Health of geography is a study that focuses on the ways through which human beings relate with the environment in which they live. The societies as well as the space it occupies are paramount aspects of health of geography. The health of human and well-being of the society are the indicators of the health of geography as these factors interrelate.
Mers-cov is a viral disease that is mostly prevalent in the Middle East. The disease is caused by a virus and affects the respiratory system of the human body. The disease is not old as it was recognized to affect human beings less than a decade ago. The illness is however spreading at a high rate and has eve reached the United States of America. The disease came to attention of the health departments in 2012 after its discovery in Middle East, specifically in Saudi Arabia. The clinical symptoms that are observed in patients who have contracted the disease include; coughs, fever and difficulty in breathing. MERS-CoV is spread through contaminated surfaces such as sheets and pillows or through inhalation of respiratory droplets from the patient (Abroug et al., 2014). The disease has increased the mortality rates in Saudi Arabia because it is fatal.
Mers-cov is a zoonotic disease which is transmitted from camels to humans. The virus that transmits the disease is called the coronavirus. The disease has symptoms that are related to fever and difficulty in breathing (Poletto et al., 2016). According to reports, 30% to 40% of patients suffering from Mers-cov have died. The most affected populations were however those who inhabit the Arabian Peninsula however, the first case of the disease were discovered at Jordan. The disease is highly associated to the people who travel around the Arabic countries. The disease is transmitted through close contact. The disease is transmitted through contact with camels and is heavily endemic in dromedary camel populations (Zumla & Hui, 2014). The people who cared for the camels for instance the herders and the long distance traders were the initial transmitters of the disease after contracting it ( E.C. PIRTLE and other , 1991). The disease is later transmitted to the people who take care of the patients due to direct or close contact with the patients. The disease is non-discriminatory in terms of the age of the patients. For instance, it can affect a child as young as one year and an elderly as old as ninety nine years.
There have been reported a number of deaths that amount up to 40%. The Mers-cov disease is hence fatal and easily spread within a geographical area. The relationship between the spatial patterns as well as the extent to which the disease is transmitted is of great importance and necessary in studying geographical health. Additionally, the epidemiology of Mers-cov requires quick response as it increases the mortality rate. There is a need to study the health geography of Saudi Arabia to identify the data concerning land cover and vegetation that will lead to curbing the prevalence of Mers-cov. The vegetation will help in studying the living conditions of the camels to reduce the transmission of the zoonotic epidemic disease within Saudi Arabia and across the borders. Identifying where the camels live will ease curbing the transmission of the disease that is becoming a monster.
My research efforts focus on identifying and quantifying spatial patterns in the distribution of MERS-CoV.
Using vegetation land cover and land scan data to detect the possibility of spread MERS-CoV. Which can help us to find where camels live?
Is MERS-CoV likely to continue into the future?
What is the relationship between time and space in disease mapping? Which tools are most effective measuring the relationship.
2.1 Geography of Saudi Arabia
audi Arabia is a country situated in the Middle East in Asia and is bordered by Yemen, Jordan, Sultanate of Oman, UAE, Kuwait, Qatar, Bahrain, and the Red Sea (Figure 1). Riyadh is the capital city of Saudi Arabia It is one of the key suppliers of crude oil and has one of the largest continuous sandy deserts in the world and the extension of the coastlines leads shipping of the oil during transportation within the country and exportation. The total land area is estimated to be 2.2 million km
S2, and the country is predominantly desert climate with extremely high temperatures (54°C) during the day and very cold nights (CIA, 2014). Much of the land is under nomadic pasture (56%) where farmers keep camels, goats, sheep and cattle.
Figure 1: Map of Saudi Arabia (Google Map)
The population of Saudi Arabia, as of January 2016, were estimated at 31.9 million people having increased by 2.31% from the previous year. It is a predominantly Muslim country, and there are more males than females with a life expectancy at birth standing at 73/76 years (http://worldpopulationreview.com/countries/saudi-arabia-population/).Although there is rapid growth among children aged 0-14 years, the country’s population is stabilizing (WHO, 2014). The total expenditure on health is 4.7 percent of the Gross Domestic Product. The main causes of mortality and the burden of disease are Malaria, Tuberculosis, and other non-communicable diseases (Almalki et al., 2011). Total fertility rate is 2.17 children per woman with a natural increase rate of 16.09 (CIA, 2014). Given the low death rates and high birth rates, the country is in the third stage of the demographic transition. However, the economic boom from oil is diminishing, which means that Saudi Arabia may experience a loss of income and increased childbirth.
