{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:12Z","timestamp":1772168892647,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.142511.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000}}],"reference-count":35,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background Sudden death is an important global public health issue. An autopsy is an important source of epidemiological data, as the considerable causes of sudden death remain hermetic until postmortem examination. This study is devoted to evaluating the sociodemographic, behavioral, clinical and pathological characteristics of sudden deaths of various ages in Ethiopia. Methods This is an observational, prospective, descriptive study that included all sudden deaths observed over 1 year at St. Paul\u2019s Hospital and Millennium Medical College, Addis Ababa, Ethiopia. Results Sudden death (n = 568) accounted for 11.5% (95% CI: 10.6-12.4) of all autopsied cases. There were 482 males and 86 females (M:F ratio of 5.6:1) and a mean age of 44.8\u00b117.349. The peak age group was the fourth and fifth decades, accounting for 43.9% of the cases. Chronic substance abuse and a history of prior illness were declared in 40.1% and 38% of cases of sudden death, respectively. Cardiovascular (36.1%), respiratory (32.6%), and gastrointestinal system (19.5%) pathologies were the most common causes. The leading underlying causes of sudden death were ischemic heart disease and pneumonia. Most (86.6%) sudden deaths occurred outside of a hospital setting. Conclusions Most of the causes of sudden death in Ethiopia can be prevented and treated. The majority of sudden deaths are silent without preexisting symptoms. Therefore, it is vital to develop public health measures that will help educate the community about the importance of recognizing the manifestation of various clinical conditions and the need to seek immediate clinical help. Furthermore, efforts should be made to make healthcare facilities accessible and affordable with adequate diagnostic and management capacity. Documentation of autopsy-based data could provide important epidemiological information to guide medical services, prevention efforts, and control measures.<\/ns3:p>","DOI":"10.12688\/f1000research.142511.2","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T06:55:16Z","timestamp":1738738516000},"page":"1441","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiological profiles and causes of sudden deaths of various ages in Ethiopia: an autopsy-based study"],"prefix":"10.12688","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2884-5609","authenticated-orcid":false,"given":"Alemayehu Shiferaw","family":"Lema","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sesen Tsegaye","family":"Tekle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"665-670","DOI":"10.26719\/2011.17.9.665","article-title":"Incidence and causes of sudden death in a university hospital in eastern Saudi Arabia.","volume":"17","author":"H Nofal","year":"2011","journal-title":"E. 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Lema<\/b>; \n<i>Posted: 15 Jan 2025<\/i>; Dear Reviewer, We sincerely appreciate the time and effort you dedicated to providing such a comprehensive and constructive review. Your feedback has been extremely valuable in shaping the quality of this work. We have thoroughly reviewed and incorporated your suggestions throughout the manuscript. Please find our detailed responses to each comment below. \n<b>Method section: Details of postmortem examinations procedure<\/b>  Response: Thank you for this valuable suggestion. We have revised the manuscript to include detailed descriptions of the postmortem examinations performed, the ancillary investigations conducted, and the limitations encountered within our setting. As suggested, we have also provided a more thorough description of the gross heart examination. Your feedback has prompted us to include recommendations for improving autopsy facilities and future research, which we believe will be valuable for informing decisions and policies in similar contexts, particularly for forensic pathologists working in resource-limited facilities.  \n<b>Result section: Sudden unexplained deaths<\/b>  Response: Thank you for this valuable suggestion. We have revised the manuscript to provide more detailed descriptions of the included cases. This study focused on all sudden unexpected deaths with a known natural cause. While our findings offer crucial epidemiological data for planning medical services, prevention, control, education, and further research, we acknowledge several limitations that could influence the interpretation of our results. Specifically, 6.2% of total autopsy cases remained undetermined due to the limitations of available resources and facilities, and these cases were therefore excluded from the study. Histopathological examination, largely using Hematoxylin and Eosin (H&amp;E) staining, was performed in all sudden death cases. Toxicological, biochemical, and microbiological investigations are performed on a selective basis, as determined by the forensic pathologist. However, it is important to note that molecular autopsy facilities were not accessible, and tissue specimens were not preserved. This lack of molecular autopsy significantly limited our ability to determine the cause of death in cases of advanced putrefaction or incomplete ancillary examinations and this exclusion of cases with undetermined cause of death may affect the prevalence estimate. This limitation is explicitly discussed in the manuscript. Furthermore, we recognize that sudden unexplained deaths (SUDs) are frequently associated with underlying inherited arrhythmogenic cardiac diseases, which molecular autopsy can help identify. Identifying the cause of