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community interventions targeted at interrupting transmission of these infections and routine population screening for early detection of the causative factors should be vigorously pursued. They say public enlightenment, good road maintenance and safe driving culture as well as sustainable security for life and property would reduce the incidence of preventable deaths.
IT is on the increase. It is no respecter of age, sex, tribe, religion, social status and state. It comes with little or no prior notice. Most times it completes its mission in a matter of seconds. Sudden death is on the prowl!
“I saw him yesterday. We played, cracked jokes and laughed. He did not show any sign of ill health. There was nothing wrong with him. But he collapsed and died.”
This scenario is fast becoming the order of the day. From the late University of Lagos Vice Chancellor, Prof. Adetokunbo Babatunde Sofoluwe, who collapsed and died, to the Italian footballer, Piermario Morosini, the story is the same: Sudden death especially due to heart attack.
Prof. Sofoluwe died on May 12. He died of a heart attack he suffered at a meeting on Friday night.
Morosini, former Italy under-21 footballer died on April 13, 2012, following a suspected heart attack on the pitch.
There has indeed been a significant rise in the number of sudden deaths in Nigeria. Even though reliable statistics may not be available, empirical information at the disposal of most clinicians tend to justify the impression of a significant rise in cases of sudden deaths.
A consultant physician at Optimal Specialist Hospital, Surulere, Lagos, Dr. Ugochukwu Chukwunenye, defined sudden death as an unexpected cessation of life in an otherwise “healthy” individual. “Note that I put the healthy in parenthesis. The more appropriate word is undiagnosed but of course some really healthy individuals die suddenly,” he said.
What are the major causes of sudden deaths in Nigeria?
Chukwunenye explained: “In infancy and early childhood, sudden death is often due to suffocation in cots (cot death) or filled water containers (basins, buckets, bath tubs, drums, wells, etc); poisoning (drugs kept within their reach), kerosene, petrol, alcohol, pesticides and rat poisons; fire outbreaks, road traffic accidents, natural disasters (earthquakes, floods, tsunamis) and wars. Children rarely die suddenly from asymptomatic illness but can suffer neglect from their caregivers, which can result in their untimely death.
“Adults and to some extent adolescents, can hide their symptoms and pretend they are healthy for weeks and months on end, until they suddenly collapse and die. In this category, undiagnosed cardiovascular diseases are prominent namely hypertension, myocardial ischaemia and infarction (shortage of blood supply to the heart muscles and their subsequent death) and ruptured blood vessels and aneurysm. An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.
“Food poisoning and psychic or spiritual forces are other common but controversial causes. That the dead can be raised back to life and the death of Ananias and his wife Saphira for lying to the Holy Spirit as recorded in the Holy Bible support this assertion of spiritual forces causing sudden death.”
The physician said suicide, homicide, communal violence and wars, fire outbreaks, collapsed buildings, hired assassinations, armed robberies, political killings, road traffic accidents, floods and natural disasters are some of the other causes.
He said poor public power supply in the country, carbon monoxide poisoning from petrol generator fumes have in recent times claimed many lives and wiped off many families. He said for women of reproductive age group, acute complications of pregnancy and childbirth could lead to sudden death if not detected and treated appropriately and on time.
On the major causes of hospital admissions, morbidity and mortality, he said: “These include the conditions already discussed above but topping the list is malaria and its complications followed by infectious diseases including tuberculosis, hepatitis and Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).” He, however, said these rarely cause sudden death.
Local studies on causes of sudden death.
A study on sudden cardiac death in Ile Ife, Osun State published in West African Journal of Medicine concluded: “Hypertensive heart disease is the most common cause of sudden cardiac death in Nigerians, and many of hypertensive cases were previously undiagnosed. Cases of coronary heart disease and myocardial infarction (heart attack) played significant roles as causes of sudden cardiac death.”
