Affiliation:
1. Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
Abstract
Armed conflict, displacement and food insecurity have affected Adamawa, Borno, and Yobe states of northeast Nigeria (population ≈ 12 million) since 2009. Insecurity escalated in 2013 to 2015, but the humanitarian response was delayed and the crisis’ health impact was unquantified due to incomplete death registration and limited ground access. We estimated mortality attributable to this crisis using a small-area estimation approach that circumvented these challenges. We fitted a mixed effects model to household mortality data collected as part of 70 ground surveys implemented by humanitarian actors. Model predictors, drawn from existing data, included livelihood typology, staple cereal price, vaccination geocoverage, and humanitarian actor presence. To project accurate death tolls, we reconstructed population denominators based on forced displacement. We used the model and population estimates to project mortality under observed conditions and varying assumed counterfactual conditions, had there been no crisis, with the difference providing excess mortality. Death rates were highly elevated across most ground surveys, with net negative household migration. Between April 2016 and December 2019, we projected 490,000 excess deaths (230,000 children under 5 y) in the most likely counterfactual scenario, with a range from 90,000 (best-case) to 550,000 (worst-case). Death rates were two to three times higher than counterfactual levels, double the projected national rate, and highest in 2016 to 2017. Despite limited scope (we could not study the situation before 2016 or in neighboring affected countries), our findings suggest a staggering health impact of this crisis. Further studies to document mortality in this and other crises are needed to guide decision-making and memorialize their human toll.
Funder
Foreign and Commonwealth Office
UK Research and Innovation
Publisher
Proceedings of the National Academy of Sciences
Reference46 articles.
1. F. C. Onuoha “Why do youth join Boko Haram?” (Special Report 348: US Institute of Peace Washington DC 2014). https://www.usip.org/publications/2014/06/why-do-youth-join-boko-haram. Accessed 14 April 2021.
2. C. Kwaja “Nigeria’s Pernicious drivers of ethno-religious conflict” (Africa Center for Strategic Studies Washington DC 2011). https://africacenter.org/publication/nigerias-pernicious-drivers-of-ethno-religious-conflict/. Accessed 14 April 2021.
3. A. Obe “Environmental degradation climate change and conflict: The Lake Chad basin area” (International Crisis Group Lagos Nigeria 2016). https://medium.com/the-future-of-conflict/environmental-degradation-climate-change-and-conflict-the-lake-chad-basin-area-6aec2bd9fa25. Accessed 14 April 2021.
4. “Nigeria: 2020 humanitarian needs overview” (United Nations Office for Coordination of Humanitarian Affairs Abuja Nigeria 2019). https://reliefweb.int/report/nigeria/nigeria-humanitarian-needs-overview-2020-december-2019. Accessed 10 February 2022.
5. J. Kurtzer “Out of sight” (Center for Strategic and International Studies (CSIS) Washington DC 2020). https://www.csis.org/analysis/out-sight-northeast-nigerias-humanitarian-crisis. Accessed 10 February 2022.
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