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Diabetes Screening, Diagnosis, and Treatment Among Adults in Nigeria: A National Analysis of the 2023–2024 Nigerian Demographic and Health Survey (NDHS)

This national analysis of the 2023–2024 Nigerian Demographic and Health Survey reveals that while diabetes screening rates are modest, diagnosis and treatment uptake remain critically low with significant sociodemographic disparities, highlighting an urgent need to expand routine screening and strengthen primary care in Nigeria.

Original authors: Henry Eziefule Nwankwo, Agozie Nworah, Florence Ubani, Chinedu Nwego, Micah Okwah, Ayodele Ayo-ige, Divine Emenuga, Onaedo Okeke, Obi-Ekekwe Chisomebi, Francisca Utah, Ufuoma Akporhuarho, Divine Aleru

Published 2026-07-08

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Henry Eziefule Nwankwo, Agozie Nworah, Florence Ubani, Chinedu Nwego, Micah Okwah, Ayodele Ayo-ige, Divine Emenuga, Onaedo Okeke, Obi-Ekekwe Chisomebi, Francisca Utah, Ufuoma Akporhuarho, Divine Aleru, Nsikan-Abasi Alfred

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine Nigeria's fight against diabetes as a long, winding relay race. The goal is to get every runner (person with diabetes) from the starting line (having the disease) all the way to the finish line (taking medication and staying healthy). This paper looks at the 2023–2024 race results to see where the runners are dropping out.

Here is the story of that race, told simply:

The Big Picture: A Race with Many Dropouts

The researchers looked at a massive, nationally representative group of adults in Nigeria (about 50,000 people). They wanted to see how many people made it through four specific "checkpoints" in the diabetes care race:

The Starting Line (Screening): Did you ever get your blood sugar checked?
The First Turn (Diagnosis): Did a doctor tell you, "You have diabetes"?
The Second Turn (Prescription): If you were diagnosed, did a doctor give you medicine?
The Finish Line (Treatment): Are you actually taking that medicine right now?

The Result: The race is losing almost everyone.

Screening: Only about 1 out of 5 adults (18%) has ever had their blood sugar checked. It's like a race where 80% of the runners never even show up to the starting line.
Diagnosis: Of those who did run the race, fewer than 1 in 100 (about 1%) were told they have diabetes.
Treatment: Even among the tiny group that was diagnosed, only about half are currently taking their medication.

The paper concludes that the "silent epidemic" is real: most people with diabetes in Nigeria don't know they have it, and the system isn't catching them.

The Uneven Track: Who Gets to Run?

The race track isn't flat; it's full of steep hills that make it harder for some people to run than others. The paper found that your chances of getting screened depend heavily on who you are and where you live:

Money (The Wealth Hill): This is the steepest hill. If you are in the richest group, you are nearly 15 times more likely to have been screened than someone in the poorest group. It's like having a VIP lane versus trying to run through a mud pit.
Education (The Knowledge Hill): People with higher education are much more likely to get checked than those with no formal schooling.
Location (The Geography Hill):
- City vs. Country: People in cities are screened much more often than those in rural villages.
- North vs. South: People in the Southern parts of Nigeria are screened more often than those in the North West or North East.
Age: As people get older, they are slightly more likely to get checked, but even for the oldest adults, the numbers are still very low.

The Gender Gap: A Slight Difference

The paper checked if men and women ran the race differently.

Screening: Women were checked slightly more often than men (18.6% vs. 17.6%), but the difference is small.
Diagnosis: Men were diagnosed slightly more often than women (1.3% vs. 0.9%), but again, both numbers are tiny.
Treatment: Once diagnosed, men and women were prescribed medicine at similar rates. However, men were slightly less likely to be currently taking the medicine, though the study says this difference might just be due to the small number of diagnosed men in the survey.

Why Is the Track So Rough?

The authors explain that the "race" is failing because of broken infrastructure:

Missing Equipment: Many local clinics don't have the tools or staff to test blood sugar.
Cost: Even if you get diagnosed, medicine is expensive. Many people have to pay for it out of their own pockets, and they can't afford to keep buying it.
No Symptoms: Diabetes often doesn't hurt at first. People feel fine, so they don't go to the doctor unless they are forced to by a check-up. Since check-ups are rare, the disease stays hidden.

The Bottom Line

The paper doesn't offer a new medicine or a new cure. Instead, it acts like a spotlight, showing exactly where the lights are off. It says that to fix this, Nigeria needs to:

Bring the check-ups to the people: Make screening a normal part of visiting a doctor, not something you have to ask for.
Help the underserved: Focus on the poor, the uneducated, and people in the North, who are currently being left behind.
Keep the medicine flowing: Ensure that once someone is diagnosed, they can actually afford and access the drugs they need to stay healthy.

