Objectives and approach
In India, 61.3 million people live with diabetes, and 50 million more are at risk (IDF, 2011). Recent data indicates that between 9 to 17 % pregnant Indian women have gestational diabetes (Seshiah V et al 2009).
Uttar Pradesh is the most populous state in India (215 million people) and also the state with one of the highest maternal and infant mortality rates. Amongst many other causes, undiagnosed and untreated GDM is speculated to play a role largely due to the lack of knowledge about and its consequences among health care professionals.
Screening for GDM is particularly crucial in this region because Indian and Asian women are considered to be at the highest risk of developing glucose intolerance and GDM compared to other ethnic groups.
The goal of this project is to improve detection and management of gestational diabetes by building capacity in the public health system, whereby the area of NCD prevention anc area shall become closer integrated with maternal care/RCH.
This project will be implemented by Jain Hospital, in collaboration with the Ministry of Health & Family Welfare of the government of Uttar Pradesh, India, and under the framework of a MoU between Jain Hospital and the National Rural Health Mission of Uttar Pradesh State (NRHM), a federal level programme implemented in all states of India.
The WDF support towards the programme consists of phase 1 which has been completed (WDF grant ref WDF12-678) and phase 2 (WDF grant ref WDF15-951, details of the latter are listed below, separate website page is in preparation).
Phase 1 (WDF12-678)
The pilot project in Kanpur district provided screenning to all pregnant women in the 24-28 weeks of pregnancy, and provided follow-up counselling to those diagnosed with GDM.
150 government primary healthcare centres, community healthcare centres, urban health centres, district hospitals, and other government hospitals were involved in screening and counselling pregnant women.
450 community camps were organised where pregnant women also could acquire follow-up. The strategic locations of the community camps focused on the population below the poverty line.
A free GDM telephone hotline was established to give guidance to pregnant women 12 hours a day, every day Monday to Sunday.
A GDM State Registry was established, and a GDM prevalence study was done based on the screening activities. This was the largest GDM prevalence study done in Uttar Pradesh with 55,000 women screened.
Local healthcare capacity was improved through technical and skills training for doctors, paramedics, and nurses. The medical professionals were trained in registering pregnant women, performing glucose tolerance tests, screening, diagnosing, and managing GDM.
The trainings were based on IDF’s Diabetes Education Module 2011. The training of trainers (ToT) model was used to disseminate knowledge, reaching a total of 4,000 healthcare professionals in the provinces targeted. New educational materials were developed for GDM education in the local language.
Further noteworthy, phase 1 supported the implementation of the mandatory GDM screening recently introduced by the India Federal Ministry of Health & Family Welfare.
Phase 1 results:
• Improved GDM screening in 150 government primary healthcare centres, community healthcare centres, urban health centres, district hospitals, and other government hospitals
• 55,000 pregnant women screened for GDM
• 5,000 diagnosed women received follow-up and counselling
• 4000 healthcare providers trained, including 1000 doctors, 3000 nurses, dieticians, and educators
• Training completed of 4,000 healthcare professionals using the training of trainers (ToT) model.
• Screening and reporting at 100 private/charity based hospitals
• 450 community camps established
• Media campaign reached 200,000 people in the Kanpur district
• Free telephone hotline established to provide information on GDM
Phase 2: WDF15-951
WDF Grant: USD 325,000
Grant period: 2016-2019
Through the second phase of WDF support to Uttar Pradesh state NCD response the structures established during phase 1 shall be further refined and expanded in order to become a statewide model. Further alignment with new (2015) FIGO recommendations towards hyperglycemia in pregnancy will be pursued and large scale awareness and education campaigns will be implemented while stakeholder mobilisation will take place at different administrative levels across Uttar Pradesh.
The institutional structure will continue with Jain Hospital as co-implementing agency under the framework of the Uttar Pradesh State government and the NRHM.
Expected results phase 2:
More than 1,000 health care facilities at referral, secondary and primary will be included and hence provided necessary material and equipment meanwhile more than 3,000 health care professionals and 6,000 community health workers of various categories will be trained.
Estimated 300,000 pregnant women will be screened for hyperglycemia in pregnancy/diabetes and provided education and counselling with an expected more than 40,000 women to be diagnosed and provided care