Post-traumatic stress disorder (PTSD) remains substantially underdetected in Nigerian district hospital clinics, where somatic presentations dominate and clinicians must decide whether bodily complaints warrant a trauma-focused assessment. The analysis draws on the DHS Program indicator 'Current users most recent supply or information from a government health center' (FP_SRCM_W_GHC), comprising 150 country-survey observations from 36 African countries between 1990 and 2025, with a mean of 25.261 and a standard deviation of 18.895. The framework proposes that clinicians operate with implicit attribution thresholds below which somatic complaints are routed to general medical pathways and above which trauma screening is triggered, and that these thresholds are anchored by facility-level diagnostic cultures. Underdetection is not primarily a knowledge deficit but a threshold-calibration problem: clinicians in high-somatic-burden settings systematically set attribution thresholds too high, and facility-level anchoring amplifies this bias. The contribution is a multilevel model that specifies how individual attribution thresholds and facility diagnostic norms interact to produce detection gaps, with implications for screening protocol design and clinician training in Nigerian district hospitals.
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Okonkwo et al. (2026) studied this question.
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