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NYT quoted me in article & if I may concur, this headline is horrendous. This pronouncement is wrong for any country in Africa. There is civil registration throughout continent; deaths are also tallied in health facilities, police records, cemeteries, records of local chiefs… 1/ https://twitter.com/LarryMadowo/status/1345664172462321665
There are widespread efforts to count deaths. For many reasons however, these systems often only capture fraction of all deaths. How large a % varies between and within countries in Africa, as well as over time. This complicates tracking effects of COVID19 (or lack thereof) 2/
I’m not sure if low % of deaths registered is central premise of NYT article, but to that point, there are many supporting references. This @oasankoh and @statsSL piece is a phenomenal overview of the issue of limited registration of births and deaths 3/ https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30442-5/fulltext#%20
Another example, @sesmak & @Cliffodimegwu also have a great review on the situation in Nigeria, and its consequences 4/: https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1811476
For a comprehensive overview of death registration in African countries (on which my quote draws), see this report: 5/ http://apai-crvs.org/sites/default/files/public/EGM%20EN-%20Report%20on%20the%20status%20of%20civil%20registration%20and%20vital%20statistics%20in%20Africa%20.pdf
I also wanted to clarify that I was not talking of “COVID deaths”, rather of all deaths. As everywhere else in world, African countries (except Tanzania) report COVID deaths daily or weekly. These are counts of deaths (primarily) among those tested positive for SARS-CoV-2 6/
COVID deaths are a flawed measure of pandemic toll anywhere in the world, because they depend on testing rates and ignore indirect effects (e.g., due to limited healthcare, economic hardship). See @andrewnoymer’s thread for a critique in the US context 7/ https://twitter.com/AndrewNoymer/status/1241620288825167874
That’s why demographers prefer to turn to “excess mortality”, i.e., the number of deaths from any cause above what usually occurs in non-pandemic years 8/ https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html
Measuring excess mortality requires nearly complete administrative death registration. Due to low % of deaths registered, it is thus not possible to estimate this measure in most African countries at the moment. This will require surveys in the future: 9/ https://twitter.com/helleringer143/status/1261867969992425474?s=20
For an exception and a superb monitoring system based on death registration, see: 10/ https://www.samrc.ac.za/reports/report-weekly-deaths-south-africa
For another fascinating data collection system in Madagascar, see @Fidydvm’s paper 11/: https://www.ijidonline.com/article/S1201-9712(20)32495-4/fulltext
Other methods (e.g., monitoring of cemeteries or morgues) have flaws IMHO, eg trends in burial behaviors, saturation, incomplete data capture… 12/
Improving death records is thus key for public health, including for documenting successes in epidemic response, as argued in this @JNkengasong piece: 13/ https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30397-3/fulltext
For much more information on all of this, please follow all these great demographers and CRVS experts @ThandoAmankwah, @oasankoh, @collins_opiyo, @PSetel, @Fidydvm, @tomtom_m, @Romesh_Silva, @Don_de_savigny, @sesmak or @GloriaMathenge 14/fin
