scholarly journals Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions

2020 ◽  
Author(s):  
Bettina Utz ◽  
Bouchra Assarag ◽  
Touria Lekhal ◽  
Wim Van Damme ◽  
Vincent De Brouwere
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Management Approach ◽  
Care Providers ◽  
Diabetes Screening ◽  
Primary Level ◽  
Care Services

Abstract Background: Gestational diabetes mellitus (GDM) is associated with an increased risk for a future type 2 diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers. Methods : As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. After transcription of data, we thematically analysed the data using a combined deductive and inductive approach. Results: The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. An existing lack of knowledge about gestational diabetes in the community and among private health care physicians required of public providers to spend more time on counselling women. Nurses had to adapt recommendation on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes, and to take decisions on treatment and follow-up. Conclusions : Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers.

scholarly journals Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions

2020 ◽  
Author(s):  
Bettina Utz ◽  
Bouchra Assarag ◽  
Touria Lekhal ◽  
Wim Van Damme ◽  
Vincent De Brouwere
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Management Approach ◽  
Care Providers ◽  
Diabetes Screening ◽  
Primary Level ◽  
Care Services

Abstract Background: Gestational diabetes mellitus (GDM) is associated with an increased risk for a future type 2 diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers. Methods : As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. After transcription of data, we thematically analysed the data using a combined deductive and inductive approach. Results: The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. An existing lack of knowledge about gestational diabetes in the community and among private health care physicians required of public providers to spend more time on counselling women. Nurses had to adapt recommendation on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes, and to take decisions on treatment and follow-up. Conclusions : Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers.

scholarly journals Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions

2019 ◽  
Author(s):  
Bettina Utz ◽  
Bouchra Assarag ◽  
Touria Lekhal ◽  
Wim Van Damme ◽  
Vincent De Brouwere
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Management Approach ◽  
Care Providers ◽  
Diabetes Screening ◽  
Primary Level ◽  
Care Services

Abstract Background Gestational diabetes mellitus (GDM) is associated with an increased risk for a future diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers. Methods As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. Looking at the main themes screening, diagnosis, treatment and service organization, we thematically analyzed the data using a combined de- and inductive approach. Results The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. Lack of knowledge about gestational diabetes in the community but also by private health care providers demanded more time for counseling. Nurses had to adapt recommendation on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes and the ability to take decisions on follow-up. Conclusions Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers.

scholarly journals Implementation of a new program of gestational diabetes screening and management in Morocco: A qualitative exploration of health workers’ perceptions

2020 ◽  
Author(s):  
Bettina Utz ◽  
Bouchra Assarag ◽  
Touria Lekhal ◽  
Wim Van Damme ◽  
Vincent De Brouwere
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Management Approach ◽  
Care Providers ◽  
Diabetes Screening ◽  
Primary Level ◽  
Care Services

Abstract Background: Gestational diabetes mellitus (GDM) is associated with an increased risk for a future type 2 diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers. Methods : As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. After transcription of data, we thematically analysed the data using a combined deductive and inductive approach. Results: The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. An existing lack of knowledge about gestational diabetes in the community and among private health care physicians required of public providers to spend more time on counselling women. Nurses had to adapt recommendation on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes, and to take decisions on treatment and follow-up. Conclusions : Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers.

scholarly journals Quality of antenatal care services in Rwanda: assessing practices of health care providers

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Akashi Andrew Rurangirwa ◽  
Ingrid Mogren ◽  
Joseph Ntaganira ◽  
Kaymarlin Govender ◽  
Gunilla Krantz
Keyword(s):  
Health Care ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Care Services

scholarly journals Health Care Providers’ Perceptions of Responsibilities and Resources to Reduce Type 2 Diabetes Risk After Gestational Diabetes Mellitus

2018 ◽  
Vol 36 (2) ◽  
pp. 160-167
Author(s):  
Sumali S. Hewage ◽  
Shweta R. Singh ◽  
Claudia Chi ◽  
Jerry K.Y. Chan ◽  
Tong Wei Yew ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Diabetes Risk ◽  
Care Providers

scholarly journals Health Care Professionals’ Perspectives On Screening And Management Of Gestational Diabetes Mellitus In Public Hospitals Of South India – A Qualitative Study

2020 ◽  
Author(s):  
Biswamitra Sahu ◽  
Giridhara R Babu ◽  
Kaveri Siddappa Gurav ◽  
Maithili Karthik ◽  
R Deepa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Public Hospitals ◽  
Effective Management ◽  
Care Providers ◽  
Management Services

