
URTI
(+)
168
URTI
(-)
62
Total
47
169
216
215
231
446
Age Group > 60 year
Exposed
Unexposed
Total
48
35
83
12
52
64
60
87
147
Age Group < 60 year
Exposed
Unexposed
Total
60
21
81
51
167
218
111
188
299
All age group
Not using mask
(Exposed)
Using mask
(Unexposed)
Total
RR
C.L
p
value
3.3
6
2.58 < RR <
4.37
0.00
0
1.9
9
1.49 < RR <
2.65
0.00
0
230
3.12 < RR <
0.00
7.5
0
For all strata
2.65 < MHRR <
0.00
(Stratified analysis)
3.82
0
C.L = Confidence Limit ; MHRR = Mantel-Haenzsel Relative Risk ; RR = Relative Risk
;
URTI = Upper Respiratory Tract Infection
2002 Digitized by USU digital library
4.4
8
3.10
6
Discussion :
The overcrowded conditions in Mecca and Medina caused by almost 2.5 million
people coming to the annual Islamic pilgrimage predispose the environment for the
spread of acute respiratory tract infection.4 The Saudi Ministry of Health tries to
control public health risks especially at this time of the year. Infections and
complications that can be acquired at the Hajj include meningococcal meningitis,
respiratory tract infections, blood-borne diseases, and zoonotic diseases, all of it
have the potential to be spread again internationally after the Muslims return.5
In the season of 1992 Hajj, El-Sheikh, et al found out that Klebsiella pneumoniae
was the predominant cause of URTI, followed by Haemophilus influenzae and
Streptococcus penumoniae. The incidence rate of tuberculosis was 1 %, and the
most common virus was Influenza A and Adenovirus.6
Travelling is always accompanied by the certain risk to health.Traveling for Hajj or
Umrah brings along an additional risk also because of change in the climate. We
investigated on the following condition :7,8
• Pilgrims represent a number of people
• Pilgrims may have to walk long distances and get very tired
• Clean water supply and sanitation is difficult to maintain in these
circumstances
• Decrease of appetite and change of foods occurs
• Psychological stress is very likely to happen during ritual hajj activities
• Chronic underlying diseases
Our experience showed that every year some of the pilgrims will came back from the
Holy Cities, Mecca and Medina, with dry or productive coughing. A common cause of
cough is acute URTI. Others causes may be : irritation of airways, allergic reactions
or combined with infection. Other symptoms observed are fever, cold, sore throat,
hoarseness, and ever haemopthysis and breathlessness sometimes.
These symptoms are caused by host factors and environmental factors. The host
factors can be a decrease of immunity due to a lack of appetite, tiredness, physical
and psychological stress, and chronic underlying diseases as a high risk especially
in the elderly. The last host factor is non compliance of pilgrims to use a mask.
The environmental factors such as, high temperature during daytime, low humidity,
crowds moving, staying together in a room for 6 – 10 persons , and air pollution with
high dust concentrations. All of these conditions tend to facilitate airborne
transmitted diseases, for instance URTI, Influenza, and Meningitis. The risk of
disease by overcrowded places, high dust level, and low humidity can be avoided by
using mouth and nose masks regularly.
Actually, only 216 pilgrims (48,4%) were using a mask regularly in this group. The
association between acute URTI and exposure was statistically significant. The
calculation of the Relative Risk, showed a Crude RR of 3.36 (CI = 95%, CL : 2.58 <
RR < 4.37) and strata calculation with separate age group between < 60 year and >
60 year by Mantel-Haenzsel Weight RR is 3.10 (CI = 95%, CL : 2.65 < MHRR < 3.82
) (Table 3). This leads to the conclusion that pilgrims who were not using masks
regularly during the ritual activities, were likely to get acute URTI 3 times more
often than other who were using masks.
Conclusion :
During the ritual Hajj activities in two holy cities and other the risk of spreading
infectious diseases, especially acute URTI occur. This condition is due to host factors
and environmental factors.