death via molecular autopsy is vital not only for medico-legal inquiries but also for guiding cascade genetic screening of the deceased's relatives. This screening is essential for risk prediction in family members and the appropriate management of those identified to be at risk. Your insightful feedback has prompted us to provide relevant recommendations regarding the need for a molecular autopsy facility. We believe that these recommendations will inform decisions and policies in our context and similar settings. As a short-term measure, considering the increasing importance of molecular autopsy, we recommend preserving DNA samples from all SUD cases to facilitate future investigations. These recommendations, we believe, will be particularly valuable for forensic pathologists and stakeholders working in resource-limited facilities. Despite these limitations, our study represents the first nationwide, autopsy-based investigation to comprehensively analyze the epidemiological, clinical, and pathological characteristics of all sudden unexpected natural deaths over a one-year period. We rigorously gathered information from all available sources, performed postmortem autopsies, and collected samples for available ancillary investigations. We believe that this study provides valuable epidemiological insights crucial for planning medical services, prevention, control, education, and further research.  \n<b>References <\/b> Response: Thank you for this critical and pertinent suggestion. We have diligently updated the references, incorporating recent publications and replacing some earlier citations with their most current versions.","URL":"https:\/\/f1000research.com\/articles\/12-1441\/v2#referee-comment-13153","order":2,"name":"referee-comment-13153","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.156070.r287008, Joseph Westaby, Cardiovascular and genomics research institute, St George's University of London, London, 14 Jun 2024, version 1, 3 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/12-1441\/v1#referee-response-287008","order":3,"name":"referee-response-287008","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Alemayehu S. Lema<\/b>; \n<i>Posted: 14 Jan 2025<\/i>; Dear Reviewer, We sincerely appreciate the time and effort you dedicated to providing such a comprehensive and constructive review. Your feedback has been extremely valuable in shaping the quality of this work. We have thoroughly reviewed and incorporated your suggestions throughout the revised manuscript. Please find our detailed responses to each comment below. \n<b><u>Method section<\/u><\/b>  \n<i>Response: <\/i>The statement, &quot;Individuals who died but were not confined to their homes, health facilities, or other related institutions due to illness for more than 24 hours before death were not considered unexpected deaths and were not included,&quot; inadvertently used the phrase &quot;not confined.&quot; This was an error; the intended criteria were that individuals that were confined. We appreciate the reviewer for identifying this inaccuracy. The statement has now been amended to read: &quot;Individuals who died but were confined to their homes, health facilities, or other related institutions due to illness for more than 24 hours before death were not considered unexpected deaths and were not included.&quot;   \n<b><u>Result section<\/u><\/b>   2.1. Figure 1 and table 3  Following your recommendations, we have made specific modifications to the presentation of results. In Figure 1, we've removed the &quot;total&quot; bars to improve the visual clarity of age-related trends, enabling a better appreciation of differences across decades. In Table 3, we have included sex-specific percentages for each cause, facilitating a direct comparison of male and female distributions.  Statistical data presentation   \n<i>Response: <\/i>Thank you so much, and comments are accommodated. All the statistical analysis and interpretation of the data have been meticulously clarified and elaborated upon, offering a more robust understanding of the findings.  Mean age   The mean age (&plusmn;SD) is corrected to 44.8 &plusmn; 17.349 years. The previous version incorrectly presented the standard deviation within the mean, writing it as 44.8117.349 years. This has now been rectified.   \n<b><u>Discussion section<\/u><\/b> 3.1. Male: female ratio  Response: Thank you for this critical and insightful comment. We acknowledge the discrepancy in male-to-female ratios compared to some studies in the literature. The references for this section have been appropriately amended to reflect this. We have now included a detailed discussion of potential reasons for the observed gender disparity in our study.  \n<b><u>Issues regarding<i> <\/i><\/u><\/b>\n<b><u>inherited cardiomyopathies<\/u><\/b>  Response: Thank you for this critical and pertinent suggestion. We agree that it is essential to highlight the potential for inherited cardiomyopathies. We have now included a statement in the discussion emphasizing the importance of screening surviving blood relatives for these conditions, and we have added the suggested reference.  \n<b><u>Issues regarding<i> <\/i><\/u><\/b>\n<b><u>inherited cardiomyopathies<\/u><\/b>  Response: Thank you for this critical and pertinent suggestion. We have addressed all concerns regarding the citations and references. This includes updating the reference list to ensure accurate representation of study locations and replacing older references with more current literature, where possible. Additionally, we have incorporated many recent and all suggested references.","URL":"https:\/\/f1000research.com\/articles\/12-1441\/v2#referee-comment-13145","order":4,"name":"referee-comment-13145","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}