Effectiveness of Health Management - Case Study Example

Project Title:The Effectiveness of Health Management Practices for Reducing Mortality due to Heat Related Illness during Hajj Affiliations/Investigators: The investigators and the affiliations will include the following: The literature reviewers The sample collectors The data collectors The data analysts The report compilers 1. Proposal Summary This proposal presents a research, which will be conducted to determine the effectiveness of health management practices used to reduce mortality due to heat related illness in Saudi Arabia. The proposal will begin by providing the background of heat related illness during Hajj and how it can develop. It will also identify the risk factors that cause heat related mortality among Hajj pilgrims, and the role that the health care management programs play in reducing mortality risk. The methods section describes the methodology that will be used in this study, including the criteria for sampling, data collection techniques, and how the results of the research will be analysed. In addition, the study will address ethical considerations such as the procedures to access the participants as well as how to observe confidentiality when collecting the datato make it more authentic. Finally, the proposal will present the expected timeline that the research will take and provide the cost estimates required in order to achieve the objectives of the project. 2. Background Heat related illnesses occur when the temperature of the body exceeds 380C, which is the normal human body temperature (Armstrong, 2003). These diseases are normally referred to as hyperthermia and can be put into different types, which include heat stroke, heat exhaustion and mild heat related illness. Their manifestation varies from mild headache to life threatening cardiovascular and respiratory interruptions (Hopkins & Ellis, 1996). Hajj is an annual Muslim pilgrimage to Mecca in Saudi Arabia, performed as one of the pillars of Islam. It is a commemoration of Prophet Abraham’s willingness to sacrifice Prophet Ishmael, his son. It lasts for five days at the end of Islamic lunarcalendar. Hajj is consideredto be the largest gathering of peoplein the world, performed annually, with over 2.5 million pilgrims each year (Gardouni, 2012). Despite being a very important event to the Islamic religion, the gathering is too large, and this increases the possibility of the spread of infectious diseases and occurrence of health related illnesses. This poses a serious challenge to the government of Saudi Arabia. In addition, based on this background, this study will review and critically analyse health protection strategies that relate to heat related illness during Hajj. The pilgrims from various countries around the world arrive in Mecca for Hajj. Most of these pilgrims are not used to extreme weather conditions found in deserts. Despite the fact that human bodies can regulate the body heat through sweating, in immense heat found in summer periods of Saudi Arabia, illness may affect anybody exercising or working under the sun. Some categories of people are more at risk such as children, old people, and people with disabilities and those with chronic illness as well as those under medications. The body may then develop health related illness (Seraj et al., 1987; Tonna, et al., 2009). 2.1. Characteristics of heat related illness Heat stroke and heat exhaustion are the major causes of morbidity and mortality of Hajj pilgrims during the summer time, when the temperatures may range between 37 and 45°C. Heat stroke is a fatal illness that causes the breakdown of the heat control in body. It is caused when the body’s thermoregulatory mechanism is overwhelmeddue to exposure to high environmental temperature (Byard, 2013). The symptoms include headache, nausea, weakness, chills and ataxia. The body temperature rises to 400C or more. Sweating may cease and the skin becomes dry and hot, followed by loss of consciousness. Heat exhaustion is an intense weakness due to salt and water loss as a result of sweating during heat exposure. Major symptoms are nausea, headache diarrhoeaand thirst (Hopkins & Ellis, 1996). 2.4. Significance of the Research Issue This research issue is of great significance because it will facilitate the understanding about heat related illness experienced by Hajj pilgrims. The extra ordinary migration caused by a huge number of people from other countries embarking on pilgrim’s journey makes the topic under discussion relevant as the pilgrimage carries health risk issues caused by communicable and non-communicable diseases that occur in large scale (Creswell, 2007). The study will characterize heat stress, its risk factors, its symptoms, and propose immediate, short-term, long-term prevention solutions, as well as identify gaps and propose further solutions to bridge these gaps. This study will assist Hajj travellers and travel specialists to better manage the travelling procedures for the pilgrims, as well as inform health practitioners in identifying changes in health related illnesses with the changing environmental conditions (Noweir et al., 2008). Specifically, it will inform the medical practitioners on how they can create infections control, public health and vaccination policies.The procedure adopted for this research is best suited for the study as the event in questionoccurs every year. It will enable the quantification of the problem, and provide analysis of the pattern of change, and allow for the prediction of future patterns, It will, therefore, create a platform for the formation of policies and strategies for the mitigation of heat-related deaths for posterity. These policies will reduce loss in terms of income and human resources (Creswell, 2007; Buffington & McDonald, 2006). 