Missed Opportunities for Integrated Hypertension and Diabetes Screening in Nigeria: A National Survey Analysis

Background: Noncommunicable diseases (NCDs) are a leading cause of morbidity and mortality globally, and the burden falls disproportionately on low- and middle-income countries. In Nigeria, hypertension and diabetes are among the most prevalent NCDs, yet diabetes screening coverage remains poorly characterised relative to blood pressure screening. This study quantifies missed opportunities for diabetes screening among adults who had already accessed blood pressure screening services and identifies the population subgroups most affected. Methods: We conducted a secondary analysis of individual-level data from the 2023-2024 Nigeria Demographic and Health Survey (NDHS), a nationally representative survey of 39,050 women aged 15-49 years and 12,204 men aged 15-59 years. A missed opportunity was defined at the individual level as reporting a prior blood pressure measurement without a concurrent blood sugar measurement. The McNemar test compared the paired proportions of blood pressure and blood sugar screening within each sex, and multivariable logistic regression identified independent predictors of missed opportunity, adjusting for residence, education, wealth, and age. Results: Blood pressure screening coverage was 52.2% among women and 35.0% among men, compared with 18.6% and 19.9% for blood sugar screening, respectively. The absolute gap was 33.6 percentage points in women (McNemar p < 0.001) and 15.1 percentage points in men (McNemar p < 0.001). Among blood pressure-screened individuals, 65.9% of women and 46.5% of men had not received blood sugar screening. In logistic regression restricted to blood pressure-screened individuals, higher education, greater wealth, and older age were each independently associated with lower odds of missing blood sugar screening in both sexes, while residence was not a significant predictor after adjustment. Conclusion: Among Nigerian adults who had been screened for hypertension, nearly two-thirds of women and almost half of men had never been screened for diabetes. This reflects a system-level integration failure rather than a lack of health-system contact. Embedding diabetes screening into existing blood pressure screening encounters represents a practical and scalable strategy for improving early diabetes detection in Nigeria.