The National Civil Registration Authority (NCRA) recorded a total of 20,491 deaths for the entire year of 2020. Based on the available data, this means that only about 22% of all deaths were recorded by the NCRA nationwide, leaving the majority of those who died in 2020 unrecorded in the official databases, and the causes of their deaths are not known.
Sierra Leone does not have a compulsory system to register deaths, and the current NCRA system struggles to take off. Registering deaths and the causes of deaths is important because many of the country’s policies on health and infrastructure depend on it. If people don’t report their dead, there will be no way of knowing exactly which disease is the most deadly and will delay much needed help to prevent unnecessary deaths.
“In order to help the living, we need to count the dead,” U.N. Population Fund demographer Romesh Silva said in a recent BBC story on the civil registration systems in Africa.
The real number of deaths is much higher
But calculating the approximate number of deaths in Sierra Leone may be possible if we consider the death rate calculated by international organizations working in Sierra Leone.
According to theWorld Bank, Sierra Leone’s death rate in 2018 was 11.745 per 1,000 living people. This means that out of every 1,000 living people, 12 died between January and December 2018. If we replace the 1,000 with Sierra Leone’s total population of 7,900,000 people, it means that in 2018 about 92,785 people died across the country.
The number of deaths declines very small for every year, so it would be fair to say that in 2020, the expected number of deaths was about 90,000.
When compared to the total number of deaths recorded by the NCRA in 2020, it is clear that approximately 75% of all people who died in 2020 were not recorded by the NCRA. Therefore, only 1 out of every 4 people who died in 2020 were recorded with the NCRA.
Civil Registrations, an African problem
According to the United Nations data, published by the BBC, only eight countries in Africa out of more than 50, have a compulsory system to register deaths, including Egypt, South Africa, Tunisia, and Algeria. In Sierra Leone, the system is not digitized, NCRA offices in the provinces do not have computers,and people lack awareness of the need to register deaths and births.
Sierra Leone is one of the many African countries who do not mandate death registrations. Source: UN via BBC.
The need to know the number and causes of death is even more important in the wake of the COVID-19 pandemic, experts cited by the BBC argue. The true extent of the coronavirus outbreak on Sierra Leone, and on Africa in general, will never be known if there are no reliable deaths records to calculate the “excess deaths.”
Excess deaths is a measure which allows governments to know if more people than expected died in a certain year. This is important especially for detecting whether or not there is a silent disease among the populations.
In 2020, the actual number of deaths is expected to exceedthe normal predictionsbecause of the increased deaths from the pandemic, which means that there was an “excess death” in the countries affected by the virus. According to the Johns Hopkins University & Medicine report, more than 2,500,000 people died of COVID-19 in the world.
In South Africa, for example, the proper registration of death and causes of death allowed experts to calculate that the excess deaths in 2020 was 138,000, who died of various causes on top of the predicted death. Of these, 46,200 deaths were of people officially recorded as having died with coronavirus.This means the other 91,500 were either undiagnosed or died as an indirect consequence of the pandemic such as delayed treatment or fear of going to hospital.
In Egypt, the excess deaths for 2020 was 68,000. But only 10% of the 68,000 were official COVID-19 deaths. The rest are either undiagnosed COVID-19 deaths, or deaths caused by lack of access to healthcare.
In Sierra Leone it is impossible to calculate excess death, and it will take years until the international organizations can estimate the real death toll caused by COVID-19.
According to the Centre of Excellence for CRVS Systems, which is a global knowledge hub on civil registration and vital statistics (CRVS) systems, NCRA Sierra Leone is mandated by law to collect, compile, abstract and publish statistics on causes of death. A Registration Officer is required to enter in the register of deaths, the required particulars associated with the event and the cause of the death as certified by a registered Medical Practitioner.
However, causes of death information is yet to be comprehensively recorded according to the International Classification of Diseases (ICD) format and disseminated.
We made multiple attempts to speak with a representative from the NCRA Sierra Leone, but our efforts were in vain.
By Hasbin Shaw
03/03/2021. ISSUE NO: 8013