Proportion of Impairments in Body Functions and Body Structures, Activity Limitations, and Environmental Factors among Hajj Pilgrims with Diabetes Mellitus in Saudi Arabia in 2026: An ICF-Based Descriptive Study
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Abstract
The Hajj is a large-scale mass gathering that demands high physical activity and exposes pilgrims to extreme heat and crowding, increasing the risk of functioning problems, particularly among those with chronic diseases such as diabetes mellitus. Within the International Classification of Functioning, Disability and Health (ICF), disability is an umbrella term covering impairments of body functions and body structures, activity limitations, and participation restrictions, all of which arise from the interaction between a health condition and environmental and personal factors. This study aimed to determine the proportion of problems in four selected ICF categories among 2026 Hajj pilgrims with diabetes mellitus in Saudi Arabia. A descriptive cross-sectional study was conducted in May 2026 at the pilgrims' accommodation in Saudi Arabia on 109 pilgrims with diabetes mellitus selected through simple random on-site sampling. One representative category was assessed for each ICF component: consciousness functions (b110) for body functions, structure of areas of skin (s810) for body structures, religion and spirituality expressed as the ability to perform prayer (d930) for activities and participation, and drugs (e1101) expressed as the type of diabetes medication used for environmental factors. Data were collected using an ICF-based assessment form and analysed descriptively as proportions. The mean age of respondents was 60.22 years and the majority were female (54.1%). No impairment of consciousness functions was found (0.0%), as all respondents were fully conscious. Impairment of skin structure was found in 18.3% of respondents and activity limitation in performing prayer in 27.5%. All respondents used diabetes medication, predominantly oral antidiabetic drugs (71.6%), followed by insulin (14.7%) and oral antidiabetic drugs combined with other medication (13.8%); this reflects a universal need for continuous pharmacological support rather than a barrier in itself, so that availability, storage and access to medication constitute a decisive environmental factor for the entire group. Activity limitation was the most frequent problem among the categories assessed, underscoring the importance of supervising medication use, early identification of skin lesions and activity limitations, and structured health monitoring for Hajj pilgrims with diabetes mellitus. Because only one category was assessed per ICF component, these proportions should be read as a preliminary profile and not as a comprehensive assessment of functioning.
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