WDF GDM Project

EXECUTIVE SUMMARY

MEDICAL WOMEN’S ASSOCIATION OF NIGERIA AND WORLD DIABETES FOUNDATION

GESTATIONAL-DIABETES PROGRAM IN NIGER-DELTA WDF16-1347

BACKGROUND

The Medical Women’s Association of Nigeria (MWAN) Rivers State is a non-governmental, non-profit, non-political organization of registered female medical doctors and dentist in Nigeria. We are affiliated to the Medical Women’s International Association and Nigerian Medical Association with the motto: ‘Matris Animo Curant’-‘Healing with the love of a mother’. Our mission is to improve the health of Nigerians especially women and children through health promotion and quality health delivery services.

 In February 2017, MWAN Rivers State Branch, in partnership with the World Diabetes Foundation, commenced a three-year project aimed at implementing access and advocacy interventions for the control of Gestational Diabetes Mellitus (GDM) through GDM prevention and care in 42 communities in five Local Government Areas (LGAs), selected from the three senatorial districts in Rivers State. A total of 30 health facilities were empowered for the implementation of GDM prevention and care. This included 15 public (10 primary, 3 secondary and 2 tertiary) and 15 private health facilities (11 primary and 4 secondary).

Project Implementation team consisted of a steering committee headed by Prof Jean Claude Mbanya with membership drawn from the leadership of Government and healthcare in the state. Baseline and end of project surveys were carried out among health workers and community residents to assess the effect of the GDM interventions. The comparative analysis showed improvements in knowledge of GDM and its prevention and utilization of antenatal and delivery services among residents of catchment communities of supported facilities. The hallmark of the intervention project was the support for free universal screening for GDM in all supported facilities.

PROJECT GOALS, OBJECTIVES, TARGETS AND RESULTS

PROJECT GOAL AND OBJECTIVES	PROJECT TARGET	PROJECT RESULTS
1) To prevent and improve Gestational Diabetes Mellitus outcomes among rural and urban poor women in Rivers State, Niger Delta region of Nigeria.	20000 pregnant women screened for GDM 2000 pregnant women diagnosed with GDM 1000 pregnancy related adverse diabetes outcomes prevented	22,202 Pregnant women screened for GDM 1310 GDM cases diagnosed (prevalence of 5.9%)1310 GDM cases followed up
2) Promote prevention of GDM through education and awareness campaigns	36000 information flyers on GDM distributed in the Niger Delta.	85,000 information flyers 17 community town hall meetings and door to door Inter-personal communications. 2300 persons reached Three community rallies held
3) Build the capacity of health care providers at primary public and private health facilities for screening and pre-referral care for GDM	360 Public & Private Primary HCPs to be trained	360 public & private HCPs trained 4 trainings organized for Primary HCPs
4) Enhance the capacity of secondary and tertiary public and private health facilities for GDM care	60 HCPs working in 4 Secondary health facilities to be trained 144 OBGYN department staff and 144 specialist staff in tertiary health facilities trained to manage GDM	78 Secondary HCPs trained 4 trainings organized for Secondary HCPs 306 OBGYN and Specialist staff trained 4 trainings organized for Tertiary HCPs
5) Promote GDM intervention activities using evidence based scientific publications, media reports and stakeholders’ fora		4 stakeholders meetings/ Dissemination of findings 10 Abstracts presentations 4 Journal publications 720 Mass media jingles 60 broadcasts (TV/Radio/Newspaper) 10 Online posts on WDF sponsored events. locally, nationally, regionally, and internationally

EMERGING ISSUES

1. Free screening services identified a GDM prevalence of 5.9%. Majority of the women diagnosed as having GDM were successfully referred to care.
2. Both baseline and end of project surveys identified poor health workers attitude to clients as a threat to utilization of antenatal and delivery services
3. Awareness of GDM prevention and care increased among community residents during the three years of project implementation.
4. Poor record keeping culture at the implementing health facilities negatively affected monitoring and evaluation.
5. Shortages in health care staff in public and private facilities and frequent internal movements of staff lead to numerous occurrences of relapse in provision of GDM.

RECOMMENDATIONS AND SUSTAINABILITY ACTIONS

1. Universal screening for Gestational Diabetes Mellitus during antenatal should be entrenched as National and State policies for antenatal care
2. The Rivers State Health Insurance Scheme should be passed into law to facilitate free screening services for gestational diabetes mellitus for every pregnant woman in Rivers State
3. There is urgent need to entrench a client feedback assessment of the services rendered by health care workers with consequence management.
4. Regular data review meetings will ensure quality data entry, use and feedback for all facilities
5. The Non-Communicable Disease Desk Office at the State Ministry of Health needs to be strengthened with the training and deployment of NCD focal persons at LGAs and facility level to ensure sustainability of universal screening for GDM.