Health Management Practices for Reducing Mortality due to Heat-Related Illness during Hajj - Research Paper Example

The Effectiveness of Health Management Practices for Reducing Mortality due to Heat Related Illness during Hajj Abstract The increasing concern about the effect of heat as a cause of mortality and morbidity has resulted in the development of public health interventions programs. The objective of this study is to analyze the effectiveness of health management practices for reducing mortality due to heat related illness for pilgrims who are attending the Hajj. The research aims to ensure improved health and wellbeing of the pilgrims and to assist policy makers and health practitioners in their decision-making. While there is currently limited research into public health interventions, concerns remain about the impact on vulnerable groups; particularly visitors and the poor. Introduction The adverse health effects of hot weather have been of great concern to the public health especially in Hajj. With the increase in the global temperatures and warmer climate, arid areas such as Saudi Arabia, are expected to experience increased temperatures, which will result in more intense heat conditions and related health hazards. Health practitioners and policy makers are being called on to decide on the best health interventions and the procedures required for decision making at both local and international level. This study focus on the effectiveness of health management practices for reducing morbidity and mortality due to heat related illness during Hajj. This study will assist policy makers and health practitioners in their decision-making. The type of health management practices that has been implemented by the authorities during Hajj is also examined. Aim 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 and morbidity 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. Research Questions 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? What could be done to mitigate heat related illness and death? Literature Review A number of studies have identified morbidity and mortality during the Hajj (Al-Harthi & Al-Harbi, 2001; Gautret et al., 2007; Tonna, et al., 2009; Dzaraly et al., 2014). Despite the seriousness of heat related illness there has been relatively little reference to it. A study conducted over the period 2002 to 2007 by Pane (2007) concluded that most mortality and morbidity occurred as a result of heat 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%. In other words, heat stroke was the least cause of death. However, other studies have demonstrated 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 heat is a major cause of deaths as the temperatures in the Summer Hajj often exceeds 400C. Additionally pilgrims are accommodated under less-than-comfortable conditions as they are away from home and without their usual lifestyle support. They reside in temporary accommodation that may lack normal environmental controls (WHO, 2007). 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 improving the health of the pilgrims, but there are still health related problems, which cause morbidity and mortality. Over 2.1 per thousand of the pilgrims die every year, approximately 70% of these are over the age of 60 (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). Methods The study will take the form of a comprehensive review of the literature and of public documents. The sources were restricted to literatures, which were less than ten years old. The study is set in Saudi Arabia and focuses on the health issues identified during the annual Hajj pilgrimage. The study will examine peer reviewed and other literature identified through a search of international databases and examination of relevant websites and public documents. Both hand search of literature sources and automated search are applied as the search strategy in this study. We will review the following databases: Medline, government reports, internet searches of Islamic websites, peer reviewed unpublished literature, fatwa banks, theses and other academic output, and our personal libraries; using the following keywords extreme heat, climate change, the public health response, preparedness, mitigating measures, heat related illness, strategy, and planning. The process of analysis will involve the following: 1. Collecting all relevant literature 2. Examining the titles for relevance 3. Examining the abstract of relevance and significance for those that appear relevant. 4. Examining the data in detail for the impact for those that appear relevant and significant 5. Collecting the information into a table and examining the content and thematic analysis for the recurring argument. The secondary data is obtained from various literature sources and the primary data is obtained by conducting qualitative research 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. Selection criteria Both the exclusion and inclusion criteria were applied in the following way. i) Inclusion The research included original research articles and reviews, published reports and books, specifically discussing heat related issues. They must also include at least one health related change in behavior. ii) Exclusion Letters, editorials, comments and correspondences are excluded in the review. The main focus is limited to the programs that have been implemented and adaptation practices with less focus on the effects. There is also no assessment of the impact of human health (Boswell & Cannon, 2011). Analysis Form the literature review, various themes comes up. One of them is that the awareness about the occurrence of heat related issues are almost universal knowledge by the public. However, most of the information does take into account vulnerable groups like the elderly, the poor people, who are marginalized and may not be reached easily through various health interventions. This study will focus on the most vulnerable groups, especially in finding out the awareness about the various interventions. Some literature actually focuses on the elderly people, but the information is not exhaustive (Rootman, 2000). The definition of the vulnerable groups in various literatures does not include other groups that equally at high risk of being affected by damaging effects of heat if they are exposed to for a long time (Canada, 2011; Connell, 2011). The groups include the tourists and the people who work outdoor like the supervisors. Thus the awareness by these groups of people also needs to be assessed. Another theme which comes out in the review is that those people who already have some illness or the older people may not be aware of the effects of heat in their health status, or how they can respond to it, considering the physiological effects (Byard, 2013). These may stem from the common perception that heat is not the main cause of dead, or the notion that the information applies to other people other than themselves, like the organizers or health practitioners themselves. The problem may have stemmed for the fact that there has been more focus on some special groups of people like the elderly and small children, leading to the general believe that the messages are meant for the vulnerable group of which they are not included. Summary of the themes are shown in the table below Table 10-15 Title Methods Findings Comments Awareness about the occurrence of heat related Literature review The awareness about the occurrence of heat related issues are almost universal knowledge by the public the poor people, who are marginalized Definition of the vulnerable groups Literature review Does not include other groups that equally at high risk of being affected by damaging effects of heat if they are exposed to for a long time Tourists and the people who work outdoor like the supervisor are excluded Awareness of the effects of heat in health status and response Literature review Those people who already have some illness or the older people may not be aware of the effects of heat in their health status More focus on some special groups like the elderly and small children Evaluation The techniques used in the assessment of the effectiveness of the management interventions for the effects of heat have unique challenges. The incidences of heat vary and it also has different impacts on the affected group of people. This is because of various factors that include the vulnerability of an individual and the level of acclimatization, which makes it difficult to evaluate varied populations in different locations in response to the heat incidences. If the study is carried out in the same population over a range of time, the heat events varies with time due to varying environmental conditions (Ritchie, 2006). Generally, the evaluations of the public health interventions are not well developed as compared to other parts of the development like the development of vaccines. This has been shown by the limited literature, which has also translated to less investment on policy making and development of other interventions programs, in contrast to the scale of the problem and the significance of looking for the effective interventions to the adverse health problem considering the climate change. Conclusions Although the limited research evaluation indicates a positive step of public health interventions, concerns remain about inclusion of all the vulnerable groups like the visitors and the poor people in the health intervention programs. More studies focused on these vulnerable groups are required so as to achieve the most effective way of health interventions to mitigate the problem. One of the ways of developing the interventions is to find out the perception on heat related risk by the people. There are challenges that are related to methods of investigating the effective programs for mitigating heat problems, however qualitative data collection from the surveys is incorporated in this research, as it is more comprehensive considering the current issue. It is thus important to continue to improve on this research work in this part. The final step in the work of the interventions is to evaluate public health policies for heat. The ideal way in dealing with such programs is to coordinate through both the national and the international programs to improve our knowledge on the effectiveness of the health interventions programs that are being applied currently especially during hot seasons. List of references Read More