Investigating the unresolved causes of sudden cardiac deaths among Nepalese labour migrants in Malaysia: A verbal autopsy study

Background: Recent studies of Nepalese male migrant workers in Gulf Cooperation Council (GCC) countries and Malaysia have highlighted substantial health risks, with many cardiovascular-related deaths reported as sudden cardiac deaths. Most such deaths are not adequately investigated. This study explored (a) the circumstances surrounding these deaths and (b) potential contributing factors. Method and Materials: Following public and patient involvement and engagement (PPIE) activities with key stakeholders and Nepalese migrant communities in Malaysia, we conducted a verbal autopsy study of 57 friends, roommates, and relatives of 40 Nepali nationals who had died unexpectedly in Malaysia. Results: Most of the deceased were men (92.5%, n=37), with a mean age of 34.5 years (SD 8.3) and a mean duration of employment in Malaysia of 5.9 years (SD 4.4). Only 40.0% (n=16) reportedly received a regular weekly rest day, while 80.0% (n=32) worked more than 8 hours per day. Among those who consumed alcohol (n=33), one-third (33.3%, n=11) drank daily. More than half of the deceased (55.0%, n=22) had at least one pre-existing health condition, most commonly hypertension (32.5%, n=13), followed by diabetes (7.5%, n=3). Conclusion: The circumstances surrounding sudden deaths among Nepalese migrant workers in Malaysia suggest a potential contribution from cardiovascular risk factors, lifestyle behaviours, and adverse working conditions. Reducing this burden will require targeted health-promotion interventions, improved prevention and management of cardiovascular risk factors, stronger occupational health protections, and measures to prevent the production and consumption of counterfeit alcohol.