Epidemiology of Sudden Unexpected Death Syndrome among Thai Migrant Workers in Singapore

Abstract

A total of 235 cases of sudden unexpected death syndrome (SUDS) among apparently healthy male Thai migrant workers in Singapore were reported between 1982 and 1990. Most of the deaths occurred during sleep and 13% were not sleep-related. The median age at the time of death was 33 years and the median interval between arrival and death was 8 months. These deaths occurred singly and sporadically throughout the year. Post-mortem examination revealed few abnormal findings except for haemorrhagic congestion or oedema of the lungs. There were moderate to severe intra-alveolar haemorrhages with some evidence of myocarditis or pneumonitis. Preliminary findings of serial sections of the hearts indicate evidence of anomalies in the cardiac conduction system. Epidemiological investigations showed that a family history of similar deaths and serological evidence of current or recent infection with Pseudomonas pseudomallei were significantly associated with SUDS. Extensive biochemical and toxicological investigations were inconclusive. There was no evidence of chronic deficiency in thiamine or potassium among the healthy Thai workers living and working in the same conditions as the cases, and no significant abnormalities were detected on electrocardiographic examination. As these migrant workers experienced various psychosocial problems which could stem from maladjustment to an urban environment, separation from the family, burden of debts and long hours of work, stress could be a precipitating factor for SUDS.

Sudden death in the working population; a collaborative study in Central Japan

“…Until now, many western and some Japanese investigators [20,[23][24][25][26] have demonstrated that sudden death occurred most frequently in the morning with or without a secondary peak in the afternoon or evening. However, some of them [25,26] also mentioned that the morning peak was diminished for younger people, and another investigator [27] reported that the peak of witnessed cases was observed during the night for young Thai workers. Coronary artery spasm, not uncommon among middle-aged Japanese people [28,29] , is usually induced late at night or early in the morning, and may play an important role in sudden death [30] .…”

Sudden unexpected nocturnal deaths among Thai immigrant workers in Singapore

“…Toxicological studies have not demonstrated poisons in the body fluids or organs. The concentration of alcohol in the body fluids was nil or negligible [1,5].…”

“…In Singapore, the victims were usually employed in moderately heavy manual jobs such as labourers, construction workers, handymen or gardeners. Most of these deaths happen during the first year of residence in their adopted country [5].…”

“…In Singapore, most of these deaths (88.9%) were among young men from provinces in northeast Thailand [5]. A recent survey by the Thai Public Health Service found that unexpected deaths among men between the ages of 20-59 was highest in the northeast provinces (32/ 100,000) compared with those in central (9.42/100,000), southern (18.26/100,000) or northern 20.9/100,000) provinces [Wichai and Sirisak, Thai Public Health Service, unpublished observations].…”

Cardiovascular Strain of Sawmill Workers in South-Western Nigeria

“…Excessive physical workload and heat stress have been identified as factors that could result in sudden unexplained death syndrome [5].…”