Prevalence and factors associated with diabetes screening uptake among adults in Zambia: evidence from the 2024 Zambia demographic and health survey

Abstract

Background

The prevalence of diabetes has been on the rise over the years, posing global public health concerns. The World Health Organization (WHO) recommends screening for early detection of prediabetes to prevent complications. Uptake of screening services is, however, still low in Africa, attributed to socioeconomic and health infrastructure disparities in the region. This study examined the prevalence and factors associated with diabetes screening uptake in Zambia. Methods

We conducted a secondary analysis of the 2024 Zambia Demographic and Health Surveys (ZDHS) involving 26,508 respondents. Diabetes screening was defined based on self-reported history of blood glucose measurement by a doctor or other healthcare worker. A weighted analysis was performed to determine the prevalence and factors associated with screening. Descriptive statistics, including frequencies and percentages, were used to summarise sample characteristics, and prevalence estimates with 95% confidence intervals (CIs) were computed. Both univariable and multivariable logistic regression analyses were performed to identify factors associated with diabetes screening uptake. Results

The weighted prevalence of diabetes screening was 14.7% (95% CI: 13.9–15.4). Screening prevalence was higher among females (15.3%), respondents aged 45 years and above (28.9%), those with higher education (37.5%), those in the richest wealth quintile (26.1%), respondents with health insurance (38.1%), urban residents (19.9%), and individuals with hypertension (31.4%). From the multivariable analysis, respondents aged 45 years and above (aOR = 3.32, 95% CI: 2.84–3.90), those with higher education (aOR = 1.89, 95% CI: 1.45–2.47), living with hypertension (aOR = 1.70, 95% CI: 1.49–1.94), and those in the richest wealth quintile (aOR = 1.44, 95% CI: 1.11–1.85), had higher odds of screening. Conversely, males (aOR = 0.75, 95% CI: 0.65–0.85) and smokers (aOR = 0.84, 95% CI: 0.71–1.00) had lower odds of screening. Residents of all other regions had lower odds of screening compared to those in Lusaka. Conclusion

Diabetes screening uptake in Zambia remains low at approximately 15%, indicating gaps in preventive service utilisation. We found out that diabetes screening is associated with socioeconomic status, health system access, and health risk profiles. Strengthening integration of diabetes screening into primary healthcare services, expanding health insurance coverage, and improving targeted awareness campaigns may improve screening uptake.