Suffocation Deaths Research Articles

The apparent burden of unexplained sudden infant deaths in Lusaka, Zambia: Findings from analysis of verbal autopsies

Background: The contribution of sudden unexpected infant death (SUID) has received little attention in global health. The objective of this study was to estimate the burden of SUID in Lusaka, Zambia. Methods: Verbal autopsies were conducted on infants who died in Lusaka, between 2017 and 2020. From these, we performed a qualitative analysis of the free text narratives of the final series of events leading to each infant’s death and classified these as symptomatic deaths or SUID. Any narrative that described an infant who was otherwise healthy with no antecedent illness prior to death and found dead in bed after a sleep episode was classified as SUID. We used logistic regression to test for statistical differences between asymptomatic deaths and SUIDs on key infant, maternal and other risk factors of SUIDs. Results: Eight hundred and nine verbal autopsies were conducted with families of decedent infants younger than six months of age. A total of 92.6% (749/809) had presented with symptoms prior to death, whereas 7.4% (60/809) died without preceding symptoms or obvious cause of death. Of these, 16/60 were compatible with accidental suffocation deaths, and 54/60 appeared to be sudden infant death syndrome. SUID deaths were concentrated in infants younger than two months of age with peak age of one to two months. Age at death was the only significant factor in multivariate analysis. Infants aged between one and two months had 2.84 increased odds of suspected SUIDs compared to infants in the first month of life (aOR = 2.84, 95% CI: 1.31, 6.16). Conclusions: Our findings suggest SUID could be accounting for a significant proportion of infant deaths in Zambia, but this cause of infant mortality is going unrecognized. Public health interventions in Zambia, and Africa more broadly, are likely overlooking SUIDs as an important cause of infant mortality.

Risk Factors for Suffocation and Unexplained Causes of Infant Deaths.

Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.

Prevalence of prescription and illicit drugs in suicides by non-poisoning means in the National Violent Death Reporting System 2003-2017

ABSTRACT Background: Prescription and illicit drugs are important social environmental variables in many suicides regardless of their role as an immediate cause of death. Objectives:To investigate the presence of prescription and illicit drugs, either through mention in the death record or toxicology reports, among suicides attributed to nonpoisonous causes to identify patterns of risk. Methods:Using the 2003–2017 National Violent Death Reporting System (NVDRS), we examined the presence of prescription and illicit drugs among 143,175 suicides (119,563 males 23,612 females) due to firearms and suffocation/hanging. The presence of drugs (opioids, stimulants, benzodiazepines, muscle relaxants, and cannabis) was determined from toxicology reports and text searches of coroner/medical examiner and law enforcement summaries. We fit multivariable logistic regression models to estimate associations between drug class and suicide method adjusting for decedent characteristics. Results: Overall prescription and illicit drugs were present in 22% of firearm deaths and 28% of suffocation deaths. Among victims with toxicology reports, over 20% tested positive for benzodiazepines. Benzodiazepines were mentioned in 4% of firearm and 5% of suffocation suicides without toxicology testing. Stimulants were more likely to occur in suffocation than firearm deaths among victims with toxicology testing (aOR = 1.44, 95% CI: 1.33–1.56) and without toxicology testing (aOR = 1.61, 95% CI: 1.31–1.98). Conclusions:Benzodiazepines were most frequently identified in both toxicology reports and narratives of suicides by firearms or suffocation. Better distinction of the presence of prescription and illicit drugs in the environment versus apparent ingestion among non-poisoning suicides are needed to inform prevention approaches.

Deaths due to suffocation in an oxygen deprived environment onboard a marine vessel – A case report

Suffocation deaths may be due to mechanical obstruction of the airways such as smothering and choking, restriction of respiration from traumatic and positional asphyxia, or from a lack of environmental oxygen. The latter may be due to entrapment in a nearly or completely air-tight container, or from consumption or replacement of the environmental oxygen by other means. Enclosed spaces onboard marine vessels are potential workplace hazards due to consumption of oxygen from rusting of the walls. Autopsy findings are typically non-specific.