Disease variance is dependent of the time of contact with disease and the nature of the disease causing agent. More importantly, the spatial factor of a population is a key interest in determination of the area which the disease spreads. The spatial structures are dependent on the temporal trends of a disease. Disease mapping in epidemiology encompasses the aspect of patterns which are spatial-temporal in nature. The health interventions are also offered where possible so as to identify the areas that are highly vulnerable. The spatial-temporal aspect is also important as it is through it that the areas and populations that are highly susceptible are identified. The elevation of the MERS-CoV is keystone in the study as it enables the researcher to compare the most affected population to the less affected ones and the conclusion can be drawn from the finding.
MERS-CoV disease prevalence has almost hit 2000 patients from the time the infection was identified in the year 2012. Who and the relevant stakeholder are continually doing the necessary surveillance so as to identify any pattern that is different from the already identified ones. The World Health Organization is continually insisting on the necessary measures to treat and control the spread of MERS-CoV. Since September in the year 2012, there have been cases of MERS-VoC and almost six hundred and eighty four patients have lost their lives since the discovery of the zoonotic respiratory disease in human. The spread of the disease is continuing and WHO reports suggest that about twenty seven nations have been affected by the infection. According to Reusken et al. (2015) MERS-CoV has symptoms flu-like nasal mucous secretions, clogged sinuses, coughing and sneezing, as well as inflammation in the upper respiratory channel. The disease is therefore infectious and necessary measures should be employed to control the prevalence (Reeves et al., 2015).
MATERIALS AND METHODS
Retrospective study will be involved whereby, 900 patients’ secondary data from the ministry of health in Saudi Arabia was collected since 2015-2016. The data was aggregated from various regions in Saudi Arabia to prevent biasness. The population was studies using the table that has thirteen units.
Land scanning data about the population was used so as to focus on different clusters of population.
Vegetation data was used to study the behavior of the camels which are assumed to be the initial hosts of the virus. The data that was collected from the ministry of health will be related to 1km distance between patients both in 2015 and 2016. Most images were from day 6 and day 26 for each month. We use this is data to see if there is relationship between vegetation and increasing incidence of the MERS-CoV in the same area.
2.3 Conceptual Framework
The study has dependent, independent and confounding factors. The independent factor is the population while the independent factors include gender, citizenship and health status. The confounding factor is the economic activity which could lead to contact with the infected camels. The Triangle of Human Ecology of a disease is a very important framework for an analysis. It is precisely the interplay between humans and their environment, which can help to expand our study. On the other hand, it also considers cultural and socioeconomic conditions in a region. the focus to population and their activity. Figure X is the Triangle of Human Ecology for MERS-CoV in Saudi Arabia.
From 1 to up 65
Meal and Female
Drink Camels milk
Figure 5: The Triangle of Human Ecology.
The geographic variation of MERS-CoV is attributed to behavior, habitats and population characteristics among the nomadic population and abattoirs. Saudi Arabian farmers keep camels and their social organization is hinged on camel and sheep for economic, social and religious reasons (Alvarez et al., 2015). With zoonotic origin from dromedary camels, it implies that camel farmers, barn workers and slaughterers of these dromedaries come into contact with camels at various stages and get infected. MERS-CoV is prevalent in camel milk and meat which is consumed by majority of the population (Azhar et al., 2014). Being nomadic animals suitable for desert habitats, a large section Saudi population breeds camels of which its uncontrolled movement across the desert leads to exposure of a large section of the population. Alraddadi et al. (2016) argued that risk factors of MERS-CoV were incompletely misunderstood and explanatory factors like environmental exposures and medical conditions may explain the disease. The authors affirmed that medical conditions such as smoking, heart disease and diabetes mellitus as well as direct exposure to dromedary camels 2 weeks prior to illness were independently associated with MERS-CoV illness. Consumption of raw camel milk and use of camel urine as traditional medicine, as has been the Arabian culture, may be the source of infection for possible zoonotic transmission which its incubation period remains unknown.
The hallmark of MERS-CoV is disease transmission in Europe and the Middle East which caused an upsurge of cases in UAE (Al Ain) and Saudi Arabia (Jeddah) in the spring 2014. In healthcare settings, outbreaks involved hospitalized patients, family members and healthcare workers (WHO, 2014). Secondary cases identified are mildly symptomatic and asymptomatic cases. Transmission in hospitals has been documented in on medical wards, intensive care units and hemodialysis units (Cotton et al., 2013). However, strict and systematic implementation of control measures and infection prevention has limited onward transmission to hospitalized patients and healthcare workers (Assiri et al., 2013). People with high exposure and risk to MERS-CoV infection are: people with exposure to camels, recent travelers from the Arabian Peninsula, healthcare workers not observing recommended infection control precautions, close contacts of a confirmed case of MERS and close contacts of ill travelers from the Arabian Peninsula.
