Nobody Knows Why Nigerians Die

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
3. HIV/AIDS
4. Malaria
5. Diarrheal Disease
6. Tuberculosis
7. Meningitis
8. Ischemic heart disease
9. Stroke
10. Cirrhosis

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One challenge the program has faced is inadequate and outdated data for most countries.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.

6 Good Things Ebola Brought To Nigeria

Ebola. A one word terror that has gripped Nigeria in the throes of national hysteria. Having no cure or vaccine, killing it’s victims in a most dehumanising way, thwarting regional efforts to curb its spread, the Ebola Virus Disease is the stuff of science fiction or real life WHO nightmares.

So, when Ebola was imported into to Nigeria by a Liberian Diplomat, the polity was understandably agitated. Social media was agog with advice, speculation, theories and lamentation. A particularly unfortunate incident was a Prank Blackberry Broadcast a girl sent asking her friends to bathe and drink salt to prevent the deadly disease. The broadcast went viral and at least two people are rumoured to have died of complications of hypernatremia, less in fact than died of Ebola within the same time frame.

However, Ebola’s arrival in Nigeria has not been an entirely evil event. It also brought some goodies. Six of these goodies include:

1. A Clean Hands Revolution.
Never in our national history have we cared about hand hygiene as we do now. Hand-washing is preached and practiced in homes, offices and schools at previously unimaginable rates.

Even more amusing is the rash of hand sanitizing creams that have flooded the country. Now, many offices, banks, companies and schools demand visitors hands are smeared with hand sanitizer before they are granted access.

It is unclear how this would help prevent Ebola in people at low or no risk, but it is certain that one can expect lower incidences of contact diseases like diarrhoea and common cold in Nigeria this year. And that is a good thing.

2. More Attention To Personal Space

Nigerians are notorious for dramatic greetings. We hug, kiss, shake hands, lift each other off the ground and spin ourselves around.

Before Ebola.

Now, a wave offered from * meter or two will do. Who wan die?

3. An End To a Protracted Doctor’s. Strike

Some will argue this point, but there is no doubt in my mind that the Draculaen measures adopted by the Federal government to stop the doctor’s strike was partly caused by the Ebola outbreak. Politicians used the outbreak to pressure doctors to return to work and the polity wailed about doctors insensitivity. Never mind that most hospitals are yet to equip or train their doctors to respond. The strike has been called off. Let’s hope many non-Ebola deaths have been so prevented.

4. An Upgrade In Personal Protective Equipment In Health Centres Nationwide.

This point is speculative. It is believed that with N1.9 Billion released for a nationwide response, Personal Protective Equipment will now become available in all government hospitals.
This will go along way to protect healthcare workers from getting infected with disease while at work.

Even before Ebola, many centre lacked protective material as basic as gloves. Googles, body suits, boots and masks were a pipe dream.

Hopefully, Ebola will mean more money devoted to Personal Protective Equipment and safer work places for Nigerian healthcare workers.

5. Fresh Respect For Field Epidemiologists.

With the success of the Ebola Response following the outbreak in Lagos, many people have scrambled to take the credit. Epistles have been written in praise of the State governor, the ruling party, and foreign aid agencies.

The truth is, the Ebola response was successful because of the efforts of little known hardly seen group of medical personnel — the field epidemiologists.

As part of the HIV/AIDS response in Nigeria, the American government has sponsored the selection and training of doctors, vets and lab scientists in the discipline of field epidemiology.

Recently, the training program began to suffer budget cuts and funding reduction. Many feared it would be scrapped altogether.

Not anymore.

Ebola has shown that the little known discipline of field epidemiology is in fact crucial to prevent public health nightmare in developing countries.

And with that, more money is being pumped into training. There’s no need to close the field epidemiology program; rather plans are underway to expand it to cater for regional and continental threat.

6. More Funding For Emergency Response.

Finally, the Ebola outbreak has brought more funding for emergency response. Research, equipment, supplies, training and strengthening of networks that would have taken years are being fast tracked in months.

Ebola is a terrible disease but it seems to have brought some good along with its terror.

If Wishes Were Horses: Using Technology To Curb The Spread Of Ebola?

It is a nightmare brought to life. Our worst fears confirmed, the deadly Ebola virus has arrived in Nigeria and already at least 8 people are feared to be infected.

Discovered in 1976, Ebola has been profiled as an ‘African Disease’ that is a reflection of poor healthcare service. The recent outbreak however puts that line of thought in doubt as well as questions all previous assumptions and knowledge about the ailment.

For instance, the co-discoverer of the virus has been quoted as saying that he wouldn’t be worries about sitting next to an Ebola patient on a train except the person vomited on him or something. He went ahead to cite instances of children living in houses with Ebola patients without contacting the disease, in 1976.

The 2014 version of Ebola seems quite different. Despite the use of full Personal Protective Gear (Masks, gloves, goggles,scrubs), health-workers are getting infected.

Mr Sawyer, an American who flew into Nigeria with the disease and was seen in a hospital in Lagos for barely 72 hours and yet at least 4 medical personnel that attended to him are believed to be infected as well.

This raises questions.

1. Is the transmission of this virus fully understood?

2. Is this strain of Ebola different? If yes, how?

3. Can we continue to use the usual methods of patient care and nursing despite the huge risks?

4. What changes could we make? If wishes were horses?

Personally, the outbreak has kept me thinking. One thing is very clear, we don’t know enough about this illness and we need to change the way we are handling it if we are to make any progress towards ending the scourge.

That’s where technology comes in. If resources were available, these are some of the things I would like to see.

1. Robots used to clean, feed and nurse the affected patients.

2. Specialized beddings that soak and disinfect secretions as they are being produced.

3. Skype type communication with affected patients.

4. Mechanised disposal of bodies in dedicated cremation machines.

And so on.

As long as a cure doesn’t exist, breaking the chain of transmission is the only hope. If one man could infect eight others then imagine: how many people could be at risk from the eight?

It is time for scientists, bio-scientists and engineers to join the fight against this dreadful disease.

It is time for a change of tactics in curbing the spread.

The sooner, the best.

P/S: Opportunities exist for clinicians interested in working with Ebola patients. Contact me.