title: 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: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  Six hundred and eighty-nine patients, belonging to 49 countries, with mean age of 62 years and male:female ratio of 1.8:1 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia. nakhan99@yahoo.com
authors.forename: Nasim A
authors.initials: NA
authors.lastname: Khan
authors.forename: Adam M
authors.initials: AM
authors.lastname: Ishag
authors.forename: Maha S
authors.initials: MS
authors.lastname: Ahmad
authors.forename: Fifi M
authors.initials: FM
authors.lastname: El-Sayed
authors.forename: Zakeyah A
authors.initials: ZA
authors.lastname: Bachal
authors.forename: Tahir G
authors.initials: TG
authors.lastname: Abbas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003144:Communication Barriers; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007514:Islam; D008171:Lung Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D014195:Travel