Pattern of medical diseases and determinants of prognosis of hospitalization during 2005 muslim pilgrimage [hajj] in a tertiary care hospital. A prospective cohort study

ABSTRACT

To document the pattern of medical diseases necessitating admission in a tertiary care hospital during Muslim pilgrimage [Hajj]. To assess the risk factors associated with mortality during hospitalization. The study was conducted at Al Noor Specialist Hospital, a 550-bed tertiary care teaching hospital, in Makkah, KSA. The participants included all Hajj patients admitted in the Department of Medicine in a 5-week period [January 3 to February 6, 2005] during the 2005 [1425 AH] Hajj. Information about demographics; past medical history; pre-Hajj functional status; presence of language barrier and translator availability; diagnosis for admission and complications during hospitalization including mortality was obtained prospectively using a standardized form. Six hundred and eighty-nine patients, belonging to 49 countries, with mean age of 62 years and malefemale ratio of 1.81 were admitted. Two hundred-twenty [31.9%] had diabetes mellitus, 256 [37.2%] had hypertension, 219 [31.8%] had cardiac disease, and 103 [14.9%] patients had chronic lung disease. Of the 449 [65.2%] patients assessed, 284 [63.2%] patients had language barrier, and translator was not available for 152 [53.5%] of them. Pre-Hajj functional status assessment of 240 patients showed that 20 [8.3%] required assistance in performing activities of daily living [ADL], and 40 [16.7%] could not walk for half kilometer without difficulty. Common causes of morbidity were 235 [34.1%] cardiovascular, 137 [19.9%] infectious and 85 [12.3%] neurological diseases. One hundered and fourteen [16.5%] patients died, with the common causes being pneumonia [28 patients], acute coronary syndrome [21], and stroke [20]. The risk factors associated with higher mortality were older age [65 +/- 1 versus 61 +/- 0.6 years, p=0.008], prior history of chronic lung disease [crude odds ratio, 1.81, p=0.034], dependence in any ADLs [4.90, p=0.025], inability to ambulate for half kilometer without difficulty [4.17, p=0.017] and non-availability of translator for patients with language barrier [5.51, p<0.0001]. Most patients were elderly with high prevalence of chronic medical disorders. Non-infectious diseases accounted for most morbidity and mortality. Pre-Hajj functional assessment should be carried out to identify patients at high risk of mortality. Provision of translator services for patients with language barrier is essential to improve future outcomes: