Abstract
BackgroundMaternal 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.MethodsQuestionnaires 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.ResultsBarriers 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.ConclusionsA 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.
Highlights
Maternal mortality and morbidity remains high in many low- and middle-income countries (LMIC)
This paper seeks to investigate societal and health system barriers hindering such efforts based on experiences gained from Gestational Diabetes Mellitus (GDM) projects supported by the World Diabetes Foundation (WDF)
Being too busy to Discussion In this study a number of barriers to improving maternal health related to GDM were identified, including lack of trained health care providers - especially female doctors; staff turnover and 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
Summary
Maternal mortality and morbidity remains high in many low- and middle-income countries (LMIC). Based on experiences from World Diabetes Foundation (WDF) supported GDM projects this paper seeks to investigate societal and health system barriers to such efforts. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the IADPSG recommendations. To be able to plan appropriate strategies to address these issues will require better understanding of the barriers currently hindering detection and treatment of GDM. This paper seeks to investigate societal and health system barriers hindering such efforts based on experiences gained from GDM projects supported by the World Diabetes Foundation (WDF)
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