2002 Digitized by USU digital library
7
Overcrowded places, high dust level, and low humidity are factors that can be
decreased by using mouth and nose masks regularly.
The risk of acute URTI in people not using masks was 3 times more likely than in
users.
*******
References :
1. Various Aspect of Hajj, In : IslamOnline.net,
From : http://www.IslamOnline.net/English/Hajj/2002/01/journey/article
7.shtml.
2. Sheikh, A , Rashid, A : Hajj : Journey of a lifetime, From :http :\\www.Hajj
health-1.htm
3. Greenberg, R.S , Daniels, S.R , Flemders, W.D , Eley, J.W , Boring, J.R : Medical
Epidemiology, a Lange Medical Book, Prentice-Hall International Inc. London,
1993, 97 - 107
4. Common Health Problems During Hajj, In : Madrasah In’aamiyah, Camperdown,
From : http ://www.alinaam.org.za/library/cproblems.htm , July 22th, 2002
5. Memish, Z.A : Infection Control in Saudi Arabia : Meeting the Challenge, Am J
Infect Control , 2002, Feb ; 30 (1) : 57-65 (Abstract).
6. El-Sheikh, S.M , El-Assouli, S.M , Mohammed, K.A , Alber, M : Bacteria and
Viruses that cause Respiratory Tact Infections during the Pilgrimage (Haj) season
in Makkah, Saudi Arabia, Trop.Med.Int.Health, 1998, Mar; 3(3) : 2059.(Abstract).
7. Guard Againts Meningitis and Save Lives at Hajj or Umrah This Year, In : Health
Advice for Travelers, From : http://www.doh.gov.uk/traveladvice/hajj.htm.
8. Farouk Hafeejee : Health Guidelines for Hajj and Umrah,
From : http://www.jamiat.org.za/isinfo/hajhealth.html, July 18 th 2001.
***********
2002 Digitized by USU digital library
8
UPPER RESPIRATORY TRACT INFECTIONS IN PILGRIMS
UMAR ZEIN
Medical Faculty
Department of Internal Medicine
Sumatera Utara University
ABSTRACT :
Annually, about 200.000 Indonesian Muslims come to two Holy Cities, Mecca and
Medina to perform the ritual Hajj; the people are divided into groups, 400 – 500
persons per flight. Until the ritual activities are finished, common symptoms like
coughing occured as an acute Upper Respiratory Tract Infection (URTI).
The aim of the study is to define the important reason of using mask to prevent
acute URTI.
Materials and methods:
We have observed 447 pilgrims in group number 15 to Medan in the year 2002.
Questionnaires have been given to the people to find out about the use of face
masks during the daily activities , and the symptoms were registered. The acute
URTI’s were diagnosed by clinical and
physical examination. We conducted a
Cohort study and Statistical analysis by Mantel-Haenszel Weight Relative Risk using
EPIInfo-6 software computer (CI = 95%).
Results :
Age range : (14 – 89) years, mean age was : 52.41 ± 12.38 year, Male : Female = 1
: 1,7. Mostly Pilgrims > 60 years old were 33%. The most common symptoms were
cough (55%), followed by cold (14%), and fever (12%) . We found out that the
overall RR , for people > 60 years , and < 60 years were 3.36 ; 1.99 ; and 4.48,
respectively (p < 0.000). Mantel-Haenzel Weight RR in case of disease in exposed
people was : 3.10 (Confidence limit : 2.65 < MHRR < 3.82 ; p < 0.000).
Conclusion :
The risk to get an URTI in pilgrims who were not using a face-mask during Hajj
activities is 3 times higher than in those using face masks.
