Abstract:
Gestational Diabetes Mellitus (GDM), defined as
‘any degree of glucose intolerance with onset or
first recognition during pregnancy’, accounts for
certain adverse maternal and perinatal outcomes.
Early detection and prompt glycaemic control
can minimize such outcomes, thus universal
screening for GDM is recommended. It has been
incorporated to the maternal care programme
since 2014 and carried out twice during antenatal
period at field antenatal clinics. This study aimed
to assess service related factors associated with
effective implementation of antenatal GDM
screening programme among mothers in Matara
district. In a cross-sectional study, 423 post-
partum mothers delivered at three secondary
care hospitals in Matara district were recruited
using a proportionate sampling technique. Data
on access to antenatal GDM screening services
and screening process were collected using an
interviewer-administered questionnaire, and
data on availability of screening facilities were
collected using a data record sheet. Chi square
test and Fisher’s exact test were used to test the
association between variables. Response rate was
92.3%. Distance to the nearest lab with blood
sugar testing was <30 minutes’ reach for 91.7%
participants. Area Public Health Midwife was
not available during the time of first and second
GDM screening for 5.5% and 13.2% participants
respectively and availability of logistics were
22.7% and 11.5%.Coverage and timeliness of first
screening were found to be 91.4% and 72.4%,
respectively and corresponding figures for
second screening were94.5% and 59.5%. Proper
documentation and appropriate referral were
done in 76.8% and 47.7% respectively after first
screening and in 65.4% and 21.2% after second
screening. Screening coverage was negatively
associated with a longer distance to nearest
laboratory (p=0.002) and timeliness with non-
availability of logistics (p=0.002) in second
screening, but not in first screening. Despite higher
coverage, GDM screening programme needs
improvement in timeliness, proper documentation
and appropriate referrals. Availability of logistics
at MOH level will improve performance of GDM
screening and hence maternal care package.
