Heat Stress Morbidity and Mortality Mitigation at the Hajj - Research Proposal Example

Heat stress morbidity and mortality mitigation at the Hajj Introduction The Hajj which happens at Mecca in Saudi Arabia is a mandatory, annual Muslim Pilgrimage, and is one of the five pillars of Islam. The Hajj is the largest annual gathering of people in the world (over 2.5 million pilgrims) (Gardouni, 2012), and thus accounts for a large number of mortalities in the region. Among the leading causes of mortality include trauma, death due to chronic illnesses due to the extreme conditions, and deaths resulting from heat stress. Majority of the deaths are heat-related as the temperatures in the Summer Hajj often exceed 100⁰F while the pilgrims exist under less-than-comfortable conditions as they are often away from home and without their usual lifestyle (Travel.state.gov, 2015). The extreme heat is further compounded by congestion of people which facilitates the spread of contagious diseases thereby increasing the group at risk for heat stress (Assiri et al., 2013). The issue of heat stress seems to not be receiving the attention it is due, and thus this study seeks to examine the problem and offer solutions for the future pilgrimages. Aim: The aim of this study is to contribute to a reduction in mortality and morbidity resulting from heat stress during the Hajj by identifying from literature the range of risk factors and remedial strategies. Research Question What is the current state of preparedness of the Hajj with respect to mitigating heat stress morbidities and mortalities? Research objectives 1. To generate the current statistics regarding heat-related mortalities in comparison to other mortality causes at the Hajj. 2. To identify the risk factors of heat stress. 3. To determine what policies are already in place mitigating heat stress and related mortalities. 4. To describe the state of preparedness of the Hajj with regard to heat stress morbidity and mortality prevention. Justification Heat stress being the number one killer of pilgrims as the Hajj calls for an urgent examination of the problem as the pilgrimage is annual and the problem is only likely to worsen with the continuing climate changes. As the conditions necessary for heat illness are present during this event, it is necessary that the problem is explored and appropriately tackled. This study should serve as a tool for the examination of the strategies laid, policies created, and actions taken towards ensuring that heat stress is kept at a minimum by the Saudi Arabian public health system. By doing so, it will then seek to find ways in which the gaps left may be filled by proposing further situations once these holes have been identified. The study aims at characterizing heat stress, its risk factors, its symptoms, and proposing immediate, short-term, long-term, and prevention solutions. Literature Review Global Warming and Climate Change With the drastic change in human habits and activities over the last 37 years according to the Union of scientists (2015), a plethora of consequences has come—among them, climate change. The factors that have led to global warming have caused dramatic changes in climate over the world with a uniform increase in environmental temperatures. This has had significant effects on our communities and their health through a number of ways: the rise in sea levels, increasing wildfire numbers, and fatal heat waves (Union of Concerned Scientists, 2015). In the United States, the twelve warmest years ever recorded have been since 1998, the hottest of which was 2012. On a global scale, the mean surface temperature has risen by over one degree Fahrenheit in the period between the late 1800s and today. This rise in temperature is attributed to human activities and events such as deforestation, use of aerosol sprays, and fossil fuels for energy. Through these activities, our atmospheric carbon dioxide levels have skyrocketed and created the green house effect by trapping heat (Union of Concerned Scientists, 2015). Extreme Heat and Heat Stress Heat stress, also known as heat illness, is defined as a spectrum of illnesses which relate to the body’s lack of capacity to cope with heat. These range from milder forms such as heat rash and heat edema, to heat cramps, tetany, syncope, exhaustion, stroke, and even death at the extreme. A heat stroke is marked by a temperature of above 41.1⁰C (106⁰F) that causes neurological dysfunction. A heat related death is that which results from exposure to extreme atmospheric heat. Those most at risk for heat-related deaths are young children, the elderly (over 65), the poor, those with chronic illnesses (especially cardiovascular), people with limited prior exposure to extreme heat, and those who do strenuous outdoor activities among others (Buffington & McDonald, 2006). Saudi Arabia mostly experiences a desert type of climate with the province of Asir on the Western coast being the exception that makes the rule. Summer temperatures average at 45⁰C but can be as high as 54⁰C. Though there are not many reliable statistics on heat stress at the Hajj in internet resources, hospitals continue to receive patients experiencing some form of heat illness during this period. Owing to the ignorance of pilgrims regarding sun exposure, preventable heat illness is experienced, and heat-related death is among the number (Noweir, Bafail & Jomoah, 2008). In the “Down Under”, the gravity of the scourge is most seriously felt. Australian Broadcasting Corporation (2014) reports that “heatwaves have killed more Australians than all other natural hazards combined”. Heat stress-related deaths are the leading causes of deaths, they account for more deaths than the combined number resulting from bushfires, floods, storms, and cyclones. Moreover, research says, this number is likely to climb even more in years to come with the continuing change in climate. As Lucinda Coates, a risk scientist from Macquarie University alongside her colleagues found, extreme heat events have been the cause of most natural hazard deaths since the year 1900. The lower estimate of