Uttar Pradesh is India’s most populous state, with 215 million residents, and has India’s second lowest per capita income with more than 80% of the population living below the poverty line. Uttar Pradesh has the highest maternal and child mortality rates in India. In the general population, knowledge about diabetes and gestational diabetes is as low as 12%. Among healthcare professionals, 80% are not aware of at which values to use when diagnosing GDM, and paramedics are not trained in diagnosis of GDM, or able to recognise and handle the effects of GDM in the mother and newborn.
Objectives
The project aims to create awareness, screen for and prevent gestational diabetes mellitus (GDM), and increase knowledge of the management of GDM, as well as build technical expertise, knowledge and skills in the government public health care delivery system.
Approach
The project seeks to consolidate, refine and expand the detection and management of gestational diabetes in 28 districts (population 125 million) based on lessons learned from WDF12-678, through the following activities:
Capacity building - includes upgrading of health care facilities for GDM screening, diagnosis, prevention, and management; training of trainers (TOT) by national level master trainers and training of HCPs (including doctors, nurses, dieticians) from all upgraded health care facilities in prevention and management of GDM.
Care and follow-up - ensured through the roll-out of universal screening of pregnant women for GDM in urban, semi-urban and rural areas. At post-partum screening after delivery, follow-up counselling and monitoring for women at risk of GDM and care and treatment for women diagnosed with GDM will take place.
Awareness of GDM- raised by holding community-based diabetes camps in remote areas and with help of IEC material produced for print and electronic media.
Monitoring and supervising interventions - performed by field block monitors in all 1.237 health care facilities in all 28 districts continuously. The GDM state registry and a GDM prevalence study from WDF12-678 will guide the project interventions.
State and district level workshops - organised involving high level key health officials and district chief medical officers, doctors from community health centres, urban health centre and districts hospitals.
Expected results
- 1,237 health care facilities (34 district hospitals, 432 community health centres, 771 primary health centres) upgraded
- 300,000 pregnant women screened for gestational diabetes
- 42,000 women diagnosed with GDM and 30,000 at risk for GDM counselled
- 100 TOTs, 3,000 doctors and 6,000 paramedical staff trained
- 1,350 community diabetes camps conducted
- 2 state level workshops conducted
- 56 districts workshop conducted in 28 districts
- Monitoring and evaluation on project implementation and impact relating to changes in clinical measures (HbA1c)
Results upon completion:
- 1,304 health facilities were capacitated for screening regarding GDM. Health structures included: Govt health facility including CHCs (community health center), Rural CHCs, PHCs (primary health centers), UHP(urban health post), UFWC (urban family welfare centres) centers, new PHCs (new primary health centers) and in 1,000 wellness Centre.
- 1,574 community camps for screening diabetes were held in 44 Districts for GDM,
- 1.290,799 pregnant women screened in 1,304 health care facilities in 44 Districts.
- 122,466 women were diagnosed as GDM (prevalence rate 9.5 %)
- 11,500 glucometers were distributed to Field ANM (nurse) and 3450 glucometers were distributed in 1304 Health facilities.
- (12.2%) 11,817 tested for post-partum blood glucose and out of them 22.6% (2,670) were detected with T2DM.
- Training of 5,165 doctors including physician, primary care physicians, gynaecologist obstetricians
- 3,638 nurses and 4,766 paramedics with total 8,404 in 44 districts trained in two days, nurses, GNMs.
- Three advocacy workshop at Lucknow with media was organised in Lucknow with SPMU.
- 57 districts Workshop was organized in 44 districts in the State
