A Continent The place the Useless Are Not Counted

LAGOS, Nigeria – Christopher Johnson was known for two things. His enthusiastic dancing in the street that made everyone laugh. And his habit of hurling insults at strangers kept him in trouble.

When Mr Johnson died in late September, probably from sepsis from a leg injury according to friends, everyone in Oluti, his bustling neighborhood in Nigeria’s largest city, heard.

All but the government official who is responsible for recording the deaths.

With the coronavirus pandemic emerging worldwide in 2020, it has become increasingly clear that in the vast majority of countries on the African continent, most deaths are never officially recorded. Reliable data on a country’s deaths and their causes are hard to come by, which means that governments can overlook emerging health threats – whether Ebola or the coronavirus – and often have to blindly formulate health policies.

Covid-19 is said to have largely bypassed Africa. Some epidemiologists believe that the youth population was less at risk. others previously exposed to other coronaviruses gave some protection. But as with other diseases, the real toll will likely never be known here, partly because increased death rates cannot be used as a measure as elsewhere.

Stéphane Helleringer, a demographer who has worked on mortality in several African countries, said on the African continent: “There are very, very few countries that even try to estimate mortality using the mortality rate.”

Recently, Abayome Agunbiade, a registrar with the Nigerian Population Commission, surrounded stacks of papers, registers and perforated books with yellow birth and death certificates at a local government office in Eti-Osa, an upscale neighborhood in Lagos.

He said survivors tended to avoid his office, which was small and poorly lit, unless they need a death certificate to settle a dispute over an inheritance or gain access to a pension.

“If they don’t need it, they won’t come,” said Mr. Agunbiade.

In 2017, only 10 percent of deaths were recorded in Nigeria, by far the largest country in Africa – up from 13.5 percent a decade ago. In other African countries like Niger, the percentage is even lower.

Often families are unaware that they are expected to die, or even if they do, there is little incentive to do so. Many families bury relatives in the yard at home, where they do not need a funeral permit, much less a death certificate.

The United Nations Statistics Department collects important statistics from around the world. North and most of South America, Europe and Oceania are said to have recorded at least 90 percent of deaths. Coverage is more inconsistent in Asia.

For most African countries, however, the UN has no death data at all.

In the absence of hard data, researchers have found other methods of estimating mortality rates.

Updated

Jan. 2, 2021, 5:52 p.m. ET

Every few years, most African countries conduct surveys to try to capture broad demographic and health trends. People are asked who died in their households and what the cause was. However, these surveys are erratic and there is plenty of room for error.

Some researchers are trying to find out how many people die by doing cell phone surveys. Others count graves on satellite images or ask grave diggers, such as the 2014 Ebola outbreak in West Africa.

I asked undertakers and coffin makers on a busy street in one of the oldest neighborhoods of Lagos, where the boys of the funeral band were chatting, drums and trumpets under their arms. For decades, Odunlami Street has been the place for anyone who receives a coffin.

Half a dozen coffin makers and funeral directors on Odunlami Street said they noticed that June and July were particularly brisk business.

“The funerals were packed,” said Tope Akindeko, manager of Peak Caskets, leaning on a coffin adorned with gilded reproductions of the Last Supper. The caskets he was selling at the time were rough, cheap models, while expensive American-made steel caskets from Batesville, Indiana remained on the shelves.

Could it have been a spike in Covid-19 deaths? Or maybe a backlog of funerals after a two month lockdown in Lagos? With few deaths recorded, it was difficult to tell.

Although death may not be recorded in the public domain, it is extremely important in the personal domain.

In southern Nigeria, when the buried person has reached old age, funerals are usually a festival of life with bands and dancing pallbearers. For many, sending out a loved one in style is extremely important. Colorful obituaries are posted on social media and, in some areas, posted in front of the houses of the bereaved like “For Sale” signs – with slogans such as “Exit of an Icon”, “A Giant Sleeps” or for a younger person. “Painful outcome.”

Many Nigerians said they received many more of these communications in 2020.

But Covid-19 hasn’t hit Africa as hard as other regions like Europe or America, at least according to official statistics, and remains a mystery epidemiologists have scratched their heads over. The figures presented daily by the World Health Organization show that far fewer people die from it than the United Nations predicted in April.

In other parts of the world, epidemics have been noted due to unusual deaths compared to the death rate in a normal year. Most African countries cannot do this because they do not know the basic mortality.

In the absence of data, experts can make completely different demands.

“Mortality from Covid in the African continent is not a major public problem,” said Dorian Job, program manager for Doctors Without Borders in West Africa. What he called “crazy predictions” about Covid – the United Nations said in April that up to 3.3 million Africans would die from it, for example – meant tough bans were in place. The economic and social impact of these measures would be felt in Africa for decades, said Dr. Job.

But on the other end of the spectrum, researchers have just stated that there was a huge, hidden outbreak in the capital of Sudan. In the absence of a good death registration system, they used a molecular and serological survey, as well as an online survey that was shared on Facebook. There, people reported about their symptoms and whether they had a test. The researchers calculated that Covid-19 killed 16,000 more people than the 477 deaths confirmed by mid-November in Khartoum, whose population is roughly the same as that of Wisconsin.

Khartoum is just a city on a vast, diverse continent with different approaches to tackling the pandemic. In many African countries, however, several factors cited by the researchers as to why the number of Covid-19 cases may be grossly underestimated – stigma, people who cannot be tested, the fact that the threshold for responding to a Disease is high.

“Every time someone says I’m so glad Africa was spared, my toes curl,” said Maysoon Dahab, an infectious disease epidemiologist at King’s College London who worked on the Khartoum study.

Mr. Agunbiade, the Lagos registrar, fills out a table every month listing the causes of the deaths he has recorded, if known. There are around a dozen categories to choose from. High age. Malaria. Maternal mortality.

There is no Covid-19 column, although he said that he sometimes crossed the AIDS / HIV pillar and put Covid on. Perhaps many Africans die from Covid-19, but their deaths are misidentified – just as studies showed they were early in the US epidemic.

On the other hand, maybe not.

Ben Ezeamalu contributed to the coverage from Lagos.

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