Date of Award

5-2019

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Miriam Lucy Mgonja

Second Supervisor/Advisor

Ibrahim Sendagire

Third Supervisor/Advisor

Mariam Noorani

Department

Family Medicine (East Africa)

Abstract

Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During pregnancy it is important to detect conditions which may harm the mother and fetus during antenatal care (ANC). Gestational diabetes mellitus (GDM) is one such condition which causes adverse effects during pregnancy, acutely and in the long term. There is lack of consensus on uniform screening and diagnostic guidelines for GDM both internationally and locally. Furthermore, there is evidence that recommendations in antenatal care guidelines are not routinely performed by health care providers despite clear mandate to do so. Because of these two reasons, it is likely that many women go unscreened for GDM. Despite international and local guidelines recommending screening for GDM during antenatal care, there is evidence to suggest that the practice is not being carried out adequately.

Objectives: The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the prevalence of missed diagnosis of gestational diabetes mellitus among women attending ANC and to determine the factors associated with screening for GDM among women attending ANC.

Methods: A cross-sectional analytical study was carried out at the Aga Khan Hospital, Dar es Salaam and Muhimbili National hospital. Using interviewer-administered questionnaires and reviewing antenatal records, the proportion of women who attended ANC who were screened for GDM was determined. The Chi square test and multiple logistic regression analysis were used to determine factors associated with screening for GDM.

Results: The magnitude of screening for GDM was 29.9%. Tests used in the screening for GDM were random blood sugar (RBS) 56.8%, fasting blood sugar (FBS) 32.8%, HbA1C 6% and the 75g Oral glucose tolerance test (OGTT) 3.4%. The uptake of the OGTT among women found not to have been screened for GDM was 27%. Of these women the magnitude of GDM was 27.4%. Factors associated with screening for GDM were history of big baby (p: 0.020, OR 2.15 C.I 1.127- 4.101), history of pregnancy induced hypertension (p: 0.021, OR 2.34 C.I 1.131- 4.827) and patient awareness of GDM (p <0.001, 2.79 C.I 1.749 - 4.459).

Conclusion and recommendations: The magnitude of screening for GDM among women attending ANC was lower than the WHO target. Tests which are convenient but lacking in diagnostic accuracy compared to OGTT were used. Stakeholders in health care should promote awareness and more screening for GDM. Further research should assess reasons for poor screening for GDM in ANC and develop a less cumbersome gold-standard test.

Download

Share

COinS