Abstract
BackgroundThe pattern of diseases causing sudden unexpected natural deaths is a function of the prevalent disease pattern in the general population. This pattern appears to be changing in Nigeria in response to changing demographics and lifestyle.MethodsThis was a descriptive retrospective autopsy-based review of cases of sudden unexpected natural deaths seen at the Obafemi Awolowo University Teaching Hospitals Complex in Ile-Ife, Nigeria (OAUTHC) over a 10-year period. Analysis was done for differences in proportion using Chi square (p is significant at <0.05) by SPSS version 15.ResultsSudden unexpected natural deaths accounted for 13.4% of all medico-legal autopsies. The male to female ratio was 2.1:1, and the mean age was 43.1 years ± 19.5 SD. Cardiovascular (28.3%), respiratory (18.2%), and central nervous system (12.6%) disorders were the major groups of causes. About 64.4% of cardiovascular deaths were due to hypertensive heart disease. Bacterial pneumonia, intracerebral haemorrhage, and breast carcinoma accounted for 34.4%, 60.0%, and 52.6% of respiratory, central nervous system, and cancer-related deaths respectively. Infectious causes predominated in all age groups below 40 years and above 70 years while hypertensive disorders predominated between 40 and 70 years. Only 16.9% of cases occurred while the patient was admitted to the hospital.ConclusionCardiovascular, respiratory, central nervous system, and cancer-related causes were the major causes of sudden unexpected natural deaths in our series. Hypertension-related disorders constituted a large proportion of cases especially in people over 40 years, whereas infectious diseases were more common below this age. The majority of deaths occurred outside the hospital setting. It is imperative that appropriate public health strategies be developed to address these issues.
Highlights
The pattern of diseases causing sudden unexpected natural deaths is a function of the prevalent disease pattern in the general population
The incidence of sudden unexpected natural deaths is known to vary in different parts of the world and may reflect the respective levels of development of the individual country’s death registration and medico-legal autopsy systems [3,5,6,7,8,9,10]
The frequency and pattern of sudden unexpected natural deaths are known to reflect the disease pattern prevalent in any particular geographic location, and vary in different parts of the world. It is well established in many studies that the cardiovascular, respiratory, and central nervous systems constitute the most common organ systems contributing to sudden unexpected natural deaths [1,6,14,15]
Summary
The pattern of diseases causing sudden unexpected natural deaths is a function of the prevalent disease pattern in the general population This pattern appears to be changing in Nigeria in response to changing demographics and lifestyle. There are controversies over the definition of the time frame for sudden unexpected death, the World Health Organisation (WHO) defines it as “death within 24 hours from the onset of symptoms” [1]. Mason, defines it as “unexpected death following so rapidly from the onset of symptoms that the cause of death could not be certified with confidence by a medical practitioner familiar with the patient” [2]. For the Nigerian population this pattern appears to be changing, especially in response to changing demographic patterns and lifestyle [11,12]
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