Death is an inevitable consequence of life. Knowing the causes of morbidity and mortality in a given population is important for seeing public health goals and monitoring progress. Globally, the Global Burden of Disease is measured by the Institite For Health Metrics and Evaluation (IHME), an objective project that calculates and monitors trends in mortality and morbidity in different countries over the years.
A glance at Nigeria’s data will show the leading causes of death for Nigerians to be:
1. Lower respiratory infections
2. Neonatal disorders
5. Diarrheal Disease
8. Ischemic heart disease
But there is a problem: The data used for these rankings is incomplete and these are just best guess estimates and projections from incomplete records.
Nobody knows for sure why Nigerians die.
One challenge the program has faced is inadequate and outdated data for most countries. To combat this problem they use sophisticated data modelling and projections to arrive at working figures. This works but it is not as accurate as actual data, collected in real time.
A cursory online search for causes of mortality in Nigeria reveals the paucity of data. About three studies are seen at first glance. All of them small facility based studies or compilation of archives. A truly representative data set would involve a record of all deaths in Nigeria. For every death there should be a documented cause and the data should be gathered, aggregated and made publicly available.
This is not the case.
Although the Nigerian Populatiom Commiom Act of 1992 stipulates that all deaths should be registered by the commissioner and duly recorded.
“The death of every person dying in Nigeria and the cause thereof shall as from the commencement of this Act be registered by the registrar of births and deaths for that area in which the death occurred by entering in a register kept for that area particulars concerning the death as may be prescribed.”
Indeed, if this law has been enforced there would be robust data about the number of deaths in Nigeria and their causes.
Alas, there has been very little compliance.
An article by the Canasian Immigration and Redugee Board, published in March 2011, the authors clearly records the frustrations of anyone trying to obtain a death certificate and the laissez faire attitude of those tasked with issuing them.
A counsellor at the Deputy High Commision of Canada to Nigeria in Lagos is said to have indicated in writing to with the Research Directorate that “it is not common for the NPC to issue death certificates because most people do not see the need to do so (Canada 25 Feb 2011).
The question is why?
A few explanations lend themselves readily:
1. The law stipulated that these deaths should be recorded free of charge.
This provision which was probably made to improve access however it has also reduced any incentives for the commission to invest time and money in death registration. Data collection is an arduous task , so without any financial incentive, it serves as an increased burden on the commison without any apparent gains.
The second issue is one of demand and supply. Most Nigerians are not concerned about causes of death or their records. Autopsies are hardly done. This lack of interest also fuels political disinterest. For the average Nigerian, a record of deaths and their causes is of little or no concern.
But this ought not to be.
Studies of morality and morbidity are of great public and global health interest. They help researchers to monitor trends and design program that can impotent life expectancy.
Today, the average life expectancy for Nigerians is 56 years, far below the international average of 72 years (source: WHO).
Accurate data on causes of death can highlight the greatest causes of death and lead to a focus on their prevention.
If the attitudes towards the collection of data change, the next thing would be to change the process.
First registering deaths should be made compulsory. The data should be collected by the communities through their leaders and the disease and notification officer a for each local government should be notified. And the collection should be the responsibility of the local governments.
A part of the budgets, both of the commission and of the local governments should be dedicated to death registrations. Families of the bereaved should be made to pay a token amount which should be waived for indigent families or people with peculiar circumstances.
Collected data should be collated by state and nationally. The figures should be updated monthly to a national database such as the DHIS. The data should be blockchain protected to avoid tampering and falsification.
If these measures are in place they would change the way data about Nigeria is reported. For the first time we would have truly representative data and be able to make better decisions. Instead of models and educated gusees, we would know for sure why Nigerian are dying and we would be able to tackle it, making it possible for Nigerian to love longer, healthier, more productive lives.