Asphyxiation, Suffocation and neck presssure deaths

Asphyxiation, Suffocation and neck presssure deaths

Social and environmental risk factors for unintentional suffocation among infants in China: a descriptive analysis

BackgroundThis retrospective study aimed to determine the epidemiological features of deaths caused by unintentional suffocation among infants in China.MethodsThe data used in this study were obtained from China’s Under 5 Child Mortality Surveillance System (U5CMSS) from October 1, 2015, to September 30, 2016. A total of 377 children under 1 year of age who died from unintentional suffocation were included in the survey. Primary caregivers were interviewed individually using the Unintentional Suffocation Mortality among Children under 5 Questionnaire. EpiData was used to establish the database, and the results were analysed using SPSS 22.0.ResultsMost (85.9%) unintentional infant suffocations occurred in rural areas, and 67.5% occurred in infants 0 to 3 months old. Among the primary caregivers of the infants, most (82.7%) had a junior middle school education or below, and 83.1% of them lacked unintentional suffocation first aid skills. Of the 377 unintentional suffocated-infant deaths, the causes of death were accidental suffocation and strangulation in bed (ASSB) (193, 51.2%), inhalation suffocation (154, 40.8%), other unintentional suffocation (6, 1.6%), and unknown (24, 6.4%). Among the infant deaths due to ASSB, overlaying (88.6%) was the most frequently reported circumstance. A total of 93.8% of cases reported occurred during co-sleeping/bed sharing with parents, and in 72.8% of the cases, the infants were covered with the same quilt as their parents. In our study, most inhalation suffocation deaths (88.3%) involved liquid food (such as breast milk and formula milk). A total of 80.5% of infant deaths reportedly occurred after eating; in 28.2% of those cases, the infants were held upright and patted by their caregivers, and 57.2% of them were laid down to sleep immediately after eating.ConclusionsTo reduce the occurrence of unintentional suffocation, local government should strengthen knowledge and awareness of unintentional suffocation prevention and safety among parents and caregivers. Additionally, health care providers should educate parents and caregivers about safety issues of unintentional suffocation, and relevant policies should be introduced to provide environments and activities that reduce the risk of suffocation, such as promoting the Safe to Sleep Campaign. It is important to enhance the focus on infant unintentional suffocation as a health issue.

Explaining Sudden Unexpected Infant Deaths, 2011-2017.

Sudden unexpected infant death (SUID) represents a broad group of explained and unexplained infant deaths (<1 year old). Explaining why SUID occurs is critical to understanding etiology and prevention. Death certificate data cannot differentiate explained from unexplained SUID cases nor describe the surrounding circumstances. We report SUID rates by explained and unexplained categories and describe demographics and history of recent injury or illness using the Centers for Disease Control and Prevention SUID Case Registry. The registry is a population-based surveillance system built on Child Death Review programs. Data are derived from multiple sources, including death certificates, scene investigations, and autopsy reports. Cases included SUIDs reported by states or jurisdictions participating in the registry during 2011-2017. Cases were classified into explained and unexplained categories by using the registry's classification system. Frequencies, percentages, and mortality rates per 100 000 live births were calculated. Of the 4929 SUID cases, 82% were categorized as unexplained. Among all cases, 73% had complete case information. Most SUIDs (72%) occurred in an unsafe sleep environment. The SUID mortality rate was 97.3 per 100 000 live births. Among explained and possible suffocation deaths, ∼75% resulted from airway obstruction attributed to soft bedding. Unsafe sleep factors were common in explained and unexplained SUID cases, but deaths could only be classified as explained suffocation for ∼20% of cases. Further analysis of unexplained deaths, including continued improvements to death scene investigation and documentation, may generate hypotheses for physiologic and genetic research, advance our understanding of gaps in SUID investigation, and enhance our understanding of infants at highest risk.

