The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (UK) witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to the conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights the contemporary necessity to equip and empower all maternity stakeholders to deliver the basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational Diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families, aiming to foster long term healthy lifestyle changes. The final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened the “diagnosis to first consultation” intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of GBP 66,384 a year.

The Good Pregnancy Network: An Alternative Approach for Gestational Diabetes

Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (U.K), witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights contemporary necessity to equip and empower all maternity stakeholders to deliver basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families; aiming to foster long term healthy lifestyle changes. Final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened ‘diagnosis to first consultation’ intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of £66,384 a year.

Knowledge and Attitudes on Gestational Diabetes Mellitus and its Associated Factors among a Selected Population of Pregnant Mothers Attending Antenatal Clinics in Mathugama, Western Province of Sri Lanka

Introduction: Diabetes Mellitus (GDM) has become an emerging metabolic disorder around the world leading to type 2 diabetes mellitus in two generations, including the mother and the offspring. Complications associated with GDM can be prevented by proper management of the disease. This study aimed to assess knowledge and attitudes on GDM and its associated factors in a selected population of pregnant mothers in Sri Lanka. Methods: A descriptive cross-sectional study was carried out among eight antenatal clinics in the Mathugama Medical Officer of Health (MOH) area, Sri Lanka. Pregnant mothers of less than 20 weeks of gestation (n=150) attending the above clinics were selected by convenience sampling. A pre-tested, interviewer-administered questionnaire was used as the data collection instrument. The SPSS version 23 was used for data analysis. Descriptive statistics, visual binning, independent sample t-test and bivariate correlation were used as statistical tools. Results: Only 4.7% of participants had developed GDM previously. The mean gestational age of the study participants was 12±5 weeks. The mean percentage knowledge score regarding GDM was 36.1±23.3%. Only 20.0% had good knowledge and 35.3% had poor knowledge about GDM. Age (p=0.017), level of education (p=0.024), history of GDM (p=0.033), and family history of diabetes mellitus (p=0.025) had significant associations with the knowledge on GDM. In addition, positive correlations were found between the mean knowledge score for GDM and gestational age (p=0.001), and the gravidity (p=0.018) of the participants (p<0.05). Conclusions: Only a minority of the study group (20.0%) had good knowledge about GDM while, more than 50.0% of the participants showed positive attitude towards the management of GDM. Therefore, taking measures to enhance the pregnant mothers’ knowledge regarding GDM is a timely and important action that ultimately leads to healthy pregnancy outcomes. Keywords: Gestational diabetes mellitus, Pregnant mothers, Knowledge, Attitudes, Associated factors

Establishing Approaches and Practices Used by Midwives in Mental Health Assessment of Pregnant Women Making Visits to Antenatal Clinics in Public Health Facilities in Tharaka Nithi County

Mental health assessment is a critical practice to promote quality health among pregnant women and unborn children. The approaches and practices that midwives adopt at the antenatal clinics determined the mental health assessment success and the effectiveness of the subsequent treatment. Different studies concerning maternal mental health assessment have focused on issues of prevalence, barriers, and factors hindering or promoting assessment. However, there are limited studies exploring approaches and practices that enhance mental health screening. A sample of 45 midwives and 85 pregnant women was selected from public health facilities in TNC. Analysis of data and coding was done using SPSS with results presented in tables, bar graphs, and pie charts. Only 14% of midwives used training as an approach towards promoting mental health. Both midwives and pregnant women registered low involvement in providing information. The county government and the hospitals’ stakeholders should invest in approaches and practices that prioritize mental health assessment to prevent any mental health complications among pregnant women. Key words: Maternal mental health; mental health assessment, pregnant women, midwives, approaches and practices.

The Good Pregnancy Network: An Alternative Approach for Gestational Diabetes

Basildon and Thurrock University Hospital witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team&rsquo;s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights contemporary necessity to equip and empower all maternity stakeholders to deliver basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic &ldquo;hub&rdquo; to Educating Gestational diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS &ldquo;faculty&rdquo; includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families; aiming to foster long term healthy lifestyle changes. Final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened &lsquo;diagnosis to first consultation&rsquo; intervals, eliminated overbooked specialist clinics (none since January 2016), substantially improved clinical outcomes, boosted research recruitment and avoided additional running costs to the tune of &pound;66,384 a year.