3. Literature Review A number of researches have been conducted that relate to the morbidity and mortality duringHajj (Al-Harthi & Al-Harbi, 2001; Gautret et al., 2007; Tonna, et al., 2009; Dzaraly et al., 2014). Despite the seriousness of heat related illness little is mentioned about it. A study between 2002 and 2007 by Pane (2007) concluded that most of the mortality and morbidity occurred due to health related issues. A related study by Dzaraly et al. (2014) showed that the respiratory disease was the leading health problem which accounted for 76% of the recorded incidences and those which are directly related to heat stroke accounted for 3.7%. However, some of the recent studies showed that heat is the main cause of morbidity and mortality among the hajj pilgrims. For example, Gautret et al., (2009) reported that heat stroke and heat exhaustion was one of the major causes of mortality and morbidity during the Hajj, especially during summer (Gautret et al., 2009). But this study does not answer questions such as the factors that put people at risk for heat stress—why other people are more readily afflicted by heat illness than others and what policies have already been put in place for the purposes of preventing such mortality. It is likely that the majority of deaths are heat-related as the temperatures in the Summer Hajj often exceed 400C. Additionally pilgrims are accommodated under less-than-comfortable conditions as they are away from home and without their usual lifestyle support; residing in temporary accommodation that may lack normal environmental controls (Travel.state.gov, 2015; Verner, 2012). The extreme heat is further compounded by population congestion. Congestion may facilitate the spread of infectious diseases thereby increasing the group of people at risk from heat stress (Assiri et al., 2013). The Saudi government has implemented health programs aimed at increasing the effort to improve the health of the pilgrims, but there are still health related problems, which affect morbidity and mortality. Over 2.1 per thousand of the pilgrims die every year, approximately 70% of the incidences in the age of 60 and above (Ministry of health, 2010). Among the leading causes of mortality are trauma, death due to acute exacerbations of chronic illnesses resulting from the extreme conditions, and death resulting from heat stress (WHO., 2004). 4. Aims The main aim of this study is to investigate the effectiveness of health management practices for reducing mortality due to heat related illness during hajj. Other objectives of this study include the following: To identify the current rates of heat-related mortality in comparison with other mortality causes at Hajj. To identify risk factors of heat stress. To determine current policies and prevention strategies intended to reduce heat stress during the pilgrimage. Develop recommendations for improvement. 5. Hypotheses There are two hypotheses that this study tries to evaluate. These hypotheses include the following: H1: There is a relationship between health management practices and reduced cases of heat related illness H0: There no is a relationship between health management practices and reduced cases of heat related illness 6. Research Question The following are the research questions What is the current state of preparedness of the government with respect to mitigating heat stress morbidities and mortality at Hajj? What factors appear to influence that preparedness? What policies have already been put in place for the purposes of preventing mortality? Why are some people more readily affected by heat illness than others? What could be done to mitigate heat related illness and death? 7. Methods This section describes how the study will be conducted to determine the effectiveness of health management practices used to reduce heat related illness in Saudi Arabia mainly during Hajj. The main variables in this research will be the health management techniques and the number of people affected by heat related illness. The researcher being aware of the biases will try to minimise these using systematic sampling techniques (Jones, 2004). Biases may be introduced when the researcher focus on a particular area and other parts are ignored. For example, in this study, the research will only focus on those who are affected within Saudi Arabia. Thus those people who are affected by the illness outside the country will not be included in the study. 7.1. Literatures sources The literature review will focus on heat related mortality review drawn from various scholarly databases such as Medline, government reports, internet searches of Islamic websites, peer reviewed unpublished literature, fatwa banks, theses and other academic output, and our personal libraries. 7.2 Research Design This research will apply qualitative research method that involves collection of opinions, views and ideas about the topic in question. The data will focus on the ideas and opinions about the current health management practices and incidences that relate to heat related illnesses, collected from health care practitioners working in health care facilities in Saudi Arabia. The views about the methods of intervention currently in place to mitigate and reduce the problem will also be collected. The data will be supplemented by personal experiences of participating in Hajj and providing medical advice to pilgrims on Umrah and Hajj. This will form the basis of data that will be examined, and will thereby serve as the study’s “participants” (study sample). The PICO is an acronym used in clinically based problems that is focused on four areas of knowledge and action. It is meant to make successful, valid decision based on clinical evidence. The PICO for the study was as follows: P: The Problem or Population of interest will be the literature retrieved containing information on heat stress during Hajj I: Intervention will be developing suggestions which can be implemented in the process of planning and policy development for Hajj in future C: Comparison of literature will enable the formation of a true conclusion regarding the current state of the problem and the steps that have already been taken in its management. O: It is expected that the Outcome of this study will contribute to the reduction of the effects of heat stress at Hajj in the future 7.3. Sampling criteria Sampling procedure adopted will be stratified purposive sampling and snowball sampling techniques, where the participants will be selected within Saudi Arabia. Both the purposive and snowball sampling techniques are used so that the wide knowledge and experience in heat related illness and policy making based on precise inclusive criteria can be identified (Houser, 2012). At least 30 interviews will be conducted. 7.4. Procedure for Participant Selection The main participants in this study will be the health care practitioners that will include the nurses and doctors working in health care facilities like hospitals, clinics, and home care in Saudi Arabia. The inclusive criteria will include the health practitioners who have knowledge on heat related illness, and have at least three years experience of dealing with patients during Hajj especially those affected by heat related illness. The exclusion criteria will be applied by excluding those who do not have knowledge about heat related illness, as well as those who have experience of less than three years. 