Trend of unintentional suffocation death for infants under 1 year of age from 2009 to 2018 in Hunan, China: a cross-sectional study

ObjectiveFew studies have addressed the unintentional suffocation of infants in China. This study is to assess the mortality rate of unintentional suffocation among infants and the differences across age groups,...

Healthy China 2030: how to control the rising trend of unintentional suffocation death in children under five years old

BackgroundTo investigate the occurrence frequency, changing trends, and epidemiological distribution of unintentional suffocation in children under 5 years old.MethodsThe data were collected from the Maternal and Child Health Surveillance system from 2009 to 2018. The cause of death was classified by ICD-10. Data on unintentional suffocation death were calculated according to the characteristics of the population, time, space, cause of death and medical treatment, and constituent ratio were calculated.ResultsThe mortality rate of children under 5 years old showed a downward trend, but the mortality of unintentional suffocation initially decreased and then increased. The death rate of unintentional suffocation in children less than 1-year-old was much higher than that in children aged 1 to 4 years old. The death rate of unintentional suffocation was higher in boys than in girls, and the rate was higher for rural children than for urban children. The number of low-weight and pre-term infants in the group under 1-year-old was significantly higher than that in the group of 1–4 years old. Children under 1-year-old are more likely to die at home than children aged 1 to 4 years old, and a higher proportion of younger children did not receive treatment. More than 80% of children under the age of 5 go untreated because it was too late to go to the hospital.ConclusionFor areas and populations with a high incidence of unintentional suffocation, we suggest that priorities should include prevention, the development of a safe environment, strengthened prevention, the development of safety habits, and the popularization of first aid knowledge.

U-Shaped Pillows and Sleep-Related Infant Deaths, United States, 2004-2015.

To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation. We examined demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment. Most infants were < 6months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object. Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers.

Fatal suffocation: A 7-year autopsy study in Lagos, Nigeria

BackgroundSuffocation is a major class of asphyxial deaths encountered in forensic post-mortem examinations. Several studies have described the patterns of different types of suffocation deaths but there is a paucity of studies and autopsy findings of suffocation in the Nigerian environment. This study is aimed at determining the prevalence and pathological features of suffocation-related deaths at autopsy as seen in the Chief Medical Examiner’s Office in Lagos State, Nigeria. MethodologyThis is a 7-year autopsy-based study of suffocation deaths between 1 st January 2008 and 31st December 2014. Demographic data and morphologic features of asphyxia were retrieved from autopsy reports, case notes, and extracts from Coroners’ request forms submitted by the Police. The results were analysed using SPSS Version 20. ResultsSuffocation deaths accounted for 57(24.8%) of all asphyxial deaths and 0.77% of all autopsies done over the study period. The peak age group of suffocation death was 31–40 years with a male to female ratio of 2:1. Most (89.47%) of suffocation cases were due to aspiration of stomach contents. Hyperaemia of the airways, petechial haemorrhages and pulmonary oedema were the most common morphologic features seen. ConclusionThis study showed that almost all suffocation deaths were due to gastric aspiration mostly secondary to delayed medical intervention. Most of the decedents were in the 4th decade of life with a male preponderance. One case of homicidal suffocation due to combined smothering and choking was observed.

Caracterização dos óbitos infantis por broncoaspiração, sufocação e síndrome da morte súbita

Objetivo: descrever e comparar as características relacionadas aos óbitos por causas evitáveis, como a brocoaspiração, sufocação e síndrome da morte súbita, buscando a definição de um perfil comum. Método: trata-se de um estudo de caso, retrospectivo, no qual, foram analisadas as fichas de investigação de óbito infantil, declaração de óbito e declaração de nascido vivo por um período de doze anos. Resultados: dos 944 óbitos ocorridos, 70 (7,4%) deles tiveram como causa básica de morte a broncoaspiração (45), sufocação (11) ou síndrome da morte súbita (14). O perfil mais frequente encontrado foi: a idade do óbito - pós-neonatal; o local de morte - no domicilio; história de coleito presente; crianças em bom estado de saúde; idade materna entre 20 a 34 anos; baixo nível sócio econômico; fumantes; crianças do sexo masculino; cor branca. Conclusão: reconhecer o perfil desses óbitos irá auxiliar em estratégias de prevenção e redução dos óbitos infantis.

