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Sustainable Development Goal number 3, target 4 (SDG 3.4), seeks a 30% reduction in premature Non-Communicable Diseases (NCDs) mortality from 2015 levels by 2030. Africa United Nations (UN) Member States continue to experience increasing NCD mortality significantly, with the highest proportion of diabetes mortality among the working-age group. Past efforts to address this burden have been centered primarily on individual risk modifications evident by the NCDs Cluster Program at the World Health Organization (WHO) Africa Regional Office. To achieve a progressive reduction, a comprehensive premature NCD reduction approach which includes a consideration of contexts within which premature NCD, such diabetes mortality arises is necessary. The aim was to examine the relationship between contextual factors and diabetes-related deaths as premature NCD mortality and to enable an improved contextualized evidence-based approach to premature NCD mortality reduction. Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected Africa UN Member States in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to examine the relationship between diabetes-related deaths in individuals 20-79 years and contextual factors identified within the SDG framework. Weighted data analysis showed that voice and accountability as a contextual factor explained approximately 47% variability in diabetes-related deaths across the selected Africa UN Member Sates in IDF East and West Region (n=32). Civil society engagement is vital to develop effective premature NCD mortality reduction policies, and strategies and stakeholders’ accountabilities are necessary to ensure adherence to obligations.

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Background Pandemic preparedness continues to be an important focus of the global health security agenda. Many nations in the sub-Saharan African region remain at high risk for a major pandemic due to limited capacity and endemic co-morbid conditions in their populations. While the literature does suggest that state capacity influences health, no studies to date indicate an association between state capacity and pandemic disease distribution, particularly in the presence of other endemic diseases. Methods This mixed methods study will contribute to existing research by examining how economic and sociopolitical attributes of state capacity influence pandemic-prone disease distribution in sub-Saharan Africa. A convergent mixed methods design was used to collect and analyze quantitative state capacity attributes and prevention, and control using correlation in six sub-Saharan countries. Results of the quantitative study were triangulated through the use of an expert panel and results integrated for an overall interpretation and conclusion. Results Variables in the study showed statistically significant relationships between proxies of state capacity and the follow areas: control of pandemics and prevention of pandemics. The Expert Panel interviews illustrated convergence between the correlated results. Conclusions This study brought forward associations with expert confirmation suggestive of areas for national governments in sub-Saharan Africa to further review and improve. While many internal factors limit state capacity in these nations (e.g. human and fiscal resources), external funders may consider adding information from this study and other metrics to test progress. Key messages Evidence is valuable for pandemic preparedness planning. Nation state capacity is a factor in pandemic preparedness.