7.5. Data Collection This study will make use of qualitative approach to obtain data about the research topic. The researcher will approach various hospitals and clinics to seek permission to conduct the research study. The participants will then be asked questions that relate to the research topic. Various techniques for recording data will be employed. These include the use of audio recording, taking photographs and taking notes of the responses during the survey. The data obtained will be stored in the database so that they can be used in analysis: by regrouping the concepts and clarifying the meanings. 7.6. Procedure Results Dissemination After the data has been collected and analysed, a report that includes recommendations will be compiled and produced in printed form. Printed copies will be distributed to the major stakeholders such as the officials in the department of health in Saudi Arabia, health care practitioners and hospital management in Saudi Arabia. The researcher will also seek to reach out to the public by forwarding the article in major newspapers to create public awareness of the status of the current topic. 8. Ethical Implications Ethical issues will be observed in this research from the beginning to the end of this research. The participants will be allowed to participate on willingness. The first ethical issue that will be considered in this research will be to seek permission from Saudi authorities in hospitals so that the researcher will be allowed to conduct the research. Thus, a letter seeking the permission will be send to most of the hospitals in Saudi Arabia (Schwartz et al., 2007). No participant will be coerced to provide personal details against his or her will. Any participant who needs to quit the exercise will be allowed to do so. Respect for autonomy through willingness to participate and quit will help in ensuring that true results are obtained at the end of research exercise. Additionally, principle of informed consent will apply in this research. This involves provision of information sheet to the participants before the research exercise. The participants will be required to fill consent forms after being given a chance to read and understand what is in the information sheet. This principle will help in ensuring that participants are not deluded into participation in the research and their interests are protected (Royal College of Nursing, 2011). As a way of protecting participants' information, codes will be used in the questionnaires provided. Participants will be made aware of presence of complaint sheets to be filled in case of violation of their rights. Any criminal matter that might be raised against this research will be solved following the right legal procedure (Gaffar et al., 2013). 9. Project Timetable To make the research successful, it requires determination of required timeline, financial requirements, and materials and equipment such as voice recorders, camera, notebook, pens and data storage facilities as described below. Camera – this will be used to collect visual data such as taking photos of equipment used for cooling purposes like sprayers. Note book – this will be used to record notes by the researcher, for example, the responses from participants. Audio recording devices - this includes the equipment used to record the audio responses from the participants. Pens – this will be used to record notes in the notebook Data storage equipment – this will be used to store data safely so that they can be used in data analysis The milestones that will be encountered in this project include the following. Collecting the data from the participants Writing a report and analysing the data. Writing the conclusion and the recommendations of the project Distribution of the report to the stakeholders Timeline This research study will undergo three steps including; preparation, implementation and evaluation. This research will be conducted for a period of 2 months starting from the 8th June 2015 until the 30th July2015. Action Dates Formulating and finalising the research topic and questions 8th June – 20th June 2015 Seeking permissions from hospitals authorities 21th June – 25th June 2 015 Sending invitation letters to participants and collecting the responses to participate 26th June – 30th June 2015 Conducting a pilot study 1st July –3rd July 2015 Conducting Actual study that includes data collection 4th July – 10th July 2015 Storing the data using different methods 11thJuly – 14th July 2015 Analysing data analysis using different data analysis tools 15th July –19th July 2015 Compiling the report, making recommendations to stakeholders, printing and binding the report 20th July – 25th July 2015 Presenting the report to stakeholders 30th July 2015 Table 1: The research timeline The financial resources required during the study are estimated. This will facilitate the accomplishment of all the activities undertaken during this research. These include transport, purchasing cameras and notebooks, recruiting and paying the research team. The following will be the estimated budget for the research. Activity Amount in dollars ($) Transport Costs 300 Purchasing camera, notebook and pens 250 Recruiting and paying research team 1000 Software installation 120 Total 1670 Table 2: Estimated costs for the study Justification This research is very important as it may provide solutions to issues that affect the economy and human welfare. Heat stress is likely to be a significant cause of mortality and morbidity during Hajj particularly because such environmental challenges have recurred over the years during Haj time. The challenges are expected to become worse as heatwave conditions are predicted to increase as a result of climate change (IGPCC). According to IPCC’s 2013 report, it is more likely that the temperature will increase over most part of the globe as the global temperature increase. The heat waves will be experienced more frequently and with higher duration (Stocker $ IPCC, 2014). Thus the significant risk to pilgrims requires further detailed research. This study intends to identify the current status of heat related health impacts for pilgrims. By doing so, it seeks to identify gaps and fill these by proposing further solutions. The study aims at characterizing heat stress, its risk factors, its symptoms, and proposing immediate, short-term, long-term, and prevention solutions. Read More