Key Word : Pilgrims – using masks – cough – URTI
The Role of Using Mask to Reduce Upper Respiratory Tract Infections in
Pilgrims
Umar Zein
Division of Tropical Diseases and Infections
Department of Internal Medicine, Medical Faculty of Sumatera Utara University
Medan – Indonesia
Introduction :
Hajj literally means to travel (i.e., towards God) and it also means to make an effort,
to dominate something (yourself). Conventionally this term is translated as
pilgrimage, although it is far from the exact significance of the word Hajj. This is the
fifth of the religious duties in Muslims people. It is obligatory to every adult, to go to
Mecca once in a lifetime in order to perform a great effort for Hajj as a capable
person.1
Annually, some 2.5 million muslim people from all over the world perform the Hajj, a
figure that continues to grow. Although it is a duty for every muslim, many,
particularly those residing in the West, including Indonesia, will travel more
frequently.2 Every year around 200,000 Indonesian Muslims come to two Holy Cities
Mecca and Medina to perform the ritual Hajj; the are divided into groups, 400 to
500 persons per aeroplane. One physician and two nurses accompany these groups
and are responsible for checking the health condition of pilgrims and to treat them in
case of illness.
During 37 days the pilgrims have to perform the ritual activities in many places, such
as Mecca, Arafat, Muzdalifa, Mina, Medina, and Jedda. The primary activity are
physical activities. For instance, you have to walk from the house to the mosque in
order to pray five times a day, walk around The Ka’bah seven times to perform the
Tawwaf, walk and run between Safa and Marwa Hills seven times to perform the Sa’i,
walk from the camp in Mina to Jamarat three or four times, and pray.
During this stay in Saudi Arabia until the end of the ritual activities, the most
common symptoms of pilgrims were coughing due to an Acute Upper Respiratory
Tract Infection (URTI). The probable reason may be the exposure to people from
various parts of the world, overcrowding, high dust levels, and changes in climate
and humidity.
To reduce air-borne transmission of acute URTI, The Indonesian Hajj Committee and
the Indonesian Health Department have suggested to use mouth and nose masks
during Hajj.
Some of the pilgrims were using the mask for the whole period, some for only a few
days, while the rest did not use it at all. These masks were provided by the Hajj
Committee to pilgrims free of charge.
We have conducted a study to assess the health condition of all pilgrims during the
Hajj period and to understand the correlation between the occurrence of acute URTI
and using a mask regularly. The acute URTI due to airborne transmission can be an
effect or a disease.
The aim of this study is to show the benefit of using masks during Hajj to prevent
acute URTI's and to explain the correlation between exposure and effect.
Materials and method :
We have observed 447 pilgrims in group no. 15 to Medan in the year 2002 that
conducted this studied and we followed and recorded the daily complains of the
people. Especially respiratory symptoms that had been occured. Questionnaires have
been given to the people to find out about the use of face masks during the daily
activities , and the symptoms were registered. The acute URTI’s were diagnosed by
clinical symptom such as cough, fever, sore throat, hoarseness, cold and by physical
examination.
The mouth and nose masks were normally out of cotton. Each person got two masks
from Indonesia Hajj Committee before departure.
This flight group departured from Medan on February 5th and came back on March
15th 2002 (37 days).
2002 Digitized by USU digital library
3
We have conducted a Cohort study by following up the pilgrims before and after
development of signs and symptoms of acute URTI. Exposure and the use of mask
we recorded by questionnaire. This is shown in Figure 1.
One person died before the ritual activities were finished because of pneumonia.
We have found out that using masks can reduce the risk of acute URTI during ritual
Hajj. When the ritual activities were finished, the number of pilgrims was 446.
After the ritual process, we collected the data and calculated by Chi square formula
and 95% Confidence Interval for Relative Risk, and p < 0.05 for significance value.
For the strata group that divided into age group, we using statistical analyzed by
Mantel-Haenszel Weight Relative Risk.3 Calculation was done by Epi Info-6 computer
software program.
Result :
In Group no. 15 to Medan in the year 2002 there were 447 pilgrims with an age
range between 14 and 89 years, the mean age was : 52,41 ± 12,38 year, Male :
Female =
1 : 1,7. Twenty-three percent pilgrims were more than 60 years old . (Table 1).