A review of all cases of medico-legal autopsies performed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, on cases of sudden unexpected deaths over a 10-year period (1987-1997) found: “The records of 2,529 medico-legal autopsies were reviewed, of which 79 were found to be cases of sudden cardiac deaths (SCD). The SCD cases consisted of 59 males (74.7 per cent) and 20 females (25.3 per cent), with age ranging from 27 to 80 years.
“…Hypertensive heart disease was the cause of death in 66 cases (83.5 per cent), of which only 20 (30.3 per cent) were previously diagnosed. Ischaemic heart disease and cardiomyopathies ranked next as the most common cause of death with five cases (6.3 per cent) each.”
According to a study on medico-legal autopsies in North Central Nigeria published in East African Medical Journal, road traffic accidents, violent communal unrest and armed robbery were responsible for 66 per cent of the medico-legal autopsies in Jos environment during the period between January 1996 to December 2003.
The study reveals: “Accidental deaths made up 51 per cent of the cases, homicides 36 per cent and sudden deaths 13 per cent. Road traffic accidents were responsible for 76 per cent of all accidental deaths. Children were affected in 34 per cent of the accidental deaths and half of them were pedestrians at the time of accident…”
A study on “Mortality pattern at the adult medical wards of a teaching hospital in Sub-Saharan Africa” published in International Journal of Tropical Medicine Year, showed that infectious, cerebrovascular, hepatic, cardiovascular, kidney and endocrine diseases were the leading causes of death in Nigerian hospitals.
According to the study, majority of the deaths occurred in the age group 20-59 years, which is the most economically productive segment of the society. This has negative implications for the development of the nation.
Similar results were found in Ilorin, Kwara State based on studies at the University of Ilorin Teaching Hospital, Ilorin.
Heart attack major cause of sudden death in Lagos state
Medical Director, Lagoon Hospitals, Apapa, Lagos, Dr. Afolabi Osunkoya elucidated sudden deaths to a situation where one has a bank account without the access to know how much is in it; whether it is debit or credit. Meanwhile, it is ideal to have a health check in accordance with ones’ age bracket in life.
“The health check should start from the third decade upwards and for as long as God tarries. The frequency of the health check will also increase as the decade progresses.”
“For the common-man, if you are having your heart palpitating or just ‘banging’, though it is a feeling that is subjective but the individual will know, especially when he or she is not doing anything strenuous, then it is time to see your doctor for proper cardiovascular evaluation done on you.”
Osunkoya, a Consultant Anesthetist and Intensive care physician said that it is not uncommon to see one or two people that were ‘brought in dead’ (BID) in a quarter.
He observed that it is a global trend with effects that usually turnout to be more disastrous in countries where critical response is still poor.
“We see the quick response in the case of the English Premiere League footballer (Fabrice Muamba) and where organisation comes to play in critical rescue, which is why the young man is still alive till date. If it had been here, because we do not have that critical response, it would have ended in fatality…
“It could be things as basic as cholesterol level and controlling it through diet or drugs to drop the cholesterol level. If the cholesterol level is high, you might end up with serious conditions, one of which could be sudden death.
“It could be as esoteric as the electrical activities of the heart and of course it could be managed with drugs. There are also more advanced devices in some parts of the world that will pick up the early warning signs in the heart and automatically correct it,” Osunkoya said.
Medical Director, City Hospital Nigeria Limited, Lagos, Dr. Bosun Babajide explained that hypertension and Diabetes Mellitus (DM) are two leading cause of deaths in Nigeria, especially when the cases have not been detected.
To prevent sudden deaths in young adults, according to Babajide, it is essential that the patient visits the hospital as frequently as weekly. This is for blood pressure check-up especially for known hypertensive patient and blood sugar levels six-monthly for any other patient.