the number of fatalities is at 4,555, most of which occur in the summer, the most lethal day being the 27th of January. The peak year for deaths due to heat stress was 1896—the highest ever recorded number of mortalities and per capita rate was seen that year, and more recently in 2009 on “black Saturday” year (Byard, 2013). Study Design The study will employ a correlational study design. This is one which explores the relationship between variables thereby determining whether an increase in the one corresponds with an increase in the other or vice versa. A subset of correlational study design—that is, a longitudinal study will be used. A longitudinal study performs observational research over a long period of time. This design will be best suited for the study to enable the quantification of the problem under investigation, analysis of the pattern of change , and allow for the predication of future patterns thus creating a platform for the formation of policies and strategies for mitigation of heat-related deaths for posterity (Creswell, 2007). Research Methodology Systematic Review This study will employ a systematic review method to research. This method is useful in exploring and explaining phenomena. In the context of this study, explorative research is important for retrieving statistical information relating to the issue at hand, like the documented numbers of heat-related deaths compared to other causes of mortality at the Hajj. It will also be helpful in answering other questions such as what policies have already been put in place for the purposes of preventing such mortalities. From this information, it will be possible to assess the state of preparedness of the Hajj in handling heat stress and related events. On the other hand, the exploratory qualities of a systematic review will be useful in answering the question of what factors put people at risk for heat stress—why other people are more readily afflicted by heat illness than others (Creswell, 2007). Systematic review is appropriate for this study as it is dynamic, allowing the researcher room to adapt as one goes on their quest to answer the research questions. Because systematic review is a journey to finding out what information already about something (in order to define it more clearly), it must be a dynamic process allowing for the direction of the research to be changed as more information becomes available to the researcher (also known as the moderator) (Jones, 2004). There are no strict lines within which the results must fit; it is not either one thing or the other, thus the research is likely to yield the truest conclusion about the issue under examination. The theoretical framework used here will be a modified version of the symbolic interaction framework. This will be most appropriate because it will enable the researcher to observe (collect and analyze data), draw conclusions, and then put forth recommendations. Given the financial constraints of the study, this method will be the best suited for this paper. Data collection Data for this study will be collected through the examination of existing literature to analyze what these sources have to say regarding the research questions. Data will be collected mostly form internet sources using the search strategy shown in detail below. Sampling frame Target articles Those containing Hajj heat stress statistics Those detailing the policies put in place to prevent heat-related morbidities and mortalities Those entailing the state of preparedness of the Saudi public health sector with regard to heat stress mitigation Those concerned with heat stress in general; risk factors, how to recognize and treat, and warning systems around the issue. Sampling frame outcomes: To serve as a guide in the literature review To collect as much relevant data as possible necessary for answering the research questions To establish the gap in research concerning the heat stress issue at the hajj, thus guide intervention strategies. Search Strategy The terms “Mecca”, “Hajj”, “heat stress”, “preparedness”, and “heat-related deaths” were used in a search through various scholarly databases such as MEDLINE, PubMed, and other sources. On recruitment of information, articles were chosen most dating between 2000 and 2015, majority of which were less than ten years old since their publication. This formed the base of data that was examined, and will thereby serve as the study’s “participants” (study sample). The sampling process will therefore be systematic. The setting of the study was online for the most part as the articles used were retrieved therein. 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 at the Hajj I – Intervention will be developing suggestions which can be implemented in the process of planning and policy development for Hajj in the 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 is to contribute to the reduction of the effects of heat stress at Hajj in the future Overview of Search Process (18th-22nd April) Websites (32) Single studies (8) syntheses (1) synopses of single MEDLINE studies (13) syntheses (6) PubMed Total identified articles (26) Removal of duplicates Duplicates (3) Primary relevance assessment Non-relevant (based on title and abstract screening) (4) Potentially relevant articles (19) Relevance assessment of full document versions Non-relevant articles (2) Does not center on heat stress (2) Total relevant articles (17) Quality assessment of relevant articles Weak articles (2) Strong articles (13) Moderate articles (2) Table of Resources Study country Study Design Research question Sample Measures Control variables Results Assiri et al. (2013). Saudi Arabia Retrospective cohort What are self management strategies for prevention of corona disease? Public health care workers Independent variables: health management practices Dependent variables: number of sick people Rate of infection and spread Australian Braodcasting Cooporation,. (2014). Australia Qualitative Research Is heat stress Australia’s leading cause of death? Existing reports on public health Independent variable: Total number of deaths Dependent