Optimizing screening practice for gestational diabetes mellitus in primary healthcare facilities in Tanzania
PhD summary
Tanzania is facing a rising prevalence of obesity in the general population, including women of reproductive age. Excess weight pre-pregnancy is a risk factor for the onset of gestational diabetes mellitus (GDM), a high-risk condition predisposing both the woman and the newborn to several complications during and after pregnancy, including an increased risk of developing type 2 diabetes. As part of good clinical practice, screening for GDM during pregnancy, particularly during antenatal care (ANC) is critical to timely diagnosis and treatment. However, screening for GDM is not standardized in primary care facilities where most pregnant women in Tanzania receive routine antenatal care, leading to missed or late diagnosis and suboptimal care during pregnancy and beyond.
This study will explore the current practices of screening for GDM during routine antenatal care, estimate the prevalence of GDM in pregnancy, compare the performance of two commonly used GDM screening modalities, and explore the best ways to develop a functional screening practice for GDM at primary level hospitals in Tanzania using perspectives of health care workers, health managers, and pregnant women.
This will be a sequential mixed-methods study [quan + QUAL] →[QUAN] → [QUAL] conducted in antenatal care (ANC) clinics of two primary hospitals: Kisarawe District Hospital (KDH) in Coast region and Mbagala Rangi Tatu Hospital (MRH) in Dar es Salaam region. Quantitative data will be collected to determine the current structural capacity and screening practices for GDM, the prevalence of GDM among antenatal care users, and the sensitivity and specificity of the two recommended screening modalities. Qualitative data will be collected through key informant interviews and focus group discussions with healthcare workers and managers to understand the rationale and benefits of the used screening modality, explore the meaning of screening/diagnosis to pregnant women, and propose a functional GDM screening modality from health managers and care providers.
The main output will be a recommendation to policy makers for a context-specific functional screening modality for GDM at a primary-level hospital setup in Tanzania. This will help standardize the practice of screening for GDM at this level.