Contextual factors in premature non-communicable disease mortality in selected African countries within the sustainable development goals framework: the implication of voice and accountability




Sustainable Development Goals, Africa, premature non-communicable disease mortality, voice and accountability, contextual factors


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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United Nations. Transforming our world: the 2030 agenda for sustainable development. Available from: Accessed on [7 December 2020].

World Health Organization. Leadership & governance. Available from: [Accessed on 6 December 2020].

NCD Alliance. NCD Countdown 2030: Pathways to achieving sustainable development goal target 3.4. Available from:,to%20achieve%20SDG%20target%203.4%20in%20most%20countries. [Accessed on 8 December 2020].

International Diabetes Federation. IDF diabetes altas, 9th edition 2019. Available from: [Accessed on 9 December 2020].

Yang JS, Mamudu HM, John R. Incorporating a structural approach to reducing the burden of non-communicable diseases. Global Health 2018;14:66. DOI:

Horton R. Offline: NCDs-why are we failing? Lancet 2017; 390:346.

Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health 2017;13:34. DOI:

Maher A, Sridhar D. Political priority in the global fight against non-communicable diseases. J Glob Health 2012; 2:1-10. DOI:

International Diabetes Federation. IDF's response to the 3rd UN HLM on NCDs political declaration. Available from: [Accessed 14 December 2020].

Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 1996; 10:282-98. DOI:

Glanz K, Rimer B, Viswanath K. Health behavior and health education: Theory, research, and practice. 4th ed. San Francisco, CA: Jossey-Bass; 2008.

Díaz-Perera G, Bacallao J, Alemañy E. Contextual and individual influences on

diabetes and heart disease in Havana primary care catchment areas. MEDICC Rev 2013; 15:10-5.

Caprio S, Daniels SR, Drewnowski A, Kaufman FR et al. Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of shaping America’s health and the obesity society. Diabetes Care 2008; 31:2211-21. DOI:

Diez Roux AV. Conceptual approaches to the study of health disparities. Annu Rev Public Health 2012; 33, 41-58.

Jobson G, Naidoo N, Matlakala N, Marincowitz G, Railton J, McIntyre JA, Struthers HE, Peters RPH. Contextual factors affecting the integration of community health workers into the health system in limpopo province, South Africa, Int Health 2020; 12:28186.

Filauri EA, Ferraro A, Ragon B. State capacity influences on the epidemiology of neglected tropical and vector-borne diseases in sub-saharan Africa. Int Health 2011; 3:15-21. DOI:

United Nations. How many African countries are members of the united nations? Available from: [Accessed 3 May 2020].

International Diabetes Federation. IDF Africa members. Available from: [Accessed 3 May 2020].

International Diabetes Federation. Diabetes-related mortality. Available from: IDF Diabetes Atlas 9th edition 2019. [Accessed 15 December 2020].

Sun D, Ahn H, Lievens T, Zeng W. Evaluation of the performance of national health systems in 2004-2011: an analysis of 173 countries. PLoS ONE 2017; 12.

Green SB, Salkind NJ. Using SPSS for windows and macintosh: analyzing and understanding data. Englewood Cliffs, NJ: Prentice Hall Press.

Statistics Solution. Regression analysis. Available afrom: [Accessed 20 December 2020].

Rocha MA, Sharma B. Joint evaluation of citizens’ voice and

accountability: synthesis report. Available from: [Accessed 21 December 2020].

Combaz E, Mcloughlin C. Voice, empowerment, and accountability. Available from:[ Accessed 22 December 2020].

Primary Health Care Performance Initiative. Governance & leadership.

Available from: [Accessed on 23December 2020].

McCoy D, Hall J, Ridge M. A systematic review of the literature for evidence on health facility committees in low and middle-income countries. Health Policy Plan 2011; 27:449-66. DOI:

Molyneux S, Atela M, Angwenyi V, Goodman C. Community accountability at peripheral health facilities: A review of the empirical literature and development of a conceptual framework. Health Policy Plan 2012; 27.

NCD Alliance. How will you act on NCDs? Act on NCDs. Available from: [Accessed 31 December 2020].

Greenhill, RG, Johnson JA, Malone P, Westrum A. Customizing health security preparedness activities in sub-Saharan Africa: leveraging political context to enhance IHR implementation. Int. J. Public Adm 2021; 1-12.

World Health Organization. The ecological framework. Available from: [Accessed 3 February 2021].




How to Cite

Dotun-Olujinmi, O., Johnson, J. A., Greenhill, R. G., Wuenstel, W., & Adedeji, O. (2022). Contextual factors in premature non-communicable disease mortality in selected African countries within the sustainable development goals framework: the implication of voice and accountability. Journal of Public Health in Africa, 13(2).



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