During the study one person died.
Table 1 : Age group and sex distribution of the Pilgrims
Age Group
Male
Female
Freq.
%
< 40 years
23
52
75
16.8
40 – 50 years
51
65
116
26.0
51 – 60 years
39
69
108
24.2
> 60 years
52
96
148
33
Total
165
282
447
100
Table 2 : Kinds of high risk conditions in Pilgrims
High Risk Factors
Frequency
Percent
1. Age > 60 years
148
33.0
2. Hypertension
104
23.3
3. Dyspepsia
22
4.9
4. Obesity
11
2.4
5. Diabetes
11
2.4
6. Rheumatoid Arthritis
10
2.2
7. Chronic Liver Diseases
9
2.0
8. COPD
5
1.1
9. Post Stroke
3
0.7
10. Chronic Renal Disease
2
0.4
11. Other
6
1.3
2002 Digitized by USU digital library
4
According to the documentation of the Indonesia Hajj Committee, people older than
60 years (33%) were at the highest risk, followed by Hypertension (23.3%) and the
other chronic diseases.(Table 2).
Not using mask
( Exposed ) 230
One died
447
Pilgrims
446
Pilgrims
Using mask
(Unexposed) 216
URTI (+)
168
URTI (-)
62
URTI (+)
47
URTI (-)
169
Figure 1 : Schematic Diagram of the Cohort Study Group
Looking at the recorded complaints of pilgrims and the need of treatment, the most
common symptoms were cough (55.0%), followed by cold (14.0%), and fever
(11.6%). (Figure 2).
2002 Digitized by USU digital library
5
4.7
1.3
1.5
1.6
1.7
3.5
3.6
4.0
%
9.5
11.6
14.0
55
0
20
40
Others
Sorethroat
Itchy
Malaise
Hoarseness
Dyspepsia
Diarrhea
Headache
Myalgia
Fever
Cold
Cough
60
Figure 2 : Percentage of symptoms in Pilgrims
The Calculation of the Relative Risk in all age groups is shown in Table 3.
The overall Relative Risk is 3.36, in age group > 60 years 1.99 , in age group < 60
years 4.48, and the stratified analysis by Mantel-Haenzsel Weight RR is 3.10.
Table 3 : Relationship between Using mask and Not using mask
URTI
(+)
168
URTI
(-)
62
Total
47
169
216
215
231
446
Age Group > 60 year
Exposed
Unexposed
Total
48
35
83
12
52
64
60
87
147
Age Group < 60 year
Exposed
Unexposed
Total
60
21
81
51
167
218
111
188
299
All age group
Not using mask
(Exposed)
Using mask
(Unexposed)
Total
RR
C.L
p
value
3.3
6
2.58 < RR <
4.37
0.00
0
1.9
9
1.49 < RR <
2.65
0.00
0
230
3.12 < RR <
0.00
7.5
0
For all strata
2.65 < MHRR <
0.00
(Stratified analysis)
3.82
0
C.L = Confidence Limit ; MHRR = Mantel-Haenzsel Relative Risk ; RR = Relative Risk
;
URTI = Upper Respiratory Tract Infection
2002 Digitized by USU digital library
4.4
8
3.10
6
Discussion :
The overcrowded conditions in Mecca and Medina caused by almost 2.5 million
people coming to the annual Islamic pilgrimage predispose the environment for the
spread of acute respiratory tract infection.4 The Saudi Ministry of Health tries to
control public health risks especially at this time of the year. Infections and
complications that can be acquired at the Hajj include meningococcal meningitis,
respiratory tract infections, blood-borne diseases, and zoonotic diseases, all of it
have the potential to be spread again internationally after the Muslims return.5
In the season of 1992 Hajj, El-Sheikh, et al found out that Klebsiella pneumoniae
was the predominant cause of URTI, followed by Haemophilus influenzae and
Streptococcus penumoniae. The incidence rate of tuberculosis was 1 %, and the
most common virus was Influenza A and Adenovirus.6
Travelling is always accompanied by the certain risk to health.Traveling for Hajj or
Umrah brings along an additional risk also because of change in the climate. We
investigated on the following condition :7,8
• Pilgrims represent a number of people
• Pilgrims may have to walk long distances and get very tired
• Clean water supply and sanitation is difficult to maintain in these
circumstances
• Decrease of appetite and change of foods occurs
• Psychological stress is very likely to happen during ritual hajj activities
• Chronic underlying diseases
Our experience showed that every year some of the pilgrims will came back from the
Holy Cities, Mecca and Medina, with dry or productive coughing. A common cause of
cough is acute URTI. Others causes may be : irritation of airways, allergic reactions
or combined with infection. Other symptoms observed are fever, cold, sore throat,
hoarseness, and ever haemopthysis and breathlessness sometimes.
