Health system and societal barriers for gestational diabetes mellitus (GDM) services - lessons from World Diabetes Foundation supported GDM projects

BMC International Health and Human Rights

Anil Kapur¹  Maximilian de Courten²  Karoline Kragelund Nielsen¹ 

[1]World Diabetes Foundation, Brogaardsvej 70, DK, 2820, Gentofte, Denmark

[2]Copenhagen School of Global Health, Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, Bd. 9, entrance P, DK, 1353, Copenhagen K, Denmark

关键词: Low- and middle-income countries;    Barriers;    Society;    Health system;    Gestational diabetes mellitus;   

Others  :  855446
DOI  :  10.1186/1472-698X-12-33

 received in 2012-05-02, accepted in 2012-11-14,  发布年份 2012

【 摘 要 】

Background

Maternal mortality and morbidity remains high in many low- and middle-income countries (LMIC). Gestational Diabetes Mellitus (GDM) represents an underestimated and unrecognised impediment to optimal maternal health in LMIC; left untreated – it also has severe consequences for the offspring. A better understanding of the barriers hindering detection and treatment of GDM is needed. Based on experiences from World Diabetes Foundation (WDF) supported GDM projects this paper seeks to investigate societal and health system barriers to such efforts.

Methods

Questionnaires were filled out by 10 WDF supported GDM project partners implementing projects in eight different LMIC. In addition, interviews were conducted with the project partners. The interviews were analysed using content analysis.

Results

Barriers to improving maternal health related to GDM nominated by project implementers included lack of trained health care providers - especially female doctors; high staff turnover; lack of standard protocols, consumables and equipment; financing of health services and treatment; lack of or poor referral systems, feedback mechanisms and follow-up systems; distance to health facility; perceptions of female body size and weight gain/loss in relation to pregnancy; practices related to pregnant women’s diet; societal negligence of women’s health; lack of decision-making power among women regarding their own health; stigmatisation; role of women in society and expectations that the pregnant woman move to her maternal home for delivery.

Conclusions

A number of barriers within the health system and society exist. Programmes need to consider and address these barriers in order to improve GDM care and thereby maternal health in LMIC.

