Individual and community-level factors affecting diabetes screening uptake among adults in 14 low- and middle-income countries: a multilevel mixed-effects analysis of recent demographic and health surveys.

Résumé

BACKGROUND: Diabetes screening is vital for the early detection and management of the condition, aiming to improve prognosis and prevent disease progression and complications. However, evidence on population‑level uptake of diabetes screening and its determinants in low‑ and middle‑income countries (LMICs) remains limited. Therefore, this study assessed uptake of diabetes screening and the associated individual‑ and community‑level factors among adults in LMICs.METHODS: We analysed recent Demographic and Health Surveys from 14 LMICs across Africa, South-East Asia, and the Americas. Weighted prevalence estimates of individuals who have ever undergone diabetes screening were calculated for each included country, by participant characteristics. Multilevel logistic regression models were fitted for each country to examine individual- and community-level determinants of diabetes screening uptake. Community variances, intraclass correlation coefficients, and proportional change in variance were used to measure community-level variability in diabetes screening uptake. Deviance, Akaike information criterion, and Bayesian Information criterion were used to select the best-fitting model for each survey. Adjusted odds ratios were used to estimate the association between covariates and diabetes screening uptake.RESULTS: The prevalence of diabetes screening uptake varied widely across countries, ranging from 5.9% in Timor-Leste to 39.8% in the Dominican Republic. In most countries, women had significantly higher screening uptake than men. Older age, higher educational attainment, marital status, health insurance coverage, media exposure, and prior blood pressure measurement were consistently associated with increased likelihood of diabetes screening uptake across multiple surveys. At the community level, higher community media exposure and, in some contexts, higher community educational attainment were associated with greater odds of screening uptake. Substantial between‑community heterogeneity was observed, with intraclass correlation coefficients ranging from 6.8% to 40%.CONCLUSION: Diabetes screening uptake remains suboptimal across many LMICs, with pronounced disparities by sex, socioeconomic status, and community characteristics. Strengthening health system performance, expanding health insurance coverage, increasing community‑level awareness, and better integrating diabetes screening into routine primary care may improve early detection. Addressing both individual‑ and structural‑level determinants is essential to enhancing screening uptake, reducing the burden of undiagnosed diabetes, and advancing global targets to mitigate diabetes‑related complications.