Burden and Determinants of Respiratory Illness among Indonesian Hajj Pilgrims

Introduction: Respiratory infections remain a major cause of morbidity during the Hajj pilgrimage due to extreme crowd density, environmental exposure, and the high proportion of elderly pilgrims with chronic conditions. This study aimed to describe clinical characteristics and identify factors associated with influenza and pneumonia among Indonesian Hajj pilgrims. Methods: An analytical observational study with a cross-sectional design was conducted among 40 Indonesian pilgrims presenting with respiratory symptoms at Indonesian Hajj Health Clinics in Saudi Arabia. Data on demographics, comorbidities, preventive behaviors, clinical findings, laboratory results, and management outcomes were obtained from medical records and structured interviews. Associations were analyzed using Fisher’s exact test. results: Most respondents were aged ≥60 years (57.5%) and male (57.5%). The most common comorbidities were diabetes mellitus and hypertension (15%). There was a significant association between age and the incidence of influenza and pneumonia (p=0.031; p=0.049), as well as between pneumonia and diabetes mellitus (p=0.049) and COPD (p=0.026). Oxygen therapy requirements were high in patients with influenza (77.3%) and pneumonia (84.2%). Furthermore, low levels of preventive behaviors such as mask use and handwashing contributed to the increased risk of infection Results: Most participants were male (57.5%) and aged ≥60 years (57.5%). Pneumonia occurred in 35%, influenza A in 15%, and COVID-19 in 2.5%. Older age was significantly associated with influenza (p=0.031) and pneumonia (p=0.049). Lack of influenza vaccination was associated with influenza (p=0.041), while poor hand hygiene was associated with pneumonia (p=0.011). Diabetes mellitus (p=0.049) and chronic obstructive pulmonary disease (p=0.026) were also associated with pneumonia. Oxygen therapy (45%) and hospital referral (42.5%) were frequently required. Discussion: These findings highlight the role of advanced age, comorbidities, and inadequate preventive behaviors in increasing infection risk, although the small sample size may limit generalizability. Conclusion: Respiratory illness among Indonesian Hajj pilgrims was associated with older age, comorbidities, and insufficient preventive measures. Strengthening vaccination, hygiene, and predeparture disease control may reduce morbidity.