Monday, 30 April 2018

Sudden Death On The Rise, Requires Urgent Intervention -NIMR

By Chioma Umeha

With over seven million people estimated to die suddenly annually, representing 40 per cent of the yearly deaths worldwide, the menace has been described by researchers as a leading global health problem in the country.
Statistics from the recent research findings released from by the Non Communicable Diseases (NCD) Research Group of Nigerian Institute of Medical Research (NIMR) said that trend in developing countries, including Nigeria remains on the rise.
At a symposium on “Sudden Death in Nigeria: Public Dissemination of National Survey Findings,” which the researchers organised, they further described the development as an alarming health challenge requiring urgent interventions.
According to them, the rate of people who die of sudden death would be 83 per cent by 2020 in developing countries, without appropriate interventions.
While making her presentation, Dr. Nkiruka Odunukwe, Head, NCD research group, NIMR, stressed; “Without appropriate interventions, this rate is expected to double by 2020 with 83 per cent of sudden death cases occurring in developing countries.
“The declining incidence of sudden death in developed countries has been attributed to availability of detailed research data for adequate intervention programmes,” Odunukwe said.
She identified the risk factors of sudden death to include cardiovascular, respiratory and central nervous system disorders as the commonest causes.
However, Odunukwe decried the dearth of autopsy result in the country, especially in the North where their research has shown that there are huge number of sudden deaths.
Odunukwe added the recent study by her group showed that the only 11 per cent do autopsy in the North.
“The geographical imbalance between the South and North has revealed that there is need for a nationally adopted survey especially in the North,” she added.
The study  was aimed at generating data on occurrence, causes and risk factors of sudden death as well as determine the levels of knowledge, perception, and practice of health workers on sudden death in selected teaching hospitals across the nation.
It revealed that the South West accounts for 70.9 per cent with the most affected age group between 41 and 50, the Head, NCD research group said.
The study  showed that the commonest cause of death was cardiovascular cases with 41.4 per cent, followed by Cerebrovascular accident with 19.5 per cent and respiratory causes with 14 per cent.
It is also revealed that working class people are mostly affected with 76.5 per cent and only 5.8 per cent has received training on sudden death.
Odunukwe said other reasons why many hospitals in the North have low account of autopsy includes insufficient pathologist, myths, cultural and religious belief.
On the solution the challenge, she advised that the coroner law be enacted in all the state and it should be supported financially by the government to encourage people to do autopsy.
She said: “Government should enact, implement and support the coroner law as done in 2007 by Lagos state, so that we can find out particularly the cause of people’s death. The enacted law in Lagos state is one of the reasons there is a high number of autopsy result in the state.”

Odunukwe added that technical report of the research would be submitted to the Ministry of Health so as to guide policy makers on intervention solutions.
“NIMR have started collaborations with teaching hospitals and other research institutes to carry out further survey in order to validate our findings,” she added.
On his part, Dr. Bamidele Salako, Director General of NIMR, said that the findings of the research would prompt the importance of public health approach to find solution to hypertension and re-count the need for a competent approach to preventing it.
“Previously, there was no national figure as to the cause of sudden death in Nigeria. Many people have to bury their dead within 24 hours, but we there is a change now due to the research.
“The research findings as shown today have reaffirmed that hypertension is the number one enemy. We should not rely on western data to formulate policies, so NIMR in collaboration with research bodies did a study to engage educate and empower the young ones on the research findings,” Salako added.
Salako corroborated earlier views and said that heart disease, heart failure, heart attack are underlying factors of high blood pressure(HBP) which result to sudden death.
He advised that more attention should be paid to prevention by those who don’t have HBP, treatment by those who have HBP and proper management by those who have developed complications.
“More precautions must be taken to reduce the number of sudden deaths,” he added.
Prof. Andre Kengne, Director, Non-communicable Diseases Research Unit, South African Medical Research, stressed that industrialisation and adoption of the Western lifestyle without taking the necessary modifications are some of the reason why hypertension is prevalent in Nigeria.
He added that hypertension is a silent killer that goes undetected till the person dies.
“We can still globalise, but we must create an enabling society. Proactive actions are to be taken to reduce drastically the number of people with sudden death. This includes creating an enabling environment to cater for the growing population.
“Promote healthy eating and take exercise serious. Regular health check would help in early detection and proper treatment to prevent death,” he stated.
On the challenges of autopsy in Nigeria, Dr. Sunday Shoyemi, Pathologist Lecturer of the Lagos State University Teaching Hospital (LASUTH), has said that lack of facilities in hospitals was a major challenge.
According to him, autopsy is post mortem examination to determine cause of death and to determine change of event on cause of death.
“Lack of x-ray and DNA facilities, proper registration system, and insufficient consultant toxilogical facilities are some of the factors hindering autopsy,” he added.
He further advocated that people do regular blood pressure check to ascertain their health status.
Dr. Bamidele Iwalokun, Chief Research Fellow and Head of Department, Molecular Biology & Biotechnology Division, Immunology & Vaccinology Research Group,  advocated more pathologist to be enrolled and trainings to be carried out on based on the findings that 47.5 per cent have knowledge on autopsy.
He recommended that surveillance guideline be developed for sudden death and improve healthcare training through programme integration and increase algorithm on other parts.
Iwalokun urged the three tiers of governments to establish sudden death registry secondary to autopsy registry in the country.



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