Background
Respiratory tract infections are one of the common infection associated with Hajj pilgrimage that is of great public health and global concern. This study is aimed at determining the factor structure of the knowledge, attitude, and practice questionnaire for the prevention of respiratory tract infections during Hajj by confirmatory factor analysis (CFA).
Methods
A multistage cluster sampling method was conducted on Malaysian Umrah pilgrims during the weekly Umrah orientation course. A total of 200 Umrah pilgrims participated in the study. The knowledge, attitude and practice (KAP) questionnaire was distributed to pilgrims at the beginning of the orientation and retrieved immediately at the end of the orientation. Data analysis was done using R version 3.5.0 after data entry into SPSS 24. The robust maximum likelihood was used for the estimation due to the multivariate normality assumption violation. A two-factor model was tested for measurement model validity and construct validity for each of the attitude and practice domains.
Results
CFA of a 25-item in total, the two-factor model yielded adequate goodness-of-fit values. The measurement model also showed good convergent and discriminant validity after model re-specification. A two-factor model was tested for measurement model validity and construct validity for each of the attitude and practice domains. The result also showed a statistically significant value (p < 0.001) with χ2 (df) values of 76.8 (43) and 121 (76) for attitude and practice domains, respectively.
Conclusion
The KAP questionnaire was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the KAP of Hajj and Umrah pilgrims towards the prevention for all respiratory tract infections.
The prevalence of respiratory illness has continued to surge among Hajj pilgrims from different countries despite having some practices of preventive measures. Respiratory illnesses during Hajj could be due to many reasons and many factors that promote disease spread. These factors include overcrowding, cigarette smoking, and direct contact with infectious agents particularly viruses promote the spread of respiratory infections. However, due to the longer duration of the pilgrimage, there are high chances of pilgrims contracting various respiratory illnesses due to exposure to respiratory pathogens. Hajj pilgrims' knowledge, attitudes, and practices toward respiratory tract infections are used as the determinant of the effectiveness of the health education interventions. Knowledge and application of basic hygiene principles, use of face masks, following cough etiquettes, engaging in social distancing, and engaging in other measures are highly important. In this paper, we reviewed the various effective intervention strategies implemented to help prevent respiratory tract infections during Hajj.
Acute respiratory symptoms such as cough, rhinitis, sore throat and fever are one of the main health problems encountered by pilgrims performing Hajj in Mekah. The possible causes include over-crowding and low immune status as a result of stress. Honey is reputed to contain multiple chemical compounds that are capable of enhancing the immune system and has antibacterial, antiviral and antifungal properties. We determined the effectiveness of Malaysian multi floral wild honey "Madu Lebah Tualang -Agromas" in reducing acute respiratory symptoms amongst Hajj pilgrims. A non-randomized control trial was conducted among Hajj pilgrims during the 2007 Hajj season.The intervention group was given two kilograms of honey and they were requested to consume 20 g of the honey twice daily throughout the 42 day Hajj journey (from Malaysia to Mekah and back), and to record any respiratory symptoms in the Health Diary provided. The number of symptoms was scored as 1, 2, 3 and 4 where each acute respiratory symptom contributed one point to the score. The outcomes were compared with the control group who were not given honey. Both intervention and control groups received an influenza vaccination.Outcomes were measured in terms of respiratory symptoms and evaluated statistically using repeated measures ANOVA by SPSS software.Results showed that the group which received honey generally scored a lower number of symptoms. They also had a significantly lower percentage of symptoms of sore throat and rhinitis during the third week of the journey. No significant differences were noted in the symptoms of cough and fever. The difference of mean symptom-score was maximum on the third week of the journey; however it was not statistically significant between the two groups. In conclusion honey "Madu Lebah Tualang -Agromas" was shown to reduce the respiratory symptom score of Malaysian Hajj pilgrims. It is significantly effective in reducing sore throat and rhinitis on the mid journey. Honey could be used as one of the prophylactic measures in reducing acute respiratory symptoms among Hajj pilgrims.
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