Hypertension, heart diseases are major killers in Borno State
The Medical Director of the Specialists Hospital, Maiduguri, Borno State, Dr. Mohammed Ghuluze, said that cases of sudden deaths in the geo-political zone are also rampant. He advised that people should worry less: “Be contented with what you have. Also people should not solve problems that are not within their powers of overcoming them. Some people raise their blood pressures for something they have no solution for. Once you are contented with what you have, you would not have unnecessary hassles. Even if your are the Chief Executive Office, you should have some rest, because stress is one of the major cause of sudden death.”
Stroke, inherited heart disorders are major causes of sudden deaths in Edo State
Just like the crisis in Nigeria’s socio-political and economic sectors, the challenges in the health sector, doctors have identified as contributing to cases of sudden deaths in the country even though they come on their different identities.
According the Edo State chairman of the Nigerian Medical Association (NMA), Dr. Philip Ugbodaga, debunked the notion that some sudden deaths were due to witchcraft. He counsels that a “full autopsy and toxicology investigation will often reveal the cause of death, but on occasions may not do so. However, it is wrong to suggest in those circumstances that the cause of death is ‘foul play’, without compelling evidence to that effect. Some people out of ignorance sometimes ascribe such deaths too to witchcraft. This has no basis in medicine.”
He asserts that: “One way of correcting the incidence of premature death is to focus on continuous service improvements for the prevention, diagnosis and treatment of coronary heart disease.”
To Dr. James Adanini, there was a need for governments to do more in Primary Health Care services.
“There is need to equip the primary healthcare sector with qualified personnel and structure to reduce the burden on secondary and tertiary health institutions.”
Also in Bauchi…
The Chief Medical Director (CMD), Bauchi State Specialist Hospital, Dr. Zailani Abubakar Isa, urged individuals to check their health status always and advised relevant healthcare teams to always strive to provide quality services as well as retraining of staff on best practice to stave off cases of sudden deaths.
Malaria is the main cause of deaths in Rivers
Health experts blamed malaria, cancer and maternal mortality as major causes of death in Rivers State.
Doctors at University of Port Harcourt Teaching Hospital (UPTH) and Rivers’ owned Braithwaite Memorial Specialist Hospital (BMH) disclosed that the state government’s unflinching resolve to eradicate malaria has been yielding remarkable results.
However, a consultant at BMSH noted that though mosquitoes are becoming resistant to some major malaria drugs, he regretted that patients who have access to malaria treatment hardly complete their drug prescription.
The Commissioner of Health, Tamunoiyoriari S. Parker regretted that despite the concerted measures by the government to combat malaria through the provision of free one million insecticide-treated mosquito nets valued at over $10 million, some individuals have refused to imbibe the culture of personal hygiene by allowing stagnant water in their environs for mosquitoes to breed.
As part of the state’s strategic plan to eradicate malaria, the commissioner said the government has instructed that all malaria treatments should be free in all the primary health centres.
Cancer related death cases are also rampant in the state. Most of the health experts blamed ignorance and lack of proper education for most of the fatalities recorded daily in the state.
They suggested that government and non-governmental organisations with a bias for health-related issues should intensify campaign to educate the people on the need to keep their environment clean, shun traditional maternity homes, and utilise government-owned health institutions.
Accidents are major cause of sudden death in Enugu
Immediate Past, Chief Medical Director of the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu State, Dr. Anthony Mbah has asked Nigerians to imbibe routine medical checkup at least once in every six months to avoid sudden deaths that might arise as a result of certain dysfunction of the body system.
He explained that most sudden deaths, which he said had been on the increase in the state, usually happen to persons believed to be previously healthy but drop dead either while at work or during sleep.
Mba said that Nigeria was not good in record keeping making it difficult to know the number of persons that may have died suddenly, stressing however that routine medical checkup could help to stem the rising cases of sudden deaths.
He recommended that Nigerians imbibe the virtue of conducting postmortem examinations on persons who died suddenly so that it could be detected on families with frequent cases of sudden deaths. He further recommended a system of information gathering about sudden death, stressing that there should be a central record of sudden death cases and what caused them so that preventive measures could be taken.
