Abstract
Musculoskeletal pain is a primary burden on individuals, social and health care systems. Annually, two-to-three million Muslims pilgrims perform Hajj as a religious duty in the holy city of Mecca, Saudi Arabia. Hajj involves high physical demands as pilgrims move, generally by foot, between a series of religious sites over 5-7 days with distances of an average of 5-15 km/day. This is likely to exceed the typical physical activity exposure for most individuals and is further complicated by overcrowding, extreme heat and fatigue. The aim of this study was to estimate the point prevalence of musculoskeletal pain by anatomical sites among adult pilgrims and to study potential associations with individual characteristics, history of major medical conditions, beliefs about Hajj, and falls during the Hajj. A cross-sectional survey was conducted during the period of Hajj. Data were collected after completion of the 2nd day of Hajj (21-31 August 2018) by volunteers who approach individuals at different sites of Mecca city using an online application or paper form. The main inclusion criteria were adult pilgrims aged 18 or older. Participants were allowed reporting more than one site of pain. A total of 2,110 responses was received, of which 1,715 were complete. The overall prevalence of musculoskeletal complaints was high (82.3%). For both sexes, foot/ankle pain was the most frequent musculoskeletal symptom (39.1%), followed by leg pain (30.4%), low back pain (28.4%), knee pain (23.0%), and shoulder pain (16.1%). Multinomial logistic regression analyses indicated that musculoskeletal complaints were more likely in females, older individuals, individuals who smoke, had diabetes and hypertension, those who believed that Hajj was physically exhausted, and those who had experienced a fall during Hajj. These data provide guidance for the potential nature of preventative programs and the allocation of resources to optimise individual's experience and capacity to complete Hajj.