Gestational diabetes is associated with a number of adverse peri-partum outcomes in mothers and their newborns and carries an increased risk for the development of type 2 diabetes later in life. Although screening modalities are well established for developed countries, their suitability for low and middle income countries is still under evaluation as many implementation challenges prevail. Recently, the FIGO (International Federation of Gynaecologists and Obstetricians) Initiative on GDM (Gestational Diabetes Mellitus) has published consensus guidelines that are expected to improve the current situation, that is still dominated by a lack of uniformity in practices.
Morocco, a lower middle income country with a reported GDM prevalence of 8.2% has been chosen for our study as GDM screening is not yet performed in a systematic way albeit the fact that health services for the management of this condition are available. In the first phase of this project, we conducted a situational analysis with regards to GDM screening and management in selected facilities in two provinces, Marrakech and Al Haouz. The results highlight various challenges that pose obstacles to universal screening including the lack of knowledge, unavailability of guidelines, delays in measuring glucose levels and lack of communication and collaboration between different levels and among different health care providers.
To evaluate the feasibility of a decentralized approach including universal screening, treatment initiation and management of gestational diabetes at the primary health care level, an implementation research project conducted in close collaboration with the National School of Public Health (ENSP) Morocco is about to start. On November 3rd and 4th a 2-day training took place to inform the providers of the 20 study facilities of Al Haouz and Marrakech provinces about the different steps of the study. Results are expected to clarify the potential of a decentralized approach for being integrated into the existing health care system in Morocco.