variable: Number of deaths due to heat stress Patients with Chronic illnesses, age, hyperthermia, the poor Reduction in rates of heat stress Buffington, E., & McDonald, S. (2006). USA Qualitative What is the state of heat stress in Colorado? Patients with heat stress and victims of heat related deaths Independent variable: Total number of deaths Dependent variable: Number of deaths due to heat stress Patients with Chronic illnesses, age, hyperthermia, the poor Reduction of heat stress in Colorado during the hot seasons Byard, R. (2013) Non specific Retrospective cohort How does heat stress lead to death as observed post mortem? Corpses of heat related deaths Independent variable: corpses of heat stress victims Dependent variable: corpses of other causes of death patients without heat stress effects Reduction in the morbidity and mortalities resulting from heat stress Gardouni, A. (2012) Saudi Arabia Qualitative Research What is the state of preparedness of Mecca in terms of public health concerns? Government of Saudi Arabia Independent Variable: Number health professionals Dependent variable: Number of intervention strategies Those without heat stress symptoms Decrease the proportion of people affected by heat stress during Hajj Heat-Related Deaths --- United States, 1999--2003. (2006) USA Qualitative What are the proportions of heat-related deaths in the USA between 1999-2003? Hospital reports regarding heat related events Independent variable: Total number of deaths Dependent variable: Number of deaths due to heat stress Patients with Chronic illnesses, age, hyperthermia, the poor who died due to heat stress Decrease the proportion of people affected by heat stress in the USA McMichael, A. (1993). Saudi Arabia Mixed Research What is the effect overpopulation and change in human activities on the planet? Pilgrims at the Hajj Independent variable: change in the planet Dependent variable: change in human activities Past climate patterns Reduce global warming trend and change climate patterns National Institute of Public Health Surveillance,. (2003). France Mixed cohort Research What are plans in place to mitigate future heat related deaths? Records of heat events in France and its environs Independent variable: number of intervention strategies Dependent variable: strategies targeting heat stress State of heat outside the heat waves Decrease the proportion of people affected by heat stress in France and its environs during heat waves Noweir, M., Bafail, A., & Jomoah, I. (2008) Saudi Arabia Qualitative Research What is the effect of heat exposure during Hajj? Pilgrims at the Hajj Independent variable: number of those exposed to heat Dependent variable: Number of hat stress patients Those unaffected by heat stress Reduce the number of heat stress affected patients Travel.state.gov,. (2015). Saudi Arabia Mixed Cohort research How does one prepare oneself for heat stress? Hajj Pilgrims Independent variable: Number of Hajj pilgrims Dependent variable: Number of those prepared for heat stress People who are exposed to heat but unaffected by heat stress Decrease the proportion of people affected by heat stress during Hajj Union of Concerned Scientists,. (2015 None specific Mixed Cohort research What is the current and future state of the planet with regard to climate change? The earth Independent variable: change in the planet Dependent variable: change in human activities Previous recorded weather patterns Reduce global warming trend and change climate patterns WHO,. (2004). None specific Qualitative What are the risk factors for heat stress? The earth Independent variable: number of those exposed to heat Dependent variable: Number of hat stress patients Those exposed to extreme heat but not affected by heat stress Reduce heat stress in those at risk during Hajj References Assiri, A., McGeer, A., Perl, T., Price, C., Al Rabeeah, A., & Cummings, D. et al. (2013). Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus. New England Journal Of Medicine, 369(5), 407-416. doi:10.1056/nejmoa1306742 Australian Braodcasting Cooporation,. (2014). Heat is Australia's number one natural killer. Retrieved 20 April 2015, from http://www.abc.net.au/environment/articles/2014/09/04/4081144.htm Buffington, E., & McDonald, S. (2006). Heat stress. Denver, Colo.: Colorado Environmental Pesticide Education Program. Byard, R. (2013). Heat-related deaths. Forensic Sci Med Pathol, 9(4), 469-470. doi:10.1007/s12024-013-9413-y Creswell, J., & Creswell, J. (2007). Qualitative inquiry & research design. Thousand Oaks: Sage Publications. Gardouni, A. (2012). The Mecca pilgrimage and its medical preparedness (1st ed.). Athens: M.Sc. in International Medicine – Health Crisis Management Review Article. Retrieved from http://crisis.med.uoa.gr/elibrary/4.pdf Heat-Related Deaths --- United States, 1999--2003. (2006). Morbidity And Mortality Weekly Report, 55(29), 796-798. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5529a2.htm Jones, M. (2004). Application of systematic review methods to qualitative research: practical issues. J Adv Nurs, 48(3), 271-278. doi:10.1111/j.1365-2648.2004.03196.x McMichael, A. (1993). Planetary overload. Cambridge [England]: Cambridge University Press. National Institute of Public Health Surveillance,. (2003). Impact sanitaire de la vague de chaleur en Fr ance survenue en août 2003; Rapport d’étape – 29 août 2003, 2003). Saint Maurice, France: National Institute of Public Health Surveillance. Retrieved from http://www.invs.sante.fr/publications/2003/chaleur_aout_2003 Noweir, M., Bafail, A., & Jomoah, I. (2008). Study of heat exposure during Hajj (pilgrimage). Environmental Monitoring And Assessment, 147(1-3), 279-295. doi:10.1007/s10661-007-0120-6 Travel.state.gov,. (2015). Hajj Fact Sheet. Retrieved 20 April 2015, from http://travel.state.gov/content/passports/english/go/Hajj.html Union of Concerned Scientists,. (2015). Global Warming. Retrieved 19 April 2015, from http://www.ucsusa.org/global_warming#.VTaiiY66SSo WHO,. (2004). Heat-waves: risks and responses. Colombo. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/96965/E82629.pdf Read More