State capacity influences on the epidemiology of neglected tropical and vector-borne diseases in Sub-Saharan Africa.

Many neglected tropical and vector-borne diseases continue to emerge and reemerge in Africa where a significant number of governments have limited state capacity. The reasons these diseases resurface are numerous and this problem remains unsolved. This study contributes to existing research by examining how economic and sociopolitical attributes of state capacity influence the transmission of disease in a population. This ecological study examined relationships between state capacity and the epidemiology of five neglected tropical and vector-borne diseases in a sample of 33 African countries. Regression analyses were used to examine the relationships between state capacity, i.e., economic and sociopolitical attributes, and disease burden, incidence, prevention/control and mortality. Results revealed statistically significant relationships between state capacity and the following dependent variables: all disease-burden variables; insecticide-treated-nets prevention and control; and all age-related and human African trypanosomiasis mortalities. A broad range of effect sizes (R(2) = 0.02-0.59) were observed and the economic and sociopolitical attributes of state capacity made different contributions to these effects. Future studies should explore the economic and sociopolitical attributes of state capacity that influence disease transmission by examining different populations or diseases, and by using different research methods.