Abstract Background Women developing Gestational Diabetes Mellitus are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM is essential in preventing progression to type 2 diabetes mellitus. Although the burden of Gestational Diabetes Mellitus is high in India, Gestational Diabetes Mellitus screening and management is suboptimal in public hospitals. We aimed to explore the perspectives of healthcare providers regarding the barriers and facilitators from the health system context that restrict the timely screening and effective management of Gestational Diabetes Mellitus. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants ( Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using grounded theory approach by NVivo 12 plus Results Health care providers recognized and supported the need for design and implementation of Gestational Diabetes Mellitus screening and management services. While obstetricians were aware of the national guidelines regarding screening and management; nurses mentioned that they had unmet training needs in health promotion. Barriers identified to timely screening and management of Gestational Diabetes Mellitus included unmet training needs of nurses regarding Gestational Diabetes Mellitus, delay in screening of pregnant women accessing antenatal care at private clinics initially and subsequently reporting at public hospital in late gestation, migration of pregnant women due to delivery of first born at natal home, lack of follow up system of deferred cases for gestational diabetes screening, resource deficit, and long waiting hours. Conclusion Provided the fact that there is effectiveness of Gestational Diabetes Mellitus screening and management services, there is a pressing need to develop and improve existing Gestational Diabetes Mellitus Screening and Management services to tackle the growing burden of Gestational Diabetes Mellitus in India. With the urgent need for these services, it needs to be extended to public hospitals.

scholarly journals Health care professionals’ perspectives on screening and management of gestational diabetes mellitus in public hospitals of South India – a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Biswamitra Sahu ◽  
Giridhara R. Babu ◽  
Kaveri Siddappa Gurav ◽  
Maithili Karthik ◽  
Deepa Ravi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Gestational Diabetes ◽  
Health Care Providers ◽  
Public Hospitals ◽  
Effective Management ◽  
Care Providers

Abstract Background Women developing Gestational Diabetes Mellitus (GDM) are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM are essential in preventing progression to type 2 diabetes mellitus. We aimed to explore the perspectives of healthcare providers regarding the barriers from the health system context that restrict the timely screening and effective management of GDM. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India’s major city (Bengaluru). The interviews were conducted in the preferred language of the participants (Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using the grounded theory approach by NVivo 12 plus. The findings are put into perspective using the socio-ecological model. Results Health care providers identified delayed visits to public hospitals and stress on household-level responsibilities as barriers at the individual level for GDM screening. Also, migration of pregnant women to their natal homes during first pregnancy is a cultural barrier in addition to health system barriers such as unmet nurse training needs, long waiting hours, uneven power dynamics, lack of follow-up, resource scarcity, and lack of supportive oversight. The barriers for GDM management included non-reporting women to follow - up visits, irregular self-monitoring of drug and blood sugar, trained staff shortage, ineffective tracking, and lack of standardized protocol. Conclusion There is a pressing need to develop and improve existing GDM Screening and Management services to tackle the growing burden of GDM in public hospitals of India.

scholarly journals Factors for Late Initiation of Antenatal Care in Kahama Municipal, Tanzania

2022 ◽  
Vol 3 (1) ◽  
pp. 1-10
Author(s):  
Hamis Bakari ◽  
Gladys Reuben Mahiti
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Health Facility ◽  
Health Care Providers ◽  
Unplanned Pregnancy ◽  
Care Providers ◽  
Care Services ◽  
Late Initiation

Background: Maternal mortality is a major public health issue in developing countries due to its shocking magnitude and lower declining pattern, 295 000 women died of pregnancy or childbirth related complications in 2017. Late initiation of Antenatal Care (ANC) services in most low-income countries like Tanzania has been reported as a major problem which increase maternal mortality rate (MMR). However, different factors for late initiation of antenatal care are not well identified. Therefore, this study aimed to identify factors for late initiation of antenatal care both individual factors and health policy factors as per pregnant women and health care providers opinions in Kahama Municipal, Tanzania. Broad Objective: The study focused on assessment of factors for late initiation of Antenatal Care (ANC) in Kahama Municipal, Tanzania. Materials and Methods: This study was conducted using a qualitative method with exploratory approach which was carried out to explore factors for late initiation of antenatal care in Kahama Municipal. An in-depth interview (IDI) and Focus Group Discussion (FGD) were methods used to collect data. The study comprised of 14 in-depth interviews (IDIs) with pregnant women with age range of 18 years to 49 years attending antenatal care clinics in two health facilities and 4 in-depth interviews (IDIs) with health care providers attending pregnant women during antenatal care clinic visit. Furthermore, two Focus Group Discussions (FGDs), one from each health facility with pregnant women were conducted. Data Analysis: Thematic analysis was conducted through use of inductive approach. The audio recordings were conducted using the Swahili language then transcribed and translated into the English language where themes were obtained after translation. Results: Findings obtained from this study were factors for late initiation of antenatal care as reported by both pregnant women and health care providers. Factors for late initiation of antenatal care were under guidance of Health Behavioral Modal (HBM): Factors mentioned by pregnant women included pregnant women education level, negligence of pregnant women to attend clinic, unplanned pregnancy among couples, distance from pregnant women settlement to the facility, pregnant women misconceptions related to antenatal care services, use of local herbs, pregnancy complications, , unfriendly services and unequal gender power relation within a family. Factors mentioned by health care providers based on health policy and managerial factors such as Partner accompanying policy, distant allocation of health facility from people’s settlement and unfriendly services provided by health care providers. Conclusion: This study focused on assessing factors for late initiation of antenatal care in Kahama municipal council in Shinyanga, Tanzania. Different factors for late initiation of antenatal care were reported which included pregnant women and health care providers. Pregnant women education level, negligence of pregnant women to attend clinic, unplanned pregnancy among couples, and distance from pregnant women settlement to the facility, pregnant women misconceptions related to antenatal care services, use of local herbs, pregnancy complications. Health policy and managerial related factors were partner accompanying policy, unfriendly services, and allocation of health facility. Recommendation: However different improvement made on maternal health services in Tanzania but still some of pregnant women are not utilizing it efficiently because of different obstacles like distance from people’s settlement to the health facility, Partner accompanying policy and unfriendly services provided by health care providers. Through such obstacles as a policy maker, I would like to advice Government through Ministry of Health to allocate health facility nearby people’s settlement, providing outreach program to educate the community about antenatal care rather than relying on partner accompanying policy and lastly is provision of refresher training related to client’s rights during health care services provision to all staff.

