In deaths certified as natural (n=58), cardiovascular diseases accounted for 44.8% (n= 26) of the deaths. These included: myocardial infarction (8 cases), heart failure (8 cases), myocarditis (2 cases), endocarditis (1 case) as well as one case of Arrythmogenic Right Ventricular Dysplasia (ARVD). One case of drug-induced Hypertrophic Obstructive Cardiomyopathy (HOCM) following long-term cocaine, cannabis and marijuana use was recorded. Furthermore, stroke due to hypertension was the cause of death in two cases, one death resulted from a pericardial tamponade following an aortic dissection while sudden cardiac death and hypertensive dilated cardiomyopathy were the causes of death in one case each respectively.
Respiratory infections and disease conditions such as pneumonia (6 cases), bronchopulmonary dysplasia (1 case), bilateral fulminant pulmonary embolism (2 cases) and status asthmaticus (1 case) were responsible for 17.2% of all the deaths certified as natural. More specifically, in the 6 cases in which pneumonia was the cause of death, the majority was secondary to bacterial infections (n=3, 50%) while viral infections were responsible for one case. One case of atypical pneumonia secondary to HIV-immunosuppression was recorded while in one case, the pneumonia illness resulted secondary to chronic opiate dependency.
Gastro-intestinal tract- related diseases, of which the majority were Upper GI bleeding due to Peptic Ulcer Disease (PUD) and ruptured esophageal varices (5 cases), accounted for 12.1 % (7 cases) of all natural deaths altogether. One death resulted from severe gastroenteritis due to HIV-immunosuppression while the cause of death was liver failure due to metastatic breast carcinoma in one case.
A total of three deaths resulting from central nervous system – related diseases and illnesses, contributed to 5.2% of all deaths that were classified as natural. Among these, infectious diseases such as bacterial meningitis and toxoplasmosis on HIV-immunosuppression were responsible for two deaths, while epilepsy-induced Central Dysregulatory Failure was the cause of death in one case.
Four deaths resulted from systemic infection (sepsis and septic shock). Of these, one case was secondary to disseminated visceral leishmaniasis infection. There were three deaths in which the cause of death was multiple organ failure secondary to disseminated tumor (two cases) and chronic kidney disease (one case).
Regarding deaths in infancy (less than 12 months of age), the causes of deaths in all the five cases in which the infant was of dark-skin color were certified as Sudden Infant Death Syndrome (SIDS). The majority of infants (80%, n=4) died aged between 4 and 5 months. Furthermore, female infants accounted for the majority (80%, n=4) of the SIDS-related deaths during the period under review.
With regard to deaths in which the manner was certified as unnatural, 35 cases were recorded altogether. Suicides and homicides accounted for 62.9% (n=22) of the deaths while seven deaths resulted from accidents (road traffic accidents, falls from a height). Two deaths occurred due to drug intoxication while two deaths due to drowning were recorded. Post – operative complications such as bleeding on the other hand, accounted for one death