Objectives & approach
Gestational diabetes greatly increases the risk of poor pregnancy outcome, later development of type 2 diabetes for both mother and child and it might also increase the risk of other complications. The national prevalence of GDM in Columbia is not known due to a lack of record-keeping and quality studies. However, as the type 2 diabetes rates increase the rates of GDM are also likely to go up.
Since 2000, the Columbian health system has developed GDM prevention, diagnosis and treatment programmes. However, the coverage and quality vary significantly, and protocols are not being followed. In addition, there is no record-keeping of women with GDM which is essential for preventing the development of future diabetes; once a case of glucose intolerance is detected it is extremely important to follow up the case regularly since she has a considerably increased risk of developing type 2 diabetes later in life in spite of her blood glucose levels having returned to normal after delivery. There is an urgent need for updating current protocols in Columbia to match the latest international guidelines.
The project will employ a comprehensive approach to GDM. It consists of three main steps:
The first step involves the development of GDM diagnosis and treatment guidelines and protocols as well as a restructuring of the Health Department of Barranquilla City in order to prepare for implementation. The protocols will contain guidelines on how to diagnose and treat GDM as well as guidelines for monitoring and on how to educate women about the importance of lifestyle in the prevention of type 2 diabetes and associated complications. The protocols are envisioned to become a part of the routine of antenatal care, and services will be provided free of charge for the women.
The second step involves capacity building of health care professionals within diagnosis and treatment of GDM. Various health care professionals, including university professors, will go through a comprehensive training programme on GDM and how to implement the new protocols. In this way the capacity building component is expected to create a snowball effect.
The third step involves the implementation of a "Pregnant Women Control Programme" where the guidelines and protocols as well as the acquired skills of the health care workers will be applied. The project will cover all public health centres and almost half of the private health centres in Barranquilla.
In addition, the programme will include an awareness and information component among other things in the shape of a campaign at primary care level. The campaign is expected to reach 70-80% of the pregnant women in Barranquilla.
In December 2010, the maternity hospital was inaugurated and it will now function as a reference centre providing the highest level of complex care for pregnant women. A special GDM department will be established providing specialised care and post-partum monitoring. Health records will be kept to ensure that women with GDM are continuously monitored at the maternity hospital after child birth.
The project expects to reach 72% of the pregnant population in Barranquilla during the initial two years of the project. It is the hope that this percentage will increase to 80% when the three year project period is over. The project will cover more than 90% of the public subsidised health care system which provides services mainly to women who have limited access to health care,.
It is the hope that Barranquilla will pave the way for a comprehensive national GDM programme.
- New GDM diagnosis and treatment guidelines to be developed and implemented in Barranquilla healthcare system
- 59 clinics to be specialised in GDM guidelines
- IEC materials to be developed and introduced
- 286 health care providers and 45 university professionals to be trained in diagnosis and treatment of GDM
- 25,000 women to be screened for GDM and 1,250 women to be diagnosed with and treated for GDM
- 25,000 women to be reached through awareness and information campaign
- GDM patient registry to be established for the Barranquilla district