Under-five mortality from unintentional suffocation in China, 2006-2016

BackgroundWe used nationally representative data to examine trends in under-five unintentional suffocation mortality from 2006 to 2016 in China and mortality differences across age groups, sexes, rural vs urban locations and injury mechanisms.MethodsMortality data came from 161 surveillance points of China’s disease surveillance points (DSPs) system. Unintentional suffocation deaths were identified through the 10th International Classification of Disease (ICD-10 codes: w75-w84). Negative binomial regression tested the significance of change in overall and subgroup mortality between 2006 and 2016.ResultsDespite minor fluctuations, a steady trend in overall age-adjusted unintentional suffocation mortality was observed from 2006 to 2016 in Chinese children under 5 years of age. Infants (<1 year), boys and rural children had higher mortality rates than children aged 1-4 years, girls and urban children, respectively. Strangulation and suffocation in bed was the most common cause of mortality for infants, accounting for 66% of deaths. Children aged 1-4 years suffered more often from inhalation suffocation (55% of deaths).ConclusionsUnintentional suffocation mortality rates in under-five children remained fairly stable in China over the past decade but remained at high levels. We discuss actions that might be implemented to reduce pediatric suffocation rates in China.

Under-five mortality from unintentional suffocation in China, 2006-2016.

We used nationally representative data to examine trends in under-five unintentional suffocation mortality from 2006 to 2016 in China and mortality differences across age groups, sexes, rural vs urban locations and injury mechanisms. Mortality data came from 161 surveillance points of China's disease surveillance points (DSPs) system. Unintentional suffocation deaths were identified through the 10th International Classification of Disease (ICD-10 codes: w75-w84). Negative binomial regression tested the significance of change in overall and subgroup mortality between 2006 and 2016. Despite minor fluctuations, a steady trend in overall age-adjusted unintentional suffocation mortality was observed from 2006 to 2016 in Chinese children under 5 years of age. Infants (<1 year), boys and rural children had higher mortality rates than children aged 1-4 years, girls and urban children, respectively. Strangulation and suffocation in bed was the most common cause of mortality for infants, accounting for 66% of deaths. Children aged 1-4 years suffered more often from inhalation suffocation (55% of deaths). Unintentional suffocation mortality rates in under-five children remained fairly stable in China over the past decade but remained at high levels. We discuss actions that might be implemented to reduce pediatric suffocation rates in China.

Sleep-Related Infant Suffocation Deaths Attributable to Soft Bedding, Overlay, and Wedging.

Unintentional suffocation is the leading cause of injury death among infants <1 year old in the United States, with 82% being attributable to accidental suffocation and strangulation in bed. Understanding the circumstances surrounding these deaths may inform prevention strategies. We analyzed data from the population-based Sudden Unexpected Infant Death Case Registry from 2011 to 2014. Cases categorized as explained suffocation with unsafe sleep factors (suffocation), per the Centers for Disease Control and Prevention's Sudden Unexpected Infant Death Case Registry classification system, were included and assigned a mechanism of obstruction, including soft bedding, overlay, or wedging. We calculated frequencies and percentages of suffocation deaths by mechanism and selected demographic and sleep-environment characteristics. Fourteen percent of sudden unexpected infant death cases were classified as suffocation; these cases were most frequently attributed to soft bedding (69%), followed by overlay (19%) and wedging (12%). Median age at death in months varied by mechanism: 3 for soft bedding, 2 for overlay, and 6 for wedging. Soft-bedding deaths occurred most often in an adult bed (49%), in a prone position (82%), and with a blanket (or blankets) obstructing the airway (34%). Overlay deaths occurred most often in an adult bed (71%), and infants were overlaid by the mother (47%). Wedging deaths occurred most often when the infant became entrapped between a mattress and a wall (48%). Safe sleep environments can reduce infant suffocation deaths. Increased knowledge about the characteristics of suffocation deaths can help inform prevention strategies by targeting highest-risk groups.

