To determine the prevalence of undiagnosed hypertension and its risk factors among adults in rural Sidama Region, Ethiopia, using a two-step diagnostic method.

A community-based cross-sectional study was conducted from 1 April to 31 July 2024. Data were collected among adults aged 45 years and above using the World Health Organization STEPwise Approach to Surveillance questionnaire. The Demographic and Health Survey questionnaire was also used to collect data on household characteristics.

Selected rural kebeles of Shebedino district, Sidama, Ethiopia.

2875 adults aged ≥45 years identified via census.

Undiagnosed hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg, in individuals with no history of the condition.

The prevalence of undiagnosed hypertension ranged from 7.7% (95% CI: 6.7% to 8.7%) to 14.3% (95% CI: 13.0% to 15.6%). The previously diagnosed hypertensive cases were found in 3.3% (95% CI: 2.7% to 4.1%). Female sex (AOR 2.02; 95% CI: 1.44 to 2.82), age ≥ 65 years (AOR 1.48; 95%CI: 1.01 to 2.15), and history of alcohol drinking and khat chewing (AOR 2.94; 95%CI: 1.52 to 5.66) were significantly associated with undiagnosed hypertension. Lack of awareness of salt-related health risks (AOR 3.14; 95% CI: 2.30 to 4.30) and no prior blood pressure measurement (AOR 5.60; 95% CI: 1.73 to 18.07) were also associated with undiagnosed hypertension.

Undiagnosed hypertension is common among adults aged ≥45 years in the rural Sidama Region. Female sex, older age, substance use, limited awareness of salt-related health risks, and lack of prior blood pressure measurement were the identified risk factors. Regular screening should be implemented to detect cases at an early stage.

To determine the prevalence of undiagnosed diabetes and identify associated factors using a two-step diagnostic method combining fasting blood sugar with confirmatory glycated haemoglobin A1c (HbA1c) testing among adults 45 years and above in rural Sidama, Ethiopia.

A community-based cross-sectional design was conducted from 1 April to 31 July 2024. Data were collected through a census of adults aged 45 years and above using a pretested WHO-STEPwise questionnaire. Physical and biochemical tests were performed following standard protocols. Data were analysed using Stata V.17.

Selected rural kebeles of Shebedino district, Sidama, Ethiopia.

2875 adults aged 45 years and above.

Undiagnosed diabetes confirmed by HbA1c levels (≥48 mmol/mol or ≥6.5%).

The prevalence of undiagnosed diabetes confirmed by HbA1c was 1.2% (35 of 2871; 95% CI: 0.9% to 1.7%). Previously diagnosed diabetes was found in 0.5% (14 of 2875; 95% CI: 0.3% to 0.8%). The total diabetes prevalence, confirmed by HbA1c or prior diagnosis, was 1.7% (49 of 2871; 95% CI: 1.3% to 2.3%). A total of 1327 out of 2875 (46%) participants were undernourished. Advanced age (β=0.21; 95% CI: 0.08 to 0.32, p=0.001), and estimated annual income (β=0.15; 95% CI: 0.02 to 0.28; p=0.029) were significantly associated with elevated fasting blood sugar levels.

The prevalence of undiagnosed diabetes among rural adult population was low. Older age and higher income were significantly associated with elevated fasting blood sugar. Routine community-based diabetes screening among older population, health education and nutrition-focused interventions are recommended to sustain the low burden and address undernutrition.