Pattern of sudden death at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South West Nigeria

Abstract

BackgroundThe purpose of this study was to determine the etiology and epidemiologic characteristics of sudden death at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, South West Nigeria.MethodsThis was a retrospective descriptive study of all cases of natural unexpected death, either occurring out of hospital or less than 24 hours after admission to LAUTECH Teaching Hospital, over a nine-year period from January 2003 to December 2011. Data were generated from information in the case notes and autopsy reports for these cases.ResultsSudden death accounted for 29 (4.0%) of 718 adult medical deaths and 1.0% of all adult medical admissions. Out-of-hospital deaths occurred in 72.4% of cases. The mean age of the patients was 46.8 ± 11.5 (range 25–74) years. The male to female ratio was 6.25:1. Cardiovascular disease were the most common cause of death (51.7%), followed by respiratory disease (20.7%), pulmonary thromboembolism (10.4%), central nervous system disease (13.8%), gastrointestinal disorders (13.8%), severe chemical/drug poisoning (13.8%), and combined cardiovascular and central nervous system disease (13.8%). Hypertension-related causes were responsible for 14/29 (48.3%) of the sudden deaths. Hypertensive heart disease accounted for 86.7% of the cardiovascular deaths, hypertensive heart failure accounted for 73.3%, whilst all heart failure cases accounted for 80.0%. Left ventricular hypertrophy was present in 69.2% of the patients with hypertensive heart disease. Moderate to severe atheromatous changes occurred in the aorta in 38.5% of patients aged ≥50 years. No case of myocardial infarction was found.ConclusionHypertensive heart disease and hypertension-related disorders are the most common causes of sudden death in South West Nigeria, so effective public health strategies should be channeled towards prevention, detection, and treatment of hypertension.

Aspirin and Diabetes Care in Nigeria: Treatment or Exploitation?

“…On the other hand, while the risk factors for occlusive atherosclerotic syndromes are not fully understood in black Africa [2,72], autopsy data [3,4,[49][50][51][52][53][54][55]consistently show that heart attack, stroke and other occlusive atherosclerotic disorders are less common health consequences of hypertension and type 2 diabetes despite rising cholesterol level in the Nigeria population. This could mean that atherosclerosis in Nigerians with type 2 diabetes and/or hypertension may not be a high risk phenomenon that progressively results in occlusive clinical syndromes requiring additional interventions beyond blood pressure reduction and or diabetes control [11,24,26,[73][74].…”

“…This could mean that atherosclerosis in Nigerians with type 2 diabetes and/or hypertension may not be a high risk phenomenon that progressively results in occlusive clinical syndromes requiring additional interventions beyond blood pressure reduction and or diabetes control [11,24,26,[73][74]. This large body of compelling autopsy data [3,4,[49][50][51][52][53][54][55] consistently shows that often less than 10% of people in Nigeria dying from hypertension and or type 2 diabetes had occlusive atherosclerotic diseases as the cause of death and this figure has remained largely the same in the last 40-50 years. This is not to say that stroke, heart diseases and other cardiovascular conditions are uncommon in local clinical practice.…”

“…This can stimulate demand and expand customer base for this indication in the wider population but what is not often mentioned is that the types of stroke and heart conditions that commonly occur in Nigeria are rarely due to occlusive atherosclerosis but almost invariably result from uncontrolled blood pressure in over 90% of cases and this is usually in those with hypertension and or type 2 diabetes [3,4,[49][50][51][52][53][54][55]. At the current price of five naira per tablet per day, this amount can pay for up to five days of antihypertensive therapy with low dose thiazide diuretics which is capable of lowering blood pressure to targets that optimally diminish the risk of untimely deaths and other cardiovascular events particularly in many black people, at least initially [39,90,91].…”

“…In the case of Nigeria, health market, despite some reports [44,45] of more cases of CAD in recent decades, accumulated data [3,4,[46][47][48][49][50][51][52][53][54][55] continue to show that atherosclerotic disorders remain infrequent. Specifically, though diagnostic tests e.g.…”

“…Specifically, though diagnostic tests e.g. coronary angiography required to confirm suspected cases may be lacking in many academic hospitals, autopsy data [3,4,[49][50][51][52][53][54][55] consistently show that occlusive atherosclerotic disorders remain an uncommon complication in people dying from type 2 diabetes and hypertension in Nigeria.…”