Numerical study of hydrogen dispersion in a fuel cell vehicle under the effect of ambient wind

In the rescue of hydrogen-fueled vehicle accidents, once accidental leakage occurs and hydrogen enters the cabin, the relatively closed environment of the vehicle is prone to hydrogen accumulation. Excessive hydrogen concentration inside the vehicle cabin may cause suffocation death of injured passengers and rescue crews, or explosion risk. Based on hydrogen fuel cell vehicle (HFCV) with hydrogen storage pressure 70 MPa, four different scenarios (i. with opened sunroof, ii. opened door windows, iii. opened sunroof and door windows and iv. opened sunroof, door windows and rear windshield) under the condition of accidental leakage were simulated using computational fluid dynamics (CFD) tools. The hydrogen concentration inside the vehicle and the distribution of flammable area (>4% hydrogen mole fraction) were analyzed, considering the effect of ambient wind. The results show that in the case of convection between interior and exterior of the vehicle via the sunroof, door windows or rear windshield, the distribution of hydrogen inside the vehicle is strongly affected by the ambient wind speed. In the least risk case, ambient wind can reduce the hydrogen mole fraction in the front of the vehicle to less than 4%, however the rear of the vehicle is always within flammable risk.

USE OF UNSAFE TEETHING REMEDIES IN A MID-SIZE CITY: A SURVEY

Abstract BACKGROUND Various remedies are available to parents for relieving teething symptoms in their infants and toddlers. Some remedies, such as amber necklaces, have no evidence of their efficacy, yet are being widely marketed and increasingly used across North America. On the contrary, teething necklaces are unsafe, corroborated by recent reports of suffocation accidents and death attributed to their use. There is no published literature on the prevalence of teething remedies and what may determine parents’ choices. OBJECTIVES The primary objective was to assess the prevalence of unsafe teething remedies, especially teething necklaces. The secondary objective was to determine any association between the use of unsafe teething remedies and (a) socioeconomic status (SES), and (b) maternal education. DESIGN/METHODS Children aged 12–18 months in a mid-sized Canadian city visiting their primary care providers for routine well-baby checks were included. Children aged &lt;12 or &gt;18 months and those with chronic medical conditions were excluded. Parents completed a survey about their child’s teething symptoms and the remedies used to relieve them. Unsafe remedies were based on recommendations published by the Canadian Paediatric Society and American Academy of Pediatrics. They included oral-numbing gels, necklaces (Amber and Hazelwood), and liquid-containing teething rings. RESULTS Out of 130 surveys, 123 were included for statistical analysis due to missing data. Mean (SD) infant age was 14.47 (2.56) months, and mean (SD) age at first tooth was 6.92 (2.00) months. Overall, 98% of families used teething remedies with 67% of them using unsafe remedies. Of these families, 27% used Amber and 5% used Hazelwood necklaces. 28% of families used more than one unsafe remedy. No significant correlations were found between unsafe remedy use and SES or maternal education. However, a significant negative correlation was noted between SES and use of oral-numbing gels (Spearman’s rho = -0.23, p=0.01). CONCLUSION This study showed that a majority of parents are using unsafe teething remedies for their infants including Amber teething necklaces, despite lack of evidence to support their efficacy and recommendations against their use. Use of unsafe teething remedies transcends SES and education level. With recent reports of child injury and death associated with their use, the findings of this survey support the need for a new approach to parental education about the safety of teething remedies.