【 授权许可】

   
2012 Kragelund Nielsen et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF, World Health Organization: Maternal mortality: Fact sheet No; 2010:348. 2: WHO analysis of causes of maternal death: a systematic review. Lancet 2006, 74(9516):1066.
• [2]Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF: WHO analysis of causes of maternal death: a systematic review. Lancet 2006, 367(9516):1066-1074.
• [3]Chanprapaph P, Sutjarit C: Prevalence of gestational diabetes mellitus (GDM) in women screened by glucose challenge test (GCT) at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai 2004, 87(10):1141-1146.
• [4]Hailu A, Kebede D: High-risk pregnancies in urban and rural communities in central part of Ethiopia. East Afr Med J 1994, 71(10):661-666.
• [5]Hossein-Nezhad A, Maghbooli Z, Vassigh AR, Larijani B: Prevalence of gestational diabetes mellitus and pregnancy outcomes in Iranian women. Taiwan J Obstet Gynecol 2007, 46(3):236-241.
• [6]Keshavarz M, Cheung NW, Babaee GR, Moghadam HK, Ajami ME, Shariati M: Gestational diabetes in Iran: incidence, risk factors and pregnancy outcomes. Diabetes Res Clin Pract 2005, 69(3):279-286.
• [7]Mamabolo RL, Alberts M, Levitt NS, Delemarre-van de Waal HA, Steyn NP: Prevalence of gestational diabetes mellitus and the effect of weight on measures of insulin secretion and insulin resistance in third-trimester pregnant rural women residing in the Central Region of Limpopo Province, South Africa. Diabet Med 2007, 24(3):233-239.
• [8]Olarinoye JK, Ohwovoriole AE, Ajayi GO: Diagnosis of gestational diabetes mellitus in Nigerian pregnant women–comparison between 75 G and 100 G oral glucose tolerance tests. West Afr J Med 2004, 23(3):198-201.
• [9]Ranchod HA, Vaughan JE, Jarvis P: Incidence of gestational diabetes at Northdale Hospital, Pietermaritzburg. S Afr Med J 1991, 80(1):14-16.
• [10]Samad N, Hassan JA, Shera AS, Maqsood A: Gestational diabetes mellitus–screening in a developing country. J Pak Med Assoc 1996, 46(11):249-252.
• [11]Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A: Gestational diabetes mellitus in India. J Assoc Physicians India 2004, 52:707-711.
• [12]Seyoum B, Kiros K, Haileselase T, Leole A: Prevalence of gestational diabetes mellitus in rural pregnant mothers in northern Ethiopia. Diabetes Res Clin Pract 1999, 46(3):247-251.
• [13]Siribaddana SH, Deshabandu R, Rajapakse D, Silva K, Fernando DJ: The prevalence of gestational diabetes in a Sri Lankan antenatal clinic. Ceylon Med J 1998, 43(2):88-91.
• [14]Sumeksri P, Wongyai S, Aimpun P: Prevalence of gestational diabetes mellitus (GDM) in pregnant women aged 30 to 34 years old at Phramongkutklao Hospital. J Med Assoc Thai 2006, 89(Suppl 4):S94-S99.
• [15]World Diabetes Foundation, Global Alliance for Women's Health: Diabetes, women, and development: meeting summary, expert recommendations for policy action, conclusions, and follow-up actions. Int J Gynaecol Obstet 2009, 104(1):46-50.
• [16]Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005, 352(24):2477-2486.
• [17]Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al.: A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009, 361(14):1339-1348.
• [18]Lohse N, Marseille E, Kahn JG: Development of a model to assess the cost-effectiveness of gestational diabetes mellitus screening and lifestyle change for the prevention of type 2 diabetes mellitus. Int J Gynaecol Obstet 2011, 115(Suppl 1):S20-S25.
• [19]Nielsen KK, de Courten M, Kapur A: The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus - lessons from projects funded by the World Diabetes Foundation. Glob Health Action 2012, 5:17277.
• [20]Canadian Diabetes Association Clinical Practice Guidelines Expert Committee: Diabetes and Pregnancy. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Diabetes Association: 32 ed; 2008:168-180.
• [21]IDF Clinical Guidelines Task Force: Global Guideline on Pregnancy and Diabetes. Brussels: International Diabetes Federation; 2009.
• [22]National Institute for Health and Clinical Excellence: Diabetes in pregnancy. London: NICE: Management of diabetes and its complications from pre-conception to the postnatal period; 2008.
• [23]World Health Organization: WHO Global Health Observatory Data Repository. 2010. http://www.apps.who.int/gho/data webcite
• [24]World Health Organization: the world health report 2006: working together for health. Geneva: WHO; 2006.
• [25]O'Brien P, Gostin LO: Health Worker Shortages and Global Justice. New York: Milbank Memorial Fund; 2011.
• [26]American Diabetes Association: Standards of medical care in diabetes--2010. Diabetes Care 2010, 33(1):11-61.
• [27]Metzger BE, Buchanan TA, Coustan DR, De LA, Dunger DB, Hadden DR, et al.: Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007, 30(2):251-260.
• [28]Bennett WL, Ennen CS, Carrese JA, Hill-Briggs F, Levine DM, Nicholson WK, et al.: Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. J Womens Health (Larchmt) 2011, 20(2):239-245.
• [29]Collier SA, Mulholland C, Williams J, Mersereau P, Turay K, Prue C: A qualitative study of perceived barriers to management of diabetes among women with a history of diabetes during pregnancy. J Womens Health (Larchmt) 2011, 20(9):1333-1339.
• [30]Mersereau P, Williams J, Collier SA, Mulholland C, Turay K, Prue C: Barriers to managing diabetes during pregnancy: the perceptions of health care practitioners. Birth 2011, 38(2):142-149.
• [31]Razee H, van der Ploeg HP, Blignault I, Smith BJ, Bauman AE, McLean M, et al.: Beliefs, barriers, social support, and environmental influences related to diabetes risk behaviours among women with a history of gestational diabetes. Health Promot J Austr 2010, 21(2):130-137.
• [32]Stuebe A, Ecker J, Bates DW, Zera C, Bentley-Lewis R, Seely E: Barriers to follow-up for women with a history of gestational diabetes. Am J Perinatol 2010, 27(9):705-710.
• [33]Haque M, Emerson SH, Dennison CR, Navsa M, Levitt NS: Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town. S Afr Med J 2005, 95(10):798-802.
• [34]Peimani M, Tabatabaei-Malazy O, Heshmat R, Moghaddam SA, Sanjari M, Pajouhi M: Knowledge, attitude and practice of physicians in the field of diabetes and its complications: A pilot study. Iran J Diabetes and Lipid Disord 2010, 9:1-7.
• [35]United Nations: Report of the Fourth World Conference on Women. New York: United Nations: Beijing, 4–15 September 1995; 1996.