# Diarrheal Illnesses and Their Association With Hygiene Practices and Food and Water Sources Among Domestic Pilgrims During the 2022 Hajj Season

## TL;DR

This study found that 32% of domestic pilgrims during the 2022 Hajj season experienced diarrhea, with hygiene practices and food/water sources significantly affecting illness rates.

## Contribution

The study provides new insights into the association between hygiene practices and food/water sources with diarrhea prevalence among domestic Hajj pilgrims in 2022.

## Key findings

- 32.4% of domestic pilgrims experienced diarrhea during the 2022 Hajj season.
- Pilgrims who consumed campaign-provided food and bottled water had lower diarrhea prevalence.
- Frequent handwashing (≥5 times) was associated with the lowest diarrhea frequency (23.1%).

## Abstract

Objectives

This study aimed to estimate the prevalence of diarrhea and its associated symptoms among domestic pilgrims in 2022, as well as to correlate hand hygiene measures and food and water sources with the occurrence of diarrhea and its associated symptoms during the 2022 Hajj season.

Methods

An analytical cross-sectional study was carried out in Makkah, Saudi Arabia, on domestic pilgrims during the 2022 Hajj season. The data collection form was built based on a literature review and adopting a previously validated questionnaire. An online survey was used after using multi-stage cluster sampling. Data was analyzed using IBM SPSS Statistics for Windows, V. 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to describe the categorical and quantitative variables.

Results

The study has 1193 participants, aged 18-65 years. The prevalence of diarrhea was 386 (32.4%), with fever being the most reported associated symptom (192, 49.7%). When compared to other food and water sources, the majority of responders who consumed campaign-provided food and bottled water had a lower prevalence of diarrhea. Diarrhea was less common among pilgrims who washed their hands more often. Individuals who cleaned ≥5 times had the lowest frequency (117, 23.1%). Consumption of expired food and the occurrence of diarrhea were statistically significant. Statistically significant associations (p<0.0001; 95% CI) were found between diarrhea prevalence and hand hygiene frequency, food sources, water sources, and sharing behaviors.

Conclusion

Our study found a diarrhea prevalence of 32.4% among domestic pilgrims during the 2022 Hajj season, which is higher than rates reported in previous studies (1-23%). Domestic pilgrims reported varying practices related to food consumption, water sources, and hand hygiene. Discrepancies were noted between the different types of campaigns. Further qualitative research is required to provide insight into these differences.