In short, the "race" to control diabetes in Nigeria is currently losing most of its runners before they even get a chance to start. The goal is to build a better track so everyone has a fair shot at finishing.

Technical Summary: Diabetes Screening, Diagnosis, and Treatment Among Adults in Nigeria (NDHS 2023–2024)

Problem Statement
Diabetes mellitus represents a rapidly escalating noncommunicable disease (NCD) burden in Nigeria and Sub-Saharan Africa. While national prevalence estimates suggest approximately 7.0% of adults are affected, a critical "silent epidemic" persists: more than half of these cases remain undiagnosed. This lack of detection leads to advanced disease presentation, high treatment costs, and increased risks of cardiovascular and renal complications. A primary determinant of this poor outcome profile is the low coverage of routine blood sugar screening within primary healthcare facilities. Prior to this study, there was a scarcity of national estimates regarding diabetes screening coverage, diagnosis rates, and treatment uptake, hindering the planning of effective public health interventions.

Methodology
This study conducted a survey-weighted secondary analysis of the 2023–2024 Nigeria Demographic and Health Survey (NDHS) individual-level microdata. The NDHS employed a stratified two-stage cluster sampling design covering all 36 states and the Federal Capital Territory between December 2023 and May 2024.

Study Population: The analytic cohort included 39,050 women and 10,876 men aged 15–49 years.
Data Analysis: Analyses were performed using IBM SPSS Statistics (Version 30) with the Complex Samples module to account for the survey's complex design. All estimates are survey-weighted and reported with 95% confidence intervals (CI).
Variables: The study constructed a diabetes care cascade using four key indicators:
1. Screening: Ever had blood sugar measured.
2. Diagnosis: Ever diagnosed with diabetes by a health worker.
3. Treatment Initiation: Prescribed medication among those diagnosed in the last 12 months.
4. Treatment Retention: Currently taking diabetes medication among all diagnosed individuals.
Statistical Testing: Sex differences at each cascade step were formally tested using design-based logistic regression. Subgroup analyses were conducted across age, residence, region, wealth quintile, and education level.

Key Contributions
This paper provides the first nationally representative description of the diabetes screening, diagnosis, and treatment cascade in Nigeria. By utilizing the 2023–2024 NDHS, the study offers the most comprehensive national assessment to date of diabetes care indicators. It constructs a full care cascade to identify specific "losses" at every stage of the continuum and formally quantifies sociodemographic disparities (sex, age, residence, region, wealth, and education) across these stages.

Results
The analysis reveals profound gaps at every stage of the diabetes care continuum:

Screening: National screening coverage is low, with 18.6% of women and 17.6% of men reporting ever having their blood sugar measured.
Diagnosis: Diagnosis rates are extremely low, with only 0.9% of women and 1.3% of men reporting a prior diagnosis. While men had a statistically higher diagnosis rate than women ( $p < 0.001$ ), the absolute difference is negligible (<0.5 percentage points), indicating both sexes are equally underserved.
Treatment: Among diagnosed individuals, prescription rates were 60.4% for women and 55.1% for men. Current medication use was 52.5% for women and 39.2% for men. Sex differences at the treatment stages were not statistically significant ( $p = 0.822$ and $p = 0.233$ , respectively).
Sociodemographic Disparities: Significant gradients were observed across all subgroups. Screening and diagnosis were markedly higher in urban areas, southern zones, wealthier households, and among the most educated.
- Wealth: Screening ranged from 4.5% (poorest women) to 39.0% (richest women), and from 2.5% (poorest men) to 37.8% (richest men).
- Education: Screening ranged from 7.1% (no education) to 44.4% (higher education) for women, and 4.4% to 37.7% for men.
- Region: The North West and North East zones showed the lowest screening and diagnosis rates compared to the South.

Significance and Claims
The authors claim that these findings highlight a critical need to expand routine opportunistic screening and strengthen long-term diabetes care within Nigeria's primary healthcare system. The study underscores that the vast majority of diabetes cases in Nigeria remain undetected and unmanaged. The steep and consistent sociodemographic disparities indicate that the most vulnerable populations—those in the lowest wealth quintiles, with no formal education, and residing in the northern regions—are disproportionately excluded from care.

The paper concludes that integrating routine opportunistic screening into primary healthcare, targeting underserved populations, and improving access to essential medicines are essential steps to address the "silent epidemic." The authors note that while the study relies on self-reported diagnosis (which may underestimate true prevalence) and cross-sectional data (precluding causal inference), the NDHS data provides uniquely valuable national insights into the structural gaps in Nigeria's diabetes care continuum.