Factors associated with health service utilization among Iranian pilgrims during the 2023 Arbaeen pilgrimage in Iraq: a cross-sectional study

INTRODUCTION: The Arbaeen Walking Ceremony (AWC) is one of the largest annual mass gatherings, posing significant challenges to health systems due to increased demand for medical services. Understanding the factors influencing health service utilization (HSU) among pilgrims is crucial for effective health planning. This study aimed to assess the prevalence and predictors of HSU among Iranian pilgrims during the 2023 AWC in Iraq. METHODS: A cross-sectional study was conducted among 461 Iranian pilgrims who participated in the 2023 Arbaeen pilgrimage, using convenience sampling. Data were collected via a structured questionnaire including demographic information, health service utilization (during and after the pilgrimage), the General Health Questionnaire (GHQ-28), and the Perceived Physical Fitness Scale (PPFS). Logistic regression models were used to identify predictors of HSU during the pilgrimage. Data were analyzed using STATA-13. RESULTS: The mean age of participants was 35.1 years (SD = 14.6), with 50.3% female. Nearly half (49.9%, n = 230) utilized health services during the pilgrimage, including wound dressing (15.6%), outpatient examination (16.5%), and non-prescription medication (21.5%). After returning, 31.5% (n = 145) sought further care. In the journey to Arbaeen, factors significantly associated with higher HSU included older age (aOR = 1.02 per year, 95% CI: 1.00-1.04, p = 0.004) and use of public transportation (aOR = 1.55, 95% CI: 1.02-2.34, p = 0.038). For the return journey, pilgrims returning via Khosravi border had higher utilization (aOR = 1.84, 95% CI: 1.12-3.03, p = 0.016), while those with longer pilgrimage duration (6-10 days) and prior experience (2-4 times) showed increased odds of HSU (aOR = 1.75, 95% CI: 1.05-2.91, p = 0.030). General health and physical fitness scores were not significantly associated with HSU. CONCLUSION: Nearly half of Iranian pilgrims used health services during the 2023 Arbaeen pilgrimage. Predictors of utilization varied by travel phase, with age and transportation mode influencing use on the way to Iraq, and return border, duration, and prior experience affecting use on the return journey. These results support the need for tailored health services and pre-travel guidance.