Retrospective study of sudden unexpected death of infants in the Garden Route and Central Karoo districts of South Africa: Causes of death and epidemiological factors

Background. Sudden unexpected death in infants (SUDI) is a major contributor to under-5 mortality rates. In attempts to better understand SUDI, an abundance of risk factors has previously been described. However, there is a lack of research pertaining to SUDI and risk factors in South Africa (SA), particularly in rural settings. Objective. To describe the profile of SUDI in rural areas of the Western Cape, SA. Methods. A retrospective analysis was conducted on SUDI cases admitted to the seven mortuaries in the Garden Route and Central Karoo districts (Western Cape) between 1 January 2012 and 31 December 2016. Results. SUDI contributed to 38.56% of all infant deaths and the rate of SUDI was 7.95/1 000 live recorded births. Of the total 5 323 case load, 401 (7.53%) were admitted as SUDI cases. In accordance with other studies, more infant deaths occurred during winter (30.7%) than other seasons and almost all infants demised while sleeping (97.7%). Contrary to other studies, there was a slight female preponderance (54.6%). Symptoms (often mild) of illness prior to demise were reported in 70.2% of infants, but only one-third of these infants’ parents/ caregivers sought medical attention. Following postmortem investigation, the majority of deaths were due to explained natural causes (93.7%), of which respiratory tract infection was the leading cause of death (74.1% of SUDI admissions). The most prevalent risk factors were: bed-sharing (especially with a smoker), side sleeping, prematurity, exposure to cigarette smoke, maternal alcohol use, unsatisfactory infant weight gain and socioeconomic indicators of deprivation. Conclusions. Overall, the risk factors observed in the rural setting were highly prevalent and were similar to those described in urban areas (both in SA and internationally). Many of these are modifiable and ample opportunity for risk factor intervention was identified, as well as future research opportunities. Most importantly, parents should be educated to not underestimate seemingly mild symptoms in their infants