These symptoms are caused by host factors and environmental factors. The host
factors can be a decrease of immunity due to a lack of appetite, tiredness, physical
and psychological stress, and chronic underlying diseases as a high risk especially
in the elderly. The last host factor is non compliance of pilgrims to use a mask.
The environmental factors such as, high temperature during daytime, low humidity,
crowds moving, staying together in a room for 6 – 10 persons , and air pollution with
high dust concentrations. All of these conditions tend to facilitate airborne
transmitted diseases, for instance URTI, Influenza, and Meningitis. The risk of
disease by overcrowded places, high dust level, and low humidity can be avoided by
using mouth and nose masks regularly.
Actually, only 216 pilgrims (48,4%) were using a mask regularly in this group. The
association between acute URTI and exposure was statistically significant. The
calculation of the Relative Risk, showed a Crude RR of 3.36 (CI = 95%, CL : 2.58 <
RR < 4.37) and strata calculation with separate age group between < 60 year and >
60 year by Mantel-Haenzsel Weight RR is 3.10 (CI = 95%, CL : 2.65 < MHRR < 3.82
) (Table 3). This leads to the conclusion that pilgrims who were not using masks
regularly during the ritual activities, were likely to get acute URTI 3 times more
often than other who were using masks.
Conclusion :
During the ritual Hajj activities in two holy cities and other the risk of spreading
infectious diseases, especially acute URTI occur. This condition is due to host factors
and environmental factors.
2002 Digitized by USU digital library
7
Overcrowded places, high dust level, and low humidity are factors that can be
decreased by using mouth and nose masks regularly.
The risk of acute URTI in people not using masks was 3 times more likely than in
users.
*******
References :
1. Various Aspect of Hajj, In : IslamOnline.net,
From : http://www.IslamOnline.net/English/Hajj/2002/01/journey/article
7.shtml.
2. Sheikh, A , Rashid, A : Hajj : Journey of a lifetime, From :http :\\www.Hajj
health-1.htm
3. Greenberg, R.S , Daniels, S.R , Flemders, W.D , Eley, J.W , Boring, J.R : Medical
Epidemiology, a Lange Medical Book, Prentice-Hall International Inc. London,
1993, 97 - 107
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Infect Control , 2002, Feb ; 30 (1) : 57-65 (Abstract).
6. El-Sheikh, S.M , El-Assouli, S.M , Mohammed, K.A , Alber, M : Bacteria and
Viruses that cause Respiratory Tact Infections during the Pilgrimage (Haj) season
in Makkah, Saudi Arabia, Trop.Med.Int.Health, 1998, Mar; 3(3) : 2059.(Abstract).
7. Guard Againts Meningitis and Save Lives at Hajj or Umrah This Year, In : Health
Advice for Travelers, From : http://www.doh.gov.uk/traveladvice/hajj.htm.
8. Farouk Hafeejee : Health Guidelines for Hajj and Umrah,
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