Prevalence and Risk Factors of COVID-19 Among Post-Hajj Pilgrims in Ivory Coast, 2024: A Retrospective Cross-Sectional Study

<i>Context: </i>Since the emergence of Coronavirus disease 2019 (COVID-19), it has profoundly disrupted healthcare systems and social dynamics around the world. Faced with this health burden, the need to curb the transmission of the virus has become a priority, particularly in high-risk contexts such as mass gatherings. As a result, many countries have been forced to cancel, postpone, or reorganize religious, cultural, and sporting events to limit community transmission of the virus. The pilgrimage to Mecca (Hajj) brings together millions of worshippers in a confined space, facilitating the transmission of infectious diseases, including COVID-19. <i>Objective: </i>To identify the prevalence and the factors responsible of the occurrence of COVID-19 among pilgrims returning to Côte d'Ivoire. <i>Methods: </i>A retrospective cross-sectional analytical study was conducted using the COUSP database on Ivorian pilgrims returning from Mecca in 2024. Epidemiological and medical data (age, comorbidities, vaccination status), clinical and paraclinical data (RT-PCR and TDR tests) were analyzed. A univariate analysis was performed on cross-references between independent variables and the dependent variable. A comparison of proportions was made using the Chi-square test or Fisher's test, depending on their conditions of application and was significant if the p-value was less than 0.05. For the multivariate analysis, variables with a p-value of less than 0.2 in the univariate analyses were selected for model construction using simple logistic regression based on a stepwise downward approach. The adjusted odds ratio (AOR) and its confidence interval were calculated. A p-value < 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval that did not include 1.00 were considered significant. The adequacy of the final model was verified using the likelihood ratio test. <i>Expected results: </i>The average age was 58.3 years, and 53.6% were women. 86.8% of pilgrims were vaccinated. The prevalence was 0.12% (5 cases out of 4,038). No sociodemographic characteristics were significantly associated with testing positive, except for gender, which was associated with a lower probability of infection (p = 0.01). The association between the presence of other clinical signs and the occurrence of positive cases was significant (p = 0.00). The type of test was also associated with positivity (p = 0.0422). The main associated factors included TDR for screening among pilgrims with 86.78% vaccination coverage. <i>Conclusion: </i>This study documented for the first time in Côte d'Ivoire the factors associated with the occurrence of COVID-19 among pilgrims returning from Mecca. Strengthen vaccination and awareness of preventive measures.