GDM advocacy and capacity building, Bangladesh

Objectives

In recent decades Bangladesh has made considerable progress in improving the health of its population. Especially infectious disease control efforts have been comparably successful. However, the burden of non-communicable diseases, like diabetes, continues to rise, with a diabetes prevalence approaching 10%. An important contributor to the increasing prevalence of diabetes is the growing number of women who develop diabetes during pregnancy - gestational diabetes (GDM). If GDM is left uncontrolled, the mother has an increased risk of developing severe complications during pregnancy, and both mother and child have a significantly elevated risk of developing type 2 diabetes later in life.

In Bangladesh, there is a pervasive lack of knowledge about GDM among the general population. GDM is largely unaddressed within the general healthcare system, with access to GDM screening and care services being limited to a few major hospitals.
Consequently, most women will remain unaware of their disease status. Rural pregnant women are considered particularly "hard-to-reach", since only a minority of them opt for antenatal care services and health facility-based delivery.

Although between five and ten percent of pregnant women suffer from GDM, Bangladesh has yet to develop policies and initiatives aiming at sensitising the population, and to provide GDM-services within the general system. Prompt action is needed to reverse the trend and will not only be beneficial to the mother but also to her child.

The aim of this project is to address GDM-related morbidity and mortality through community-based advocacy and capacity building in six districts of Bangladesh.

Approach

This project is initiated by the Health and Disease Research Center for Rural Peoples (HDRCRP), an NGO focusing on emerging health problems among poor, vulnerable populations. The project activities will be piloted in twelve sub-districts (upazilas) in six different districts; Manikgonj, Tangail, Sirajgonj, Bogra, Chittagong and Lakshmipur. Project activities will be run in collaboration with Grameen Kalyna; BIRDEM; local HCPs; Local communities; Preach International; National Heart Foundation Hospital & Research Institute; Bangladesh Diabetic Association (BDA); Bangladesh Society of Gynaecology and Obstetrics (BSGO).

The project has three main objectives:
1. To ensure GDM service availability within the national health care system
2. To increase GDM awareness among the general population
3. To seek policy reforms through community-based advocacy

Twelve existing Primary Health Centres (PHC) , providing ante natal care (ANC) services, will be strengthened to perform GDM screening and care. 24 general practitioners from public and private primary health care facilities will be trained as trainers in diabetes and GDM management and screening. They will be responsible for training 48 nurses and paramedics at the primary level. At the secondary level, twelve diabetologists and gynaecologists, and 24 nurses from private and public hospitals will be trained; as well as 10 doctors from highly specialised tertiary health facilities. 480 community and village-based health workers, including traditional birth attendants, will also be trained. Women diagnosed with GDM will receive education on diet and exercise at the primary level, and referred if necessary. As a support mechanism, a web-based database will be set up to ensure proper follow up and referral.

The ultimate aim of the project is to ensure equal access to GDM services for all. While opting for universal screening, special attention will be paid to the “hard-to-reach” rural women who do not attend ANC services. These women will in part be reached by having trained community health workers conducting motivational visits to increase utilisation of ANC services.

Various community sensitisation activities will be carried out to create awareness among the general population. IEC materials for this component of the project will be based on a survey conducted in selected rural communities, collecting information on GDM indicators as well as knowledge levels.

The project will organise Advocacy Forums and train stakeholders from all administrative levels. The Advocacy Forums will serve as a mediating forum between local community and government, and will gather government representatives, health care providers, teaching institutions and other stakeholders.

The project is envisioned to be mainstreamed within public health services and replicated throughout Bangladesh.

Results at completion

• 12 GDM corner establishment
• 46 medical doctors, 72 nurses and 480 community health workers trained in GDM management
• Database creation on GDM
• Baseline survey and KAP on GDM involving 2,400 persons
• 36,250 pregnant women screened for GDM
• 3791 GDM positive cases treated
• Two round-table conference at national level on GDM conducted