scholarly journals Health Care Professionals’ Perspectives on Screening and Management of Gestational Diabetes Mellitus in Public Hospitals of South India – a Qualitative Study

2020 ◽  
Author(s):  
Biswamitra Sahu ◽  
Giridhara R Babu ◽  
Kaveri Siddappa Gurav ◽  
Maithili Karthik ◽  
R Deepa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health System ◽  
Health Care Providers ◽  
Resource Scarcity ◽  
Public Hospitals ◽  
Care Providers

Abstract Background Women developing Gestational Diabetes Mellitus (GDM) have a higher risk of developing Type 2 Diabetes later in life. We aimed to explore the perspectives of healthcare providers regarding the barriers from the health system context that restrict the timely screening and effective management of GDM. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants ( Kannada for nurses, English for the obstetricians), and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using grounded theory approach by NVivo 12 plus. The findings are put into perspective using the socio-ecological model. Results Health care providers identified delayed visits to public hospitals and stress on household-level responsibilities as barriers at the individual level for GDM screening. Also, migration of pregnant women to natal home during first pregnancy is a cultural barrier in addition to health system barriers such as unmet nurse training needs, long waiting hours, uneven power dynamics, lack of follow-up, resource scarcity, and lack of supportive oversight. The barriers for GDM management included non-reporting women to follow - up visits, irregular self-monitoring of drug and blood sugar, trained staff shortage, ineffective tracking, and lack of standardized protocol. Conclusion There is a pressing need to develop and improve existing GDM Screening and Management services to tackle the growing burden of GDM in public hospitals of India.

scholarly journals Utilization of antenatal health care services and its impact on birth weight of newborn in rural area of Western Rajasthan, India

2017 ◽  
Vol 4 (3) ◽  
pp. 680 ◽  
Author(s):  
Sandeep Kumar Uppadhaya ◽  
Neha Agrawal ◽  
Suman Bhansali ◽  
Kapil Garg ◽  
Mahendra Singh
Keyword(s):  
Health Care ◽  
Birth Weight ◽  
Antenatal Care ◽  
Rural Area ◽  
Health Care Providers ◽  
Health Care Services ◽  
Nuclear Family ◽  
Care Providers ◽  
Care Services ◽  
Antenatal Visits

Background: Antenatal care is an important component of reproductive and child health but has not been utilized to the full extent in India. The study is aimed to assess the utilization of antenatal health care services by mothers and its impact on birth weight of their newborn.Methods: A community based cross sectional study was conducted in a rural area of Jodhpur, Rajasthan. A total of 198 women of study area who have delivered between 1st July 2013 to 30thJune 2014 (12 months period) were interviewed by pre-designed and semi-structured questionnaire by door to door approach.Results: Present study showed that 100% of mothers registered their pregnancy in any health facility and 56.6% were registered in 2nd trimester. Only 32.8% mothers had received four or more antenatal visits. Only 26.26% mothers had utilized full antenatal care (minimum four antenatal visits, minimum one TT and minimum 100 IFA tablet taken) during pregnancy. The prevalence of low birth weight was 12.6%. Proportion of LBW babies was more (15.9%) in mothers who had not availed of full antenatal care. This difference was statistically significantly (P<0.05).Conclusions: The important factors related to low utilization of Antenatal services were lower socioeconomic status, lower literacy of mothers, working mothers, parity and nuclear family. The findings of this study may be utilized by the health managers and health care providers to address the problem of low ANC coverage.

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