Reusken et al. (2015) took some serum samples from persons with and without dromedary contact in Qatar were tested for MERS-CoV virus by determining the presence of neutralizing antibodies. Using two-level based cohorts of non-animal contact and animal contact persons, study found that MERS-CoV neutralizing antibodies were detected in persons with daily contact with dromedaries and not those without contact. This shows that habitats with continuous flow of dromedaries from different immune statuses and places of origin expose dromedary handlers to MERS-CoV infection. Similarly, Already et al. (2016) conducted an experimental study of laboratory-confirmed MERS-CoV cases. The authors made observations that were aggregated according to case-patients, level of exposure and the control group. The study found that MERS-CoV illness was directly associated with contact with dromedaries 2 weeks before the onset of illness. The study did not find positive association of MERS-CoV illness with zoonotic origin from exposure to sheep, horses, goats and bats. In another study, Reeves et al. (2015) investigated MERS-CoV infections and the interplay between camels and humans in being disease victims and reservoirs for further transmission in Jordan, Saudi Arabia, Oman and the UAE. The data aggregated as persons with existing co-morbidities, healthcare workers, and exposed persons to domestic animals (camels). Although exposure patterns were rather unreliable and uneven, the study found that MERS-CoV case-occurrence was more concentrated in Saudi Arabia and circumscribed portions of the Arabian Peninsula. Just like Alradaddi et al. (2016b), Reeves et al. (2015) did not find any evidence of bat or sheep transmissions of the virus across human populations. Moreover, Assiri et al. (2013a) investigated 47 cases of patients and healthcare workers for MERS-CoV infections reported from 10 regions in Saudi Arabia. The study found that the case-fatality rates of MERS-CoV rose with increasing age and that transmission in two health-care facilities were a result of readmissions and transfer of patients. All the above studies agreed that there was limited evidence of MERS-CoV transmission in sheep, bats and other domestic animals. A general understanding of MERS-CoV was made to the extent that it is associated with milk and meat of dromedary camels likely to affect middle aged men, especially those with existing comorbidities such as diabetes, respiratory infections and chronic renal diseases.
2.4 Healthcare system in Saudi Arabia
The Saudi Arabian Ministry of Health is tasked with the provision of preventive, curative, and rehabilitative health care to all citizens. With a broad base of 220 general and specialist hospitals, Saudi Arabia has adopted a referral system that has advanced technology specialist curative services to care for all members of society at all levels (2). Primary care is provided by the National Health Service (NHS), while secondary and tertiary care are financed and delivered by the Saudi Arabian National Guard (SANG), the Ministry of Interior (MOI), and the Ministry of Defense and Aviation (MODA). All non-Saudi Arabian nationals are required to have health insurance coverage (Cooperative Health Insurance Council, 2013). Although Saudi Arabian government has opened nursing schools and medical studies to substitute expatriate workforce, Ajlan et al. (2014) observes that the resources are thinly spread across health care facilities, which decrease future expansion. New technology is highly priced and puts considerable cost pressure on the Saudi Arabian government, which provides free-of-charge public health services to its citizens. According to Memish et al. (2013), the Ministry of Health allocation of 35 million Riyals per year for the prevention and treatment of MERS-CoV has been exceeded. In partnership with Center for Disease Control (CDC) and World Health Organization (WHO), the Saudi Arabian government has created public awareness regarding issues such as basic sanitation, immunization of children, and the prevention and control of MERS-CoV.
The Ministry of Health has created quarantine centers have been constructed along the national boundaries to conduct health check-ups and vaccinations against MERS-CoV. With most hospitals located in Riyadh and Jeddah, they have been able to conduct convalescent plasma therapy for MERS-CoV and routinely advise people on proper sanitation (Balkhy, and other, 2016) fortunately, medical services in Saudi Arabia are accessible by 99 percent of the population and all patients suffering from MERS-CoV illness are assured of diagnosis and treatment. Hospitals in Saudi Arabia have capabilities such as ICU, laboratory, and research into MERS-CoV infections. Common ICU treatment therapies include plasmapheresis, hemodialysis, and extra-corporal membrane oxygenation (Hemida et al., 2014). Such hospitals conduct laboratory testing and screening of blood-borne viruses after testing blood cultures, urine bacterial antigen testing, and pneumonia. In promoting local clinical research initiatives, the Saudi Arabian healthcare system conducts retrospective observational studies, trials and prospective studies, and randomized clinical trials (Al-Tawfiq & Memish, 2015). Healthcare workers are required to wear gowns, surgical masks, gloves and observe hand hygiene to support infection control measures (Zumla & Hui, 2014). Some of the known treatment methods for MERS-CoV are; oxygen therapy, pain relievers, fluids and rest. Sterilization and epidemiological surveillance are common prevention and control methods for an outbreak of MERS-CoV.
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