Heart attack as major cause of sudden death in Imo
Dr. Benneth Ajuonoma, a Consultant Neurologist at the Federal Medical Centre (FMC), Owerri, Imo State said that cases of sudden deaths in the state are rampart.
For solutions, he also counseled on regular health check, and stoppage of eating of junk foods.
…And in Delta State
Dr. Emmanuel Ezeonu, a Consultant Neurologist at the Federal Medical Centre, Asaba said generally before now sudden deaths occurred only in populations abroad. But with changing lifestyles of Africans especially Nigerians, many cases of sudden deaths were beginning to be seen.
Ezeonu said what one can do is more of advocacy to make individuals to be more aware so that they can go for regular medical check-up which is key. “Prevention is the key word. Another aspect is life style. People should know that African food is still healthy and should go back to it. People should keep away from sugary foods,” he said.
In Kwara State, lifestyle changes are harbingers of sudden deaths
The Provost, College of Medicine, University of Ilorin, Prof. Ayo Omotosho, has canvassed total abstinence from fast food as a veritable panacea to cardiac arrest.
A renowned cardiologist, Omtosho said that, “occurrence of sudden death is not a new phenomenon in our society, and cannot also be localized. The fact of it is that we are just becoming more aware of it. Sudden death results from cardiovascular pathology conditions that have to do with the heart and the blood vessels.”
To him, lipid rich diets have the propensity to increase the cholesterol level. He advised those with family history of sudden deaths to visit their doctors as they remain prone to cardiac arrest. Besides, he warned those in the habit of making the heart “to electrically misbehave” by way of ingesting into their systems stimulants like cocaine or heroin, noting that such a way of life could trigger off cardiac arrest.
He advised “we should shun the eating and social habits of the Western world, they are parts of the risk factors of sudden death. We should replace such food with our traditional food. We should avoid the rat race, as that age is over. We should have enough time to rest. A male is more prone to developing pulmonary heart disease than a woman. A woman can only develop this at certain age of life. Again we should stop the ingestion of stimulant especially cocaine, leading to disturbance of the rhythm of the heart or causing dangerous cardiac arrhythmias.”
Omotosho urged Nigerians to exercise regularly at least three to four times per week. Besides, he encouraged them to eat more vegetable while those already diagnosed of the causative diseases should see their doctors frequently and should also take their pills as recommended by their doctors.
In Taraba, accidents are more to blame
The Medical Director of the Federal Medical Centre (FMC), Jalingo, Taraba State, Dr. Yunusa Wiza, explained: “Cases of industrial or road traffic accidents we know that the government has taken some measures in order to reduce those deaths. Whether those measures have been successful or not, I have not really seen convincing statistics to tell me otherwise. With regard to disease conditions that we have discussed now, the first thing the government needs to do is to have the will power to tackle these problems.”
Recommendations and solutions and recommendations on preventing rising cases of sudden deaths
The JUTH researchers recommended public enlightenment, good road maintenance and safe driving culture as well as sustainable security for life and property would reduce the incidence of preventable deaths.
According to the UITH researchers, community interventions targeted at interrupting transmission of these infections and population screening for early detection of hypertension, diabetes, chronic kidney disease and cancers should be vigorously pursued.
The International Journal of Tropical Medicine Year study noted that there is urgent need for community interventions targeted at interrupting TB, HIV and hepatitis B transmission with provision of free treatment for patients who are infected with these diseases.
To Chukwunenye, the solution to the increase in sudden deaths lies with preventive and not curative medicine. To avoid or minimize sudden death in infants and children, he said, parental education and guidance and education of the caregivers and schoolteachers is paramount.
For adults, he recommended routine and regular medical check ups as the most important antidote.
He said: “Sadly, many highly educated Nigerians including medical doctors! belong to this school of thought. There is therefore a need for massive enlightenment campaigns to combat this ignorance about routine medical check ups. Good governance, good religious/spiritual practices would be an effective antidote to the other adult causes.
Source- The Guardian
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