Improving antenatal care screening and monitoring of women with GDM, Indonesia

Objectives

The transition from agricultural to industrial community has been recognised as the main contributor to the increasing prevalence of diabetes in Asia. Changing lifestyles have resulted in increasing rates of obesity in the general population and many women have delayed their first pregnancy to a later age; two factors that may explain the increasing rate of gestational diabetes (GDM) – diabetes in pregnancy.

Gestational diabetes increases health risks to the woman and her developing fetus, both during pregnancy and shortly after delivery, but also the long term risk of developing type 2 diabetes in both mother and child.

The prevalence of gestational diabetes in 2011 was estimated to be between 1.9 to 3.6 %, but this estimate may be too low and outdated. Overweight women have a higher risk of developing GDM, studies report, and those numbers have doubled in recent years: Prevalence in obesity among adult women has gone from 15.5 % in 2010 to 32.9 % in 2013.



Objectives

The project will implement a pilot project on GDM at primary level in two provinces in Indonesia. The goal is to provide training and improve knowledge in health care professionals about the importance of screening and monitoring patients with GDM, as well as improving knowledge about GDM in pregnant mothers and their families.

Approach

This project builds to some extent on previously WDF-supported projects that strengthened diabetes clinics in the targeted areas.

After initial development of health education materials, medical doctors and obstetricians will receive a 2-day training to become Trainer of Trainers (ToTs).

Next step will be a 2-day training of health care professionals from primary health care centres, training them in screening for GDM and GDM management, which is followed by a separate 2-day training of community health workers.

Then, universal GDM screening, health education and care will be rolled out at targeted primary level centres providing ANC services.

This screening model will use a one-step approach screening for GDM (at first antenatal care visit and at 24-28 weeks), referral and treatment and postpartum screening (6 weeks) and follow-up services to those diagnosed with GDM. This part of the programme also will include regular forum group discussions with pregnant women and family members that are held by trained HCPs in order to advocate for GDM screening.

Additionally, patients will be given education in self-evaluation every three months by the primary health care staff.

Finally, for the purpose of presenting outcomes and to advocate for inclusion of antenatal/GDM screening and treatment in the Indonesian health care reimbursement scheme, national and regional forum group discussions with National Health Insurance (BPJS) will be organised.

Results at completion

20 trainers (ToTs) trained
203 primary level health care professionals trained
512 community health workers trained
1,400 pregnant women screened and 18 GDM patients detected and followed-up
GDM screening register, referral forms and tracking tools introduced