Calling all mothers

In South India, the team behind a WDF supported project is working with the local government to find and treat GDM, gestational diabetes mellitus.  Communication is one of the important weapons in the fight against GDM.

Gestational diabetes - a disease every woman is at risk of developing during pregnancy - has shown to have a high prevalence in this part of India; 12-17 % of pregnant women in urban areas develop GDM. Untreated GDM can lead to serious medical conditions for the mother and child, abortions, stillbirths and malformations appear.

Getting the attention

To attract the pregnant women, the project team has taken advantage of local methods to be sure that every woman will know about screening events in her area. Although a number of people in the target group will be informed by posters and pamphlets, there are downsides if you limit yourself to this type of one way communication; one risk is that the illiterate population is not informed about the opportunities of screening.

Therefore the team has adapted traditional Indian methods of spreading the message. One method used is to drive around in speaker vans to announce the GDM screening event. This method is used by the Tamil Nadu Government health services to motivate the community for vaccination programs and in preventing outbreaks like cholera.

“As we enter the village, a significant number of people come out of their residence due to curiosity and they hear as well as take the pamphlet and the screening schedule.”, says project responsible Dr. Seshiah; “We were most often able to stop and interact with the community. The biggest advantage is that doubts can be cleared or more information can be given immediately."

Creating short and long term awareness

Another original way of communicating used in this project is propaganda using “dandora men” - drumming men. An ancient methods used in villages to inform the community about disease outbreaks and other important community related issues. Dr. Seshiah describes event sponsoring in the local village functions as a method used to create general awareness as well as promote the screening. Door to door canvassing by field animators is a time consuming method, but is effective because it is two-way communication.

“Targeting school children works well because every household has a child who attends some kind of educational institution. This may also be more effective in creating awareness on diabetes in general. Also young girls who are likely to become mothers in the future may become aware of GDM.”

Recognising GDM is crucial for mother and child

Taking a glance at gestational diabetes it could seem as if the condition is a “light”-version of the chronic diabetes, because women with GDM during pregnancy after delivery do not have diabetes. But gestational diabetes is still a serious condition that can affect both mother and child and have long term consequences.
The mother - and in some situations depending on the inherited genetic risk - also the baby can later in life develop diabetes. During pregnancy the mother is at higher risk of developing pre-eclamtic toxemia, and of going through Caesarean delivery.

For the fetus several serious risk factors appear:

• Increased risk of early abortion
• A more than three times higher risk of congenital malformations - babies are born with deformities
• Large babies, with the risk of injury during birth
• Stillbirths
• Intrauterine growth retardation - the baby has a low weight in the uterus, which may result in significant fetal morbidity and mortality if not properly diagnosed

  
Congenital malformations have appeared in babies born by late diagnosed GDM mothers during the project

Screening day

Screening begins in the early morning. The mothers attend fasting; they are asked to skip their breakfast so that the nurses can perform the necessary blood tests.
Once the pregnant women have been diagnosed they are advised in how to handle their diabetes. Advice on diet and exercise is given and if necessary they are offered insulin and are instructed in the use and storing of insulin. After a period of introduction the women are asked to return for a monthly check-up. The women who do not show any signs of GDM are welcome to return for another check up two months later, to establish if GDM has developed.