Copenhagen School of Global Health, Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, Bd, 9, entrance P, DK, 1353, Copenhagen K, Denmark.
BMC Int Health Hum Rights. 2012 Dec 5;12:33. doi: 10.1186/1472-698X-12-33.
Maternal mortality and morbidity remains high in many low- and middle-income countries (LMIC). Gestational Diabetes Mellitus (GDM) represents an underestimated and unrecognised impediment to optimal maternal health in LMIC; left untreated - it also has severe consequences for the offspring. A better understanding of the barriers hindering detection and treatment of GDM is needed. Based on experiences from World Diabetes Foundation (WDF) supported GDM projects this paper seeks to investigate societal and health system barriers to such efforts.
Questionnaires were filled out by 10 WDF supported GDM project partners implementing projects in eight different LMIC. In addition, interviews were conducted with the project partners. The interviews were analysed using content analysis.
Barriers to improving maternal health related to GDM nominated by project implementers included lack of trained health care providers - especially female doctors; high staff turnover; lack of standard protocols, consumables and equipment; financing of health services and treatment; lack of or poor referral systems, feedback mechanisms and follow-up systems; distance to health facility; perceptions of female body size and weight gain/loss in relation to pregnancy; practices related to pregnant women's diet; societal negligence of women's health; lack of decision-making power among women regarding their own health; stigmatisation; role of women in society and expectations that the pregnant woman move to her maternal home for delivery.
A number of barriers within the health system and society exist. Programmes need to consider and address these barriers in order to improve GDM care and thereby maternal health in LMIC.
在许多中低收入国家（LMIC），孕产妇死亡率和发病率仍然很高。妊娠糖尿病（GDM）是 LMIC 中孕产妇健康的一个被低估且未被识别的障碍；如果不加以治疗，它也会对后代造成严重后果。需要更好地了解阻碍 GDM 检测和治疗的障碍。基于世界糖尿病基金会（WDF）支持的 GDM 项目的经验，本文旨在探讨社会和卫生系统对这些努力的障碍。
10 个 WDF 支持的 GDM 项目合作伙伴在 8 个不同的 LMIC 实施项目，填写了问卷。此外，还对项目合作伙伴进行了访谈。使用内容分析法对访谈进行了分析。
项目实施者提名的与 GDM 相关的改善孕产妇健康的障碍包括缺乏经过培训的医疗保健提供者，特别是女医生；人员流动率高；缺乏标准协议、耗材和设备；卫生服务和治疗的融资；缺乏或不良的转诊系统、反馈机制和随访系统；距离医疗机构远；对女性身体大小和与怀孕相关的体重增加/减轻的看法；与孕妇饮食相关的做法；社会对妇女健康的忽视；妇女在自己的健康问题上缺乏决策权；污名化；妇女在社会中的角色和期望孕妇搬回娘家分娩。
在卫生系统和社会中存在一些障碍。为了改善 GDM 护理，从而改善 LMIC 的孕产妇健康，方案需要考虑并解决这些障碍。
