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LAGOS, Nigeria – Christopher Johnson was known for two things. His enthusiastic dance in the street, which made everyone laugh. And his habit of hurling insults at strangers, which constantly got him in trouble.
So when Mr Johnson died at the end of September, probably of sepsis after a leg injury according to friends, everyone in Oluti, his bustling area in Nigeria’s largest city, heard him.
Everyone except the government registrar responsible for registering deaths.
As the coronavirus pandemic swept the world in 2020, it has become increasingly evident 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 governments can miss emerging health threats – whether it’s Ebola or coronavirus – and often need to formulate a blind health policy.
It is often said that Covid-19 has largely bypassed Africa. Some epidemiologists believe that its young population was less at risk; others that prior exposure to other coronaviruses has given some protection. But like other illnesses, its true toll here will likely never be known, in part because the high death rates cannot be used as a measure as they are elsewhere.
Stéphane Helleringer, a demographer who has worked on mortality in several African countries, said that on the African continent, “there are very, very few countries that even attempt to estimate mortality based on the death rate.
Recently, at a local government office in Eti-Osa, an upscale neighborhood of Lagos, stacks of papers, registers and perforated books with yellow birth and death certificates surrounded Abayome Agunbiade, a registrar of the Commission of the Nigerian population.
He said bereaved residents tended to avoid his office, which was small and poorly lit, unless they needed a death certificate to settle an inheritance dispute or access a pension.
“If they don’t need it, they won’t come,” Agunbiade said.
In 2017, only 10% of deaths were recorded in Nigeria, by far the largest country in Africa in terms of population, down from 13.5% a decade earlier. In other African countries, such as Niger, the percentage is even lower.
Families are often unaware that they are supposed to report deaths, or even if they do, there is little incentive to do so. Many families bury their loved ones in the yard at home, where they do not need a burial permit, let alone a death certificate.
The United Nations Statistics Division collects vital statistics from around the world. In North America and most of South America, Europe and Oceania, at least 90% of deaths are recorded. In Asia, coverage is more uneven.
But for most African countries, the UN has no data on deaths.
In the absence of hard data, researchers have developed other ways to estimate death rates.
Every few years, most African countries carry out surveys to try to capture major demographic and health trends. People are asked who in their household died and what was the cause. But these inquiries are irregular and there is a lot of room for error.
Some researchers are trying to determine how many people are dying by taking cell phone surveys. Others count graves on satellite images, or question gravediggers, as during the 2014 Ebola epidemic in West Africa.
I interviewed undertakers and casket makers on a busy street in one of Lagos’ oldest neighborhoods, where the boys from the funeral band chatted, drums and trumpets under their arms. For decades, Odunlami Street has been the perfect place for anyone who wants to get a coffin.
Half a dozen casket carpenters and funeral directors on Odunlami Street said they noticed business was particularly buoyant in June and July.
“The mortuaries were packed,” said Tope Akindeko, director of Peak Caskets, leaning on a coffin decorated with golden reproductions of the Last Supper. The coffins he was selling at the time were crude and cheap, he said, while expensive American-made steel ones shipped from Batesville, Indonesia, remained on the shelves.
Could this have been a spike in Covid-19 deaths? Or perhaps a backlog of funerals, after two months of lockdown in Lagos? Because few deaths are recorded, it was difficult to say.
Although death is not recorded in the public domain, it is extremely important in the personal domain.
In southern Nigeria, if the person buried has reached a great age, the funeral tends to be a celebration of life, with marching bands and porters dancing. Sending a loved one in style is extremely important to many. Colorful death notices are posted on social media and, in some areas, placed outside the homes of bereaved families as “For Sale” signs – bearing slogans like “Out of an Icon,” “A Giant sleeping ”or for a younger person,“ Painful exit. ”
Many Nigerians said they had received many more of these notices in 2020.
But Covid-19 has not hit Africa as hard as other regions, like Europe or the Americas, at least according to official statistics, presenting a puzzle that epidemiologists have scratched their heads on. Figures presented daily by the World Health Organization show that far fewer people die from it than the United Nations predicted in April.
Elsewhere in the world, epidemics have been identified by unusual spikes in deaths compared to the death rate in a normal year. Most African countries cannot do this because they do not know the baseline mortality.
In the absence of data, experts can make very different statements.
“Mortality from Covid on the African continent is not a major public problem,” said Dorian Job, West Africa program manager for Doctors Without Borders. What he called “crazy predictions” on Covid – the United Nations said in April that as many as 3.3 million Africans would die from it, for example – meant severe lockdowns had been imposed. The economic and social effects of these would be felt in Africa for decades, Dr Job said.
But at the other end of the spectrum, researchers have just declared that there is a huge epidemic hidden 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 been tested. Researchers calculated that Covid-19 killed 16,000 more people than the 477 confirmed deaths in mid-November in Khartoum, which has a population roughly equal to that of Wisconsin.
Khartoum is just one city on a vast and diverse continent with a variety of approaches to tackling the pandemic. But several factors cited by researchers to explain why the number of Covid-19 cases could be vastly underreported – stigma, people unable to get tested, the fact that the threshold for responding to disease is high – are true in many African countries.
“Every time someone says, ‘I’m so glad Africa was spared’ my toes curl up,” said Maysoon Dahab, an infectious disease epidemiologist at King’s College London who worked on the study. from Khartoum.
Mr Agunbiade, the registrar of Lagos, fills out a table each month showing what caused the deaths he recorded, if known. There are a dozen categories to choose from. Old age. Malaria. Maternal mortality.
There is no Covid-19 column, although he sometimes said he crossed out the AIDS / HIV column and put Covid. Perhaps many Africans are dying from Covid-19, but their deaths are poorly identified – just as studies suggest at the start of the epidemic in the United States.
Again, maybe not.
Ben Ezeamalu contributed reporting from Lagos.
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