IJCM_44A: Analysis of Health System and Community Readiness for Adhering to Government Guidelines on Gestational Diabetes Mellitus in India

Abstract

Background: GDM affects approximately 7% of all pregnant women worldwide. India has one of the highest prevalence of Diabetes Mellitus in the world. In a field study in Tamil Nadu, the prevalence of GDM was 17.8% in the urban, 13.8% in the semi urban and 9.9% in the rural areas. It is estimated that at any given time, approximately 4 million women in India are affected by GDM. Though there is availability of national guidelines, screening and management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocol. There are huge challenges in GDM management both at the individual and provider level. Objective: To understand the challenges and possible solutions for successfully implementing the GDM program Methodology: Data were collected from both public and private health facilities in two districts of Maharashtra. Self-administered questionnaire, IDIs and FGDs were conducted with medical officers and staff of PHCs, RH, SDH and District Hospital. Thematic analysis was done. Results: There were lack of training to Staff and Doctor of the government and private health system regarding GDM guidelines. Infrastructure was lacking for conducting the OGTT. Staff were not willing to conduct OGT and MNT(Medical nutrition therapy) on regular basis. Conclusion: Improvement in infrastructure, manpower and training of the staff is needed. Training in OGTT and MNT is must for the filed staff. More involvement of private players is needed for better implementation of GoI guidleines.