Sudden Unexpected Natural Deaths of Adults in Southeastern Nigeria: A 12 Years Autopsy Review

Abstract

Background: Sudden unexpected natural death (SUND) though a global health problem continues to pose serious challenges in our environment. Evaluation of the causes and risk factors will provide baseline data for planning and implementation of desired urgent interventions. Objectives:  To determine the patterns of adult sudden unexpected natural deaths in southeastern Nigeria. Methods: This is a twelve years retrospective descriptive review of sudden unexpected natural death cases at the Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria from the year 2007 to 2018. Data from the case notes and autopsy reports of these cases were collected and analyzed. Results: One hundred and two (102) SUNDs were identified constituting 13.6% of all autopsies done in our hospital during the twelve years period under review. There were 76 (74.5%) males and 26 (25.5%) females giving a ratio of 2.9: 1, and a mean age of 48.2 years ± 16.0 SD. Cardiovascular disease (26.5%) was the commonest cause of SUNDs followed by respiratory (21.6%), central nervous system (16.7%), gastrointestinal system & liver (12.7%), cancer related (8.8%), renal (7.8%), diabetes complications (3.9%) and miscellaneous (2.0%). The major specific causes were Hypertensive heart disease (16.7%), pneumonia (6.9%), subarachnoid hemorrhage (5.9%), and aspiration pneumonitis (5.9%). Most SUNDs (13.7%) peaked bi-modally in the 36-40yrs and 61-65yrs age groups. Hypertension (25.5%), cancer (8.8%), and nonspecific bacterial infections (8.8%) were the most prevalent risk factors identified. Conclusion: Cardiovascular, respiratory, and central nervous system disorders are the major group causes of adult SUNDs in southeastern Nigeria with hypertensive heart disease being the predominant specific cause occurring mostly in middle aged married men. Identifying high risk patients of hypertension could allow for timely interventions and prevention of sudden death.