An Analysis of Levels and Trends in HIV Prevalence Among Pregnant Women Attending Antenatal Clinics in Karnataka, South India, 2003-2019

Background and Objective: Periodic tracking of the trends and the levels of HIV prevalence at regional and district levels helps to strengthen a state’s HIV/AIDS response. HIV prevalence among pregnant women is crucial for the HIV prevalence estimation of the general population. Karnataka is one of the high HIV prevalence states in India. Probing regional and district levels and trends of HIV prevalence provides critical insights into district-level epidemic patterns. This paper analyzes the region- and district-wise levels and trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in Karnataka, South India. Methods: HIV prevalence data collected from pregnant women in Karnataka during HIV Sentinel Surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into four zones (Bangalore, Belgaum, Gulbarga and Mysore regions), totaling 60 sites, including 30 urban and 30 rural sites. Regional and district-level HIV prevalence was calculated; trend analysis using Chi-square trend test and spatial analysis using QGIS software was done. For the last three HSS rounds, HIV prevalence based on sociodemographic variables was calculated to understand the factors contributing to HIV positivity in each region. Results: In total, 254,563 pregnant women were recruited. HIV prevalence in Karnataka was 0.22 (OR: 0.15 95% CI: 0.16 - 0.28) in 2019. The prevalence was 0.24, 0.32, 0.17 and 0.14 in Bangalore, Belgaum, Gulbarga, and Mysore regions, respectively. HIV prevalence had significantly (P< 0.05) declined in 26 districts. Conclusion and Global Health Implications: HIV prevalence among pregnant women was comparatively higher in Bangalore and Belgaum regions. Analysis of contextual factors associated with the transmission risk and evidence-based targeted interventions will strengthen HIV management in Karnataka. Regionalized, disaggregated, sub-national analyses will help identify emerging pockets of infections, concentrated epidemic zones and contextual factors driving the disease transmission. Copyright © 2021. Arumugam et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Suboptimal HIV status ascertainment at antenatal clinics and the impact on HIV prevalence estimates

IntroductionHIV prevalence estimates is a key indicator to inform the coverage and effectiveness of HIV prevention measures. Many countries including Kenya transitioned from sentinel surveillance to the use of routine antenatal care data to estimate the burden of HIV. Countries in Sub Saharan Africa reported several challenges of this transition, including low uptake of HIV testing and sub national / site-level differences in HIV prevalence estimates.MethodsWe examine routine data from Kwale County, Kenya, for the period January 2015 to December 2019 and predict HIV prevalence among women attending antenatal care (ANC) at 100% HIV status ascertainment. We estimate the bias in HIV prevalence estimates as a result of imperfect uptake of HIV testing and make recommendations to improve the utility of ANC routine data for HIV surveillance. We used a generalized estimating equation with binomial distribution to model the observed HIV prevalence as explained by HIV status ascertainment and region (Sub County). We then used marginal standardization to predict the HIV prevalence at 100% HIV status ascertainment.ResultsHIV testing at ANC was at 91.3%, slightly above the global target of 90%. If there was 100% HIV status ascertainment at ANC, the HIV prevalence would be 2.7% (95% CI 2.3-3.2). This was 0.3% lower than the observed prevalence. Similar trends were observed with yearly predictions except for 2018 where the HIV prevalence was underestimated with an absolute bias of -0.2%. This implies missed opportunities for identifying new HIV infections in the year 2018.ConclusionsImperfect HIV status ascertainment at ANC overestimates HIV prevalence among women attending ANC in Kwale County. However, the use of ANC routine data may underestimate the true population prevalence. There is need to address both community level and health facility level barriers to the uptake of ANC services.Key questionsWhat is already known?▪HIV surveillance estimates from antenatal clinics (ANC) can serve as a useful proxy for HIV prevalence trends in the general female population.▪Kenya has conducted multiple studies which have shown that national HIV prevalence estimates from sentinel surveillance and those from routine program data to be similar.▪However, these studies have also revealed ongoing challenges to the suitability of using routine data as compared to sentinel surveillance including sub optimal uptake of HIV testing and sub national/ site-level differences in HIV prevalence estimates.What are the new findings?▪HIV positive pregnant women are more likely to be tested at ANC as compared to HIV negative women, leading to higher HIV prevalence estimates among women attending ANC.▪Health facility level HIV prevalence estimates are lower than that of the general population.What do the new findings imply?▪HIV positive women are underrepresented in antenatal clinics.▪In Kwale County (and similar contexts), use of routine ANC data is still not a reliable method to estimate HIV prevalence, both at facility and community level.