Contextual factors in premature CHD mortality in selected African countries within the SDG framework

Background

The sustainable development goal number 3, target 4 (SDG 3.4) seeks by 2030, a 30% reduction in four premature chronic disease mortality (4CHD) from 2015 values. Since the implementation of SDG 3.4 in 2016, the highest risk of dying from CHD was observed in low and lower-income countries mainly in Africa. This study examined the relationship between contextual factors and diabetes-related deaths as an example of the 4CHD; to enable an improved contextualized evidence-based approach, to attain in part the SDG 3.4 among United Nations Member States in Africa region (UNMSAFR).

Methods

Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected UNMSAFR located in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to ascertain the association between diabetes-related deaths in individuals 20-79 years in UNMSAFR and contextual factors identified in the SDGs framework. Two regression models were tested by conducting unweighted and weighted data analysis.

Results

The unweighted analysis showed that diabetes-related deaths in individuals 20-79 years/1,000 varied across the selected UNMSAFR in IDF East and West Regions (n = 31), with a range of 0.06 - 0.48/1,000 and an average of 0.24/1,000. Contextual factors, i.e., unemployment rate and geographical region explained 23% variability in diabetes-related deaths across the selected UNMSAFR. However, in the weighted data analysis, voice and accountability explained 47% variability in diabetes-related deaths across selected UNMSAFR in IDF East and West Region (n = 32).

Conclusions

Contextual factors such as unemployment rate, geographical region, and voice and accountability (governance) were associated with diabetes mortality; identifying that salient modifiable features can inform targeted interventions and policies to reduce premature CHD mortality.

Key messages

Contextual factors should be considered in policies and interventions for a comprehensive approach to premature CHD mortality reduction. Spatial clustering of CHD is critical for region interventions.

A review of social determinants of health for dashboard development for SDG 3.4 for sub-Sahara Africa

Background

All sustainable developmental goals (SDGs) require implementing sustainable strategies and monitoring to track progress. But what is known of sub-Sahara Africa (SSA)'s efforts in following this stride to reduce by 30% mortality from non-communicable diseases (NCDs) through prevention (SDG 3.4), by considering the effect of social determinants of health (SODHs) on type 2 diabetes increasing prevalence?

Methods

Our search produced 2005 unique articles. Only 10 studies were used in the analysis of this study. These studies include 1 from Botswana, 2 from Ghana, 2 from Kenya, 3 from Nigeria and 2 from South Africa. The findings were evaluated in a greater extent.

Results

All studies (100%) showed non-adherence to exercise and poor glycemic control. 7 studies (70%) on education revealed lack of knowledge or misconceptions, 5 studies (50%) with obesity showed a strong linkage between obesity and type 2 diabetes, and 4 studies (40%) on diet, showed diets high in carbohydrates, saturated fats, and sodium predisposition to type 2 diabetes. All studies (100%) linked urbanization with an increased prevalence of type 2 diabetes.

Conclusions

Changes in SODHs seem to be contributing to the growing prevalence of diabetes in SSA. These changes with other key data should be considered and tailored to policy processes, environment, infrastructures, and norms for prevention strategies and informing dashboard development for SDG 3.4.

Key messages

Social determinants of health must reflect in relevant causal pathways, settings, and sectors for preventive intervention such as in taxation; regulation of food advertising, school, and healthcare. Analysis of the effect of the changing social determinants of health on type 2 diabetes, will assist in establishing indicators for the dashboard development for SDG 3.4 for sub-Sahara Africa.