hajj is one of the main rituals of islam , a religious duty that must be performed by each healthy and able - bodied muslim who can afford to do it . the population of mecca and medina increases from 200000 to over 3 million in times of annual hajj ( 1 ) . such increase introduces various challenges such as provision of sufficient food and water , supplying hygienic accommodation in mecca , mina , and arafat where the pilgrims must perform part of their rituals . from iran , about 100000 pilgrims in caravans of 100 and 200 pilgrims are transferred to saudi arabia during hajj season ( 1 ) . due to the health and hygienic issues during this 35-day event and to remain immune from medical interventions , iranian hajj policymakers has categorized health services during hajj for the sake of providing more accommodation and welfare for iranian pilgrims ( 2 ) . in the first level , there is a general physician in each caravan who accompanies the pilgrims in the caravan and is informed of the medical conditions of his assigned pilgrims . if a pilgrim needs specialized or complementary medical services , he / she would be transferred to the iranian red crescent hospital in mecca and medina after filling the hospital reference form by the caravan physician ( 3 ) . caravan physician is in charge of pilgrims health and he is the highly referred person . this is why a review on the degree of disease outbreak in times of hajj can be regarded as an effective help in designing hajj health plan and enables authorities to develop a right plan to protect the pilgrims ` health and to train them in managing the most prevalent diseases in hajj . generally , the first data obtained from the patients includes symptoms and problems articulated by them ( 4 ) , which are the main causes of seeking treatment . the objective of this study was to review the frequency of pilgrim s chief complaints in hajj to plan and develop medical protocols in hajj . in this retrospective cross - sectional study , which was conducted in 2010 , the physictional system of medical reports on patient by the physicians was reviewed . this system provided the medical screening of all pilgrims specifications before travel in form of software for caravan physicians . in the course of travel , all data regarding the prescribed medicines , patients chief complaint , and diagnosis would be registered in this software . such inputs were delivered to hospital information system and would be extracted and reviewed accordingly . examined variables included patient s complaints and their clinical diagnosis . there were any executive restrictions except for the change of the caravan 's physicians every year . all iranian pilgrims ' data in software were selected and enrolled in this study by census sampling method and analyzed . the study was ethically approved by the health research ethics committee of the hajj and pilgrimage center . confidentiality of names and data of all the subjects was observed . after completing checklists , spss software 15 ( spss , inc . , chicago , il ) was used for analysis of data and variables were described using frequencies and percentages or means and standard deviations . in general , medical d107074 cases was registered in this software with 70754 persons ( 66.08% ) in mecca , 31083 ( 29.03% ) in medina , 1874 ( 1.75% ) in arafat , and 3363 ( 3.14% ) in mena . the mean age of patients was 54.71  21.84 years ( range , 21 to 98 ) . other frequent complaints were consecutively coryza , dysphagia , control of underlying disease , musculoskeletal pain , fever , headache , and low back pain . figure 2 shows that the respiratory tract infections , with 66197 affected persons ( 61.82% ) , were the most diagnosed diseases in times of annual hajj of 2010 . other frequent diagnoses were consecutively muscular spasm , allergy , purulent pharyngitis , acute bronchitis , gastritis , pneumonia , laryngitis , and trauma . the most prescribed medicine was adult cold tablets with 12280 cases ( 13.21% ) followed by amoxicillin ( 5942 cases [ 6.93% ] ) and diphenhydramine syrup ( 5867 cases [ 6.31% ] ) . the present study showed that the most frequent diagnoses in pilgrims of hajj 2010 were consecutively respiratory tract infection ( 54.02% ) , muscular spasm , gastrointestinal , and skin diseases . prolonged cough was reported in a large proportion of two million pilgrims who participate in hajj in saudi arabia . in hajj pilgrimage season , people gather in a small confined area in mecca . respiratory tract infection is the most common disease transmitted during this period ( 2 ) . other studies showed the high rate of influenza virus infection outbreaks among pilgrims returned from mecca . it indicates the necessity of developing an international strategy to reduce the risk of epidemics ( 5 ) . in addition to highlighting prevention , such strategy must be able to made the immediate diagnosis and provide treatment for infected cases . the shift in time of hajj to winter form year 2000 , has led to an increase in the outbreak of respiratory tract infections caused by influenza and other common viruses ( 6 ) .   in spite of excellent efforts by health ministry of saudi arabia in provision of hygienic and medical facilities , such huge gathering is an appropriate ground for the outbreak of diseases . in time of hajj , as the largest annual gathering of the world , many people are in close contact with one another , which increases the probability of the outbreak of common as well as new respiratory tract infections . recommendation saudi arabia ministry of health to pilgrims , especially those with underlying diseases ( elderly or people with chronic diseases , heart failure , etc . ) , is vaccination against influenza before trip . nonetheless , due to high rate of influenza attacks in winter and cold months , influenza vaccination before travel to the pilgrims is recommended to all age groups . however , an independent study on the efficacy of influenza vaccine during the hajj is necessary ( 5 ) . according to other results of our study , with high frequency of common colds frequent administration of non - steroidal anti - inflammatory drugs and antibiotics seems to be more than usual . therefore , revising in prescription of medications by caravan physicians is essential because this problem increases the risk of adverse effects of steroids and antibiotics as well as microbial resistance . this study is the first study on the prevalence of disease in hajj with a large of samples size . we have not data for analyzed association between demographic variables and kind of disease because our software recorded demographic data with complaints and diagnosis .
background : the primary data on the patient s status are articulated by the patient and consist of conditions that force the patient to seek treatment . 
 such data helps the physician effectively to make an appropriate list of differential diagnoses to establish a treatment protocol.objectives:the objective of this study was to review the frequency of patients chief complaints in hajj to plan and develop medical protocols for expected problems in hajj.patients and methods : in this short - term past - oriented study , all medical files of the hajj pilgrims were reviewed and all data regarding the diagnoses were extracted.results:in general , medical data of 107074 cases had been registered in this software . 
 cough with the frequency of 24083 ( 22.45% ) was the most frequent complaints of the patients . 
 respiratory tract infections diseases with 66197 persons ( 61.82% ) were the most frequently diagnosed diseases in times of annual hajj of 2010.conclusions:respiratory disease , musculoskeletal pain , headache , and digestion problems were among the most important reasons of patients ' referral to physicians in times of hajj . 
 the mentioned complications could be prevented through correct trainings and conforming to health recommendations in times of hajj .