LAGOS, Nigeria – Christopher Johnson was known for two things. His enthusiastic dance in the street, which made everyone laugh. And his habit of insulting strangers, which constantly got him into trouble.
When Mr. Johnson, end friends, probably died of sepsis after a leg injury, heard everyone in Oluti, his lively neighborhood in Nigeria’s largest city.
Everyone, that is, except the registrar who is responsible for recording deaths.
As the coronavirus pandemic spread around the world in 2020, it has become increasingly clear that most deaths in the vast majority of countries on the African continent have never been formally registered. It is difficult to obtain reliable data on the death of a country and its causes, which means that governments can miss emerging health threats – whether it is Ebola or the coronavirus – and often have to formulate health policies blindly.
It is often said that Covid-19 largely bypassed Africa. Some epidemiologists claim that its youth population was less at risk; others that prior exposure to other coronaviruses provided some protection. But like other diseases, the actual toll here will probably never be known, in part because increased mortality rates cannot be used as a measure.
Stéphane Helleringer, a demographer who has worked on deaths in several African countries, said that there are very, very few countries on the African continent that even try to calculate the death rate. ‘
Recently, Abayome Agunbiade, a registrar at the Nigerian Population Commission, surrounded Abayome Agunbiade in a local government office in Eti-Osa, a luxury area of Lagos.
He said grieving residents tended to avoid his office, which was small and poorly lit, unless they needed a death certificate to settle a dispute over an inheritance or gain access to a pension.
“If they do not need it, they will not come,” he said. Agunbiade said.
In 2017, only ten percent of deaths were registered in Nigeria, by far the largest country by population in Africa – down from 13.5 percent a decade earlier. In other African countries, such as Niger, the percentage is even lower.
Families often do not know that they are expected to report deaths, or even if there is little incentive to do so. Many families bury loved ones in the garden at home, where they do not need a funeral permit, let alone a death certificate.
The United Nations Statistics Division collects important statistics from around the world. In North and most of South America, Europe and Oceania, it says at least 90 percent of the deaths have been registered. In Asia, coverage is dusk.
But for most African countries, the UN has no death data at all.
If there is no hard data, researchers have come up with other ways to estimate mortality rates.
Every few years, most African countries conduct surveys to try to capture broad demographic and health trends. People are asked about who died in their households and what was the cause. But these surveys are irregular and there is a lot of room for error.
Some researchers are trying to figure out how many people die by doing cell phone recordings. Others count graves on satellite images, or ask gravediggers, as in the Ebola outbreak in West Africa in 2014.
I asked funeral directors and coffin makers in a busy street in one of Lagos’ oldest districts, where funeral boys chatted among themselves, drums and trumpets. Odunlami Street has been the place for everyone to get a coffin for decades.
A half-dozen coffin workers and funeral directors in Odunlami Street said they noticed very quickly in June and July.
“The mortuaries were packed,” said Teak Akindeko, manager of Peak Caskets, leaning on a coffin decorated with gilded versions of the Last Supper. The cabinets he sold at the time were rugged, inexpensive models, he said, while expensive American-made steel shipped from Batesville, India, remained on the shelves.
Could it have been an increase in Covid-19 deaths? Or maybe a backlog of funerals, after two months of locking up in Lagos? Because there were few deaths registered, it was difficult to see.
Although death may not register in the public realm, it is extremely important in the personal matter.
In southern Nigeria, when the person being buried has reached a great age, funerals tend to be a celebration of life, complete with bands and dancing corpses. Sending out a loved one in style is very, very important to many. Colorful obituaries are circulated on social media and in some areas posted outside homes of bereaved families such as “For Sale” signs – with slogans such as “Exit of an Icon”, “A Giant Sleeps” or for a younger person, “Painful Exit”. ‘
Many Nigerians said they would receive many more of these notifications in 2020.
But at least according to official statistics, Covid-19 did not hit Africa as hard as other regions, such as Europe or the Americas, and offered a puzzle over which epidemiologists scratched their heads. The numbers presented daily by the World Health Organization show that far fewer people are dying from it than the United Nations predicted in April.
Elsewhere in the world, epidemics have been identified by an unusual increase in deaths compared to the mortality rate in a normal year. Most African countries cannot do this because they do not know the basic death.
If there is no information, experts can make many different claims.
“The death of Covid on the African continent is not a major public issue,” said Dorian Job, West Africa’s Médecins Sans Frontières program manager. What he calls “crazy predictions” about Covid – the United Nations said in April that up to 3.3 million Africans would die from it, for example – meant that hard ties had been put in place. The economic and social consequences of this would be felt in Africa for decades, said dr. Job said.
But on the other end of the spectrum, researchers have just stated that there was a large, hidden outbreak in the capital of Sudan. In the absence of a good death registration system, they used a molecular and serological survey and an online survey distributed on Facebook, where people reported their symptoms and whether they had undergone a test. The researchers calculated that Covid-19 killed 16,000 more people than the 477 deaths confirmed in Khartoum in mid-November, with a population about the size of Wisconsin.
Khartoum is just one city in a large, diverse continent with a variety of approaches to fighting the pandemic. But several factors that the researchers cited as to why the Covid-19 case study can be very underreported – stigma, people who cannot be tested, the fact that the threshold for responding to any disease is high is true in many African countries.
“Every time someone says ‘I’m so glad Africa was spared,’ my toes just curl up,” said Maysoon Dahab, an infectious disease pathologist at King’s College London, who worked on the Khartoum study. said.
Agunbiade, the registrar of Lagos, fills in a table each month that summarizes what caused the deaths he registered, if known. There are about a dozen categories to choose from. Age. Malaria. Maternal mortality.
There is no Covid-19 column, although he said he sometimes crossed the AIDS / HIV column and placed Covid. Many Africans may die from Covid-19, but their deaths are misidentified – just as studies suggest they were in the early US epidemic.
Then again, maybe not.
Ben Ezeamalu reported from Lagos.