Mansoor Javeria, Alvi Shafaq, Iqbal Romaina, Rizvi Narjis, Naz Sabahat
Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan.
Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan
BMJ Open Qual. 2025 May 30;14(2):e003362. doi: 10.1136/bmjoq-2025-003362.
Since gestational diabetes mellitus (GDM) prevalence is increasing in Pakistan, the quality of care provided to women with GDM is crucial for improving maternal and neonatal outcomes. Therefore, our study aimed to assess the quality of existing healthcare services related to GDM management across different hospitals in Karachi, Pakistan.
We used Donabedian's model to evaluate the input, process and output phases. The first two phases were assessed through a cross-sectional design, while the output was evaluated via in-depth interviews. The study included six hospitals, one public and five private. We interviewed department heads (n=6) to assess the workforce and facilities (input) and nurses (n=17) and doctors (n=8) to examine qualifications for GDM management protocols (process). The output phase involved interviewing postpartum women with GDM (n=6) about their understanding of GDM, its complications and lifestyle modifications. We report frequencies and percentages for quantitative and thematic analysis for qualitative data.
Monthly, 9000 women sought antenatal care (ANC) services, with 500 deliveries in public hospitals, while 2000-5500 sought ANC services, with 160-461 deliveries in private hospitals. All hospitals, except the public one, had standard GDM protocols. Three hospitals had neonatal intensive care units, six employed an endocrinologist, three had a dietician and only one appointed nursing staff as GDM counsellors. Two hospitals provided blood glucose monitoring charts, three offered diet charts and five gave breastfeeding instructions. While all doctors attended GDM education, no nurses participated. Thematic analysis highlighted postpartum women's lack of knowledge about GDM, its complications and the importance of lifestyle modification postdelivery.
Our study identified gaps in GDM care and highlighted the need for policies to develop and implement standardised GDM screening and management protocols, ensure mandatory training for healthcare providers and integrate multilingual educational material in healthcare settings to improve health outcomes for mothers and children.
由于巴基斯坦妊娠期糖尿病（GDM）的患病率在上升，为患有GDM的妇女提供的护理质量对于改善母婴结局至关重要。因此，我们的研究旨在评估巴基斯坦卡拉奇不同医院中与GDM管理相关的现有医疗服务质量。
我们使用唐纳贝迪安模型来评估投入、过程和产出阶段。前两个阶段通过横断面设计进行评估，而产出则通过深入访谈进行评估。该研究包括六家医院，一家公立医院和五家私立医院。我们采访了部门负责人（n = 6）以评估劳动力和设施（投入），并采访了护士（n = 17）和医生（n = 8）以检查GDM管理方案的资质（过程）。产出阶段涉及采访患有GDM的产后妇女（n = 6），了解她们对GDM、其并发症和生活方式改变的理解。我们报告定量数据的频率和百分比以及定性数据的主题分析结果。
每月有9000名妇女寻求产前护理（ANC）服务，其中公立医院有500例分娩，而2000 - 5500名妇女寻求ANC服务，私立医院有160 - 461例分娩。除公立医院外，所有医院都有标准的GDM方案。三家医院设有新生儿重症监护病房，六家聘请了内分泌学家，三家有营养师，只有一家指定护理人员担任GDM顾问。两家医院提供血糖监测图表，三家提供饮食图表，五家提供母乳喂养指导。虽然所有医生都参加了GDM教育，但没有护士参与。主题分析突出了产后妇女对GDM、其并发症以及产后生活方式改变的重要性缺乏了解。
我们的研究发现了GDM护理方面的差距，并强调需要制定政策来制定和实施标准化的GDM筛查和管理方案，确保对医疗保健提供者进行强制性培训，并在医疗机构中整合多语言教育材料，以改善母婴健康结局。
