The impact of late diagnosis on health outcomes among women and children in low-income communities in Northern Nigeria: a quantitative feasibility study

Late diagnosis of treatable conditions like severe acute malnutrition, obstetric emergencies, malaria, HIV, and tuberculosis is a critical driver of morbidity, mortality, and catastrophic household expenditure among women and children in Northeastern Nigeria. Borno State bears an extreme burden, with maternal mortality ratio of 1,549/100,000 live births, under-five mortality of 160/1,000 live births, and skilled birth attendance below 30%. No integrated, multi-condition quantitative study has measured the prevalence, determinants, and outcome impact of diagnostic delay/capacity across this population. This feasibility study therefore aimed to: (i) estimate the prevalence of late diagnosis among women and children accessing primary healthcare in Borno State; (ii) identify its socioeconomic and health-system determinants; (iii) quantify its association with clinical and economic outcomes; and (iv) validate data-collection instruments and procedures ahead of a definitive multi-state study. Structured Record Abstraction Forms were applied to 425 eligible female records in five health facilities in Borno State between January 2020–December 2024 (identified by systematic probability proportional to size sampling). Bivariate associations were assessed by Pearson’s Chi-square test where cell counts permitted and Fisher’s exact test for 2 × 2 comparisons with sparse cells; continuous outcomes were compared using Mann-Whitney U tests. Independent predictors were identified by binary logistic regression. All analyses were conducted in IBM SPSS version 25, at α = 0.05, two-tailed. Late diagnosis was identified in 94.8% of cases (n = 403/425). Bivariate and multivariable analyses confirmed household income and travel time as significant correlates of late diagnosis in the hypothesised direction. Household income < ₦20,000/month (AOR 4.87; 95% CI 1.55–15.30; p = 0.007) was the most robust individual predictor. Late-diagnosed patients had significantly higher rates of severe complications (25.3% vs. 8.0%, p = 0.042), longer hospital stay (median 7 days [IQR 3–15] vs. 3 days [IQR 1–5], p = 0.003), and higher direct medical costs (₦20,000 vs. ₦10,000, p < 0.001) than early-diagnosed patients. Inadequate diagnostic capacity was associated with a lower proportion of late diagnosis than adequate capacity (Fisher’s exact p = 0.004, OR = 0.22), and the presence of a skilled worker at first contact was associated with a higher proportion of late diagnosis than its absence (Fisher’s exact p < 0.001, OR = 0.01). Late diagnosis is highly prevalent among women and children accessing primary healthcare in Borno State and is independently associated with higher direct medical costs. Household income is the most robust individual-level predictor identified. A definitive, prospective multi-state study is needed to confirm the full predictor set, clarify the mechanism underlying the diagnostic-capacity and skilled-worker associations, and establish population-representative estimates before these findings inform policy at scale.