Incidence estimates of sudden cardiac arrest (SCA) in athletes living in sub-Saharan Africa (SSA) are unknown.

Over 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala (Cameroon) registered all deaths among 86,188 inhabitants aged under 18 years. As part of an extended multi-source surveillance system, all sport fields, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths.

There were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3–40.6]/100,000 person–years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4–44.9)/100,000 person–years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital SCA occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed CA, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%. While running, death occurred in 1 (3.7%) non-competitive female athlete aged 35 years.

Sport-related SCA in this African population claimed an annual incidence of 1.15 cases per 100,000 person–years, which is in accordance with reported rates in the literature. Long-term cohort studies in many African countries are warranted to better understand incidence estimates of SCA in black athletes.