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“Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey

BACKGROUND: The prevalence of gestational diabetes (GDM) in low and lower middle income countries (LLMIC) is increasing. Despite its associated short and long term complications for mothers and their newborns, there is a lack of knowledge about how to detect and manage GDM. The objective of our stud...

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Autores principales: Utz, Bettina, De Brouwere, Vincent
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100214/
https://www.ncbi.nlm.nih.gov/pubmed/27821132
http://dx.doi.org/10.1186/s12884-016-1143-1
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author Utz, Bettina
De Brouwere, Vincent
author_facet Utz, Bettina
De Brouwere, Vincent
author_sort Utz, Bettina
collection PubMed
description BACKGROUND: The prevalence of gestational diabetes (GDM) in low and lower middle income countries (LLMIC) is increasing. Despite its associated short and long term complications for mothers and their newborns, there is a lack of knowledge about how to detect and manage GDM. The objective of our study was to identify the challenges that first line healthcare providers in LLMIC face in screening and management of GDM. METHODS: We conducted a cross-sectional survey of key informants from 40 low and lower-middle income countries in Africa, South-Asia and Latin-America by sending out questionnaires to 182 gynecologists, endocrinologists and medical doctors. Sixty-seven respondents from 26 LLMIC provided information on the challenges they encounter. Data was thematically analyzed and revealed eight overarching themes, including guidelines; human resources; access; costs; availability of services, equipment and drugs; patient and community factors; and collaboration and communication. RESULTS: Unavailability of guidelines combined with lack of knowledge about GDM on the part of both providers and patients poses a substantial barrier to detection and management of GDM, leading to deficiencies in screening and counseling. Limited access to regular monitoring and follow-up care as a result of distance and costs, in particular with respect to additional expenses related to specific tests and changes in diet were identified as important challenges. Services were not available at all levels nor was adequate testing equipment. Patient factors included lack of motivation and compliance with the recommended therapy. Respondents also highlighted the lack of communication and collaboration between different specialists and treatment delays as a result of patients being seen by multiple providers. CONCLUSIONS: Providers from LLMIC face various challenges related to screening and managing GDM. Policy makers need to address these challenges by strengthening their health care system as a whole and by assuring that non-communicable diseases are better integrated into the existing packages of free or subsidized maternal health care.
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spelling pubmed-51002142016-11-08 “Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey Utz, Bettina De Brouwere, Vincent BMC Pregnancy Childbirth Research Article BACKGROUND: The prevalence of gestational diabetes (GDM) in low and lower middle income countries (LLMIC) is increasing. Despite its associated short and long term complications for mothers and their newborns, there is a lack of knowledge about how to detect and manage GDM. The objective of our study was to identify the challenges that first line healthcare providers in LLMIC face in screening and management of GDM. METHODS: We conducted a cross-sectional survey of key informants from 40 low and lower-middle income countries in Africa, South-Asia and Latin-America by sending out questionnaires to 182 gynecologists, endocrinologists and medical doctors. Sixty-seven respondents from 26 LLMIC provided information on the challenges they encounter. Data was thematically analyzed and revealed eight overarching themes, including guidelines; human resources; access; costs; availability of services, equipment and drugs; patient and community factors; and collaboration and communication. RESULTS: Unavailability of guidelines combined with lack of knowledge about GDM on the part of both providers and patients poses a substantial barrier to detection and management of GDM, leading to deficiencies in screening and counseling. Limited access to regular monitoring and follow-up care as a result of distance and costs, in particular with respect to additional expenses related to specific tests and changes in diet were identified as important challenges. Services were not available at all levels nor was adequate testing equipment. Patient factors included lack of motivation and compliance with the recommended therapy. Respondents also highlighted the lack of communication and collaboration between different specialists and treatment delays as a result of patients being seen by multiple providers. CONCLUSIONS: Providers from LLMIC face various challenges related to screening and managing GDM. Policy makers need to address these challenges by strengthening their health care system as a whole and by assuring that non-communicable diseases are better integrated into the existing packages of free or subsidized maternal health care. BioMed Central 2016-11-08 /pmc/articles/PMC5100214/ /pubmed/27821132 http://dx.doi.org/10.1186/s12884-016-1143-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Utz, Bettina
De Brouwere, Vincent
“Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
title “Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
title_full “Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
title_fullStr “Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
title_full_unstemmed “Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
title_short “Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
title_sort “why screen if we cannot follow-up and manage?” challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100214/
https://www.ncbi.nlm.nih.gov/pubmed/27821132
http://dx.doi.org/10.1186/s12884-016-1143-1
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