Most common causes of natural and injury-related deaths in Addis Ababa, Ethiopia

Abstract

In Ethiopia, like many developing countries, autopsy is rare unless conducted in the medico-legal arena, making vital statistics that include pathological diagnoses sparse. To determine the most common factors contributing to death among individuals who died from natural or injury-related events in Ethiopia 200 consecutive autopsies were conducted in 2006 at the Forensic Medico-legal Pathology Department, Menelik II Hospital, Addis Ababa, Ethiopia. The results describe significant pathological observations, putative cause of death, age distribution, and gender ratios. Eighty-one percent of the cases were male, and the mean age was 38.9 (+/-15.5 years). Fifty-two percent of the individuals died from natural causes, including infections, and 48% died from injury-related events. In the natural deaths group, as determined by gross examination at autopsy pulmonary complications were the most commonly reported cause of death, with suspected tuberculosis accounting for 12%. Tuberculosis (21, 8%) and liver disease (14, 5%) were the most common histopathological findings in the natural and injury-related causes groups, respectively. In the injury-related group, automobile accident was the most common cause of accidental death (80%), and homicide by beating was the most common cause of death in the intentional injury group (31%). These data provide valuable unbiased analyses of causes of death among individuals in Addis Ababa, Ethiopia.

Figure 1

Whole brain from a 35-year-old patient who died from PTB with severe wasting syndrome, splenomegaly, and suspected HIV/AIDS. The brain atrophied, and a purulent exudate was observed over the entire brain.

Figure 2

Neuropathological findings in sections from white matter tracts underlying frontal cortex stained with H&E (Panels A–C); anti-GFAP antibody (Panels D–F); or anti-HIV p24 antibody from a subset of autopsy cases from Addis Ababa. Panels A, D, G are sections from a 37-year-old individual who died from a gunshot wound to the abdomen, with no evidence of chronic illness or brain trauma; Panels B, E, H are sections from the case shown in Figure 1. Panels C, F, I are sections from a 55-year-old patient with PTB who died from pneumonia with hepatomegaly and suspected HIV/AIDS. A) H&E stain showing well-preserved white matter and vascular architecture (arrowhead), with no evidence of lymphocytic infiltration; B) H&E stain showing extensive vacuolarization of white matter and microglial nodular formation (arrow); C) H&E stain showing disruption of vascular architecture with white matter vacuolarization, lymphocytic and macrophage infiltration (arrowhead); D) GFAP immunoreactivity observed in a normal control; E) GFAP immunoreactive astrocytes surrounding an area suggestive of a migroglial nodule; F) GFAP immunoreactivity indicating reactive gliosis in a case with accompanying white matter damage; G) Absence of HIV-p24 immunoreactivty in the non-HIV case; H) HIV-p24 immunoreactive macrophage closely abutting capillary (arrow) with accompanying white matter vacuolarization; I) HIV-p24 immunoreactivity in a macrophage closely abutting capillary (arrowhead). H&E: hematoxylin and eosin; GFAP: glial fibrillary acidic protein; p24: HIV p24 protein.