P3.02a-035 Can Airway Stenting Avoid Suffocation Deaths Caused by Malignant Airway Obstruction?: Topic: Miscellaneous

Airway stenting is undoubtedly the mainstay procedure for treating patients with malignant airway stenosis to prevent a variety of airway symptoms. Suffocation death is the most painful ending for those patients. The impact of airway stent treatment to avoid this tragic event was investigated. Between 2000 and 2014, 57 patients underwent airway stenting in our department for malignant airway stenosis. They included 25 lung cancer cases, 15 esophageal cancer cases and 7 thyroid cancer cases. The location of the stenosis was the carina for 31 cases, the right or left main bronchus in 12, and the trachea 14. Either Dumon silicon (n=50) or self-expandable metallic stents (n=7) were used. The effect of airway stenting to prevent suffocation death, and the factors for predicting the prognosis were analyzed. There were no cases of in-hospital death. An improvement in airway symptoms was achieved in 54 patients (94.7%) and the median survival after stenting was 3.7 months. At death, only 8 (14%) of those patients died due to direct airway symptoms, including respiration difficulty, even when their general condition was good (Suffocation death group). Conversely, the other 49 patients mostly died due to systemic cancer spread, but all 49 cases had no pain associated with airway symptoms. Therefore, suffocation death appears to have been avoided in those 49 (85.9%) patients (Non-suffocation death group). In a univariate analysis, “Stent migration,” “Tracheal stenosis,” and “Thyroid cancer” were potentially significant factors regarding suffocation death. In a multivariate analysis, “Stenosis at mid trachea” was found to be an independent predictive factor for suffocation death (p = 0.02). Suffocation death can be effectively prevented by the use of airway stenting treatment. “Stenosis at mid trachea” is the most problematic factor when attempting to obtain some benefit from stenting and this may be due to the difficulty of achieving accurate stent (mainly straight silicon stent) fixation in such lesions.

Over Half of US Infants Sleep in Potentially Hazardous Bedding

Accidental suffocation deaths increased in the U.S. from 7 in every 100,000 live births in 2000 to 15.9 in 2010. TRENDS IN INFANT care practices can be identified by research that gives clinicians insight into caregiving practices and guides them in providing education on an individual as well as a community level. Beginning in 1993 studies have found that soft bedding under and over an infant increases the risk of sudden infant death syndrome (SIDS) and sleep-related suffocation. The American Academy of Pediatrics (AAP) has identified the use of potentially hazardous bedding (e.g., pillows, quilts, comforters, loose bedding) as a modifiable risk factor for SIDs and sleep-related suffocation because soft objects and loose bedding can obstruct an infant's airway, posing a suffocation risk and increasing risk for SIDS. The risk was so substantial that in 1996 the AAP issued recommendations that infants be placed to sleep on firm sleep surfaces without any soft or loose bedding. A recently published study by researchers at the National Institutes of Health and the Centers for Disease Control and Prevention is the first study to report on the trends in infant sleep practices (sleep position and sleep location) in the U.S. (Shapiro-Mendoza et al., 2015). The study analyzed data from the National Infant Sleep Position report which surveyed nearly 19,000 caregivers about infant sleep practices between 1993 and 2010. There were several disturbing findings from the study. The study found that although the prevalence of infant bedding use declined over the study period, the rate of decline had slowed markedly— from 86% in 1993 to 1995 to 55% in 2008–2010 and that over half of U.S. infants still sleep in hazardous situations. The researchers also noted that although the rate of SIDS

An Epidemiological Study of Suffocation Deaths In Twin Cities of South India

In spite of advancement in medical facilities, the end of life is inevitable. Suffocation deaths have increased over the years and are becoming a large group in medico legal autopsies. In such deaths, a detailed and meticulous autopsy plays a major role to solve the case, while the scene visit and collection of samples have their own significance. To analyse the recent trends such as manner, methods, motive etc., in suffocation deaths, a prospective study was conducted for two years period. 34 suffocation deaths were studied, which comprised 0.18% of all Forensic autopsies; 38.23% of the cases were aged between 21–30 years. Males constituted 67.63% of all the cases. The most frequent method of suffocation death was smothering (35.29%) followed by environmental and traumatic asphyxia (20.58%), choking (17.64%) and positional asphyxia (5.88%). The most common manner of suffocation was found to be accidental (67.64%). But in homicidal cases (29%), the common motive was domestic disputes. Only 30% of suffocation victims were found positive for blood alcohol.