Phase I

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PROJECTS

Gestational diabetes prevention and control WDF12-678
Supporting Uttar Pradesh state NCD response: Maternal care and diabetes in the public health system. Phase 1:WDF12-678/Phase 2:WDF15-951.

OBJECTIVES AND APPROACH

In India, 61.3 million people live with diabetes, and 50 million more are at risk (IDF, 2011). Recent data indicates that between 9 to 17 % pregnant Indian women have gestational diabetes (Seshiah V et al 2009).

In India, 61.3 million people live with diabetes, and 50 million more are at risk (IDF, 2011). Recent data indicates that between 9 to 17 % pregnant Indian women have gestational diabetes (Seshiah V et al 2009).
Screening for GDM is particularly crucial in this region because Indian and Asian women are considered to be at the highest risk of developing glucose intolerance and GDM compared to other ethnic groups.

OBJECTIVES

The goal of this project is to improve detection and management of gestational diabetes by building capacity in the public health system, whereby the area of NCD prevention anc area shall become closer integrated with maternal care/RCH.

APPROACH

This project will be implemented by Jain Hospital, in collaboration with the Ministry of Health & Family Welfare of the government of Uttar Pradesh, India, and under the framework of a MoU between Jain Hospital and the National Rural Health Mission of Uttar Pradesh State (NRHM), a federal level programme implemented in all states of India.
The WDF support towards the programme consists of phase 1 which has been completed (WDF grant ref WDF12-678) and phase 2 (WDF grant ref WDF15-951)

PHASE I

Goal: A total of 55,000 Pregnant women will be been screened for gestational diabetes, Diagnosing around assuming (10%) GDM,5500 women GDM women in Urban, Periurban and rural will be in our suveillance. As 67% delivery are Institutional delivery in UP 2010 Its very Essential to target Screening in Public health system and build capacity therein for detection and management of GDM

Objectives: The project seeks to create awareness, screening, prevention, control and management of gestational diabetes mellitus (GDM) and to build Technical knowledge and skills in the Government Public health care system to Develop capacity,Technical Manpower to implement State GDM surveillance in all 72 District & therefore reduce outcome of pregnancy,

Target Groups(s):

Intended project results

  • An estimated 3000 health care staff, including doctors, nurses, dieticians and extension educators will be trained directly or indirectly on symptoms, treatment and preventive/control measures/Management.
  • Screening of Pregnant women in Govt. PHC/CHC/Urban health center/Dist Hospital to be mandatory and routine part of ANC at 24-28 Weeks of gestation
  • An estimated 2000 women with gestational diabetes will be treated and taught how to prevent subsequent type 2 diabetes for themselves as well as their families
  • 3000 women at risk of gestational diabetes will be taught how to prevent subsequent diabetes for themselves as well as their families.

Planned activities to reach objectives:

Intended project results

  • Screening of pregnant women of District 55,000 and at least 2 follow up to All patients detected for GDM( BSPP 2 hr>140 Mg/dl and High Risk(where BSPP after 2 hr >120 mg/dl- <140 mg/dl) and finally follow up for Detected GDM(2000-3000) for 2 year
  • Technical & skills upgradation needed for the Medical Proffessional and Paramedical staff like nurses,ANM,CHVCapacity will take place at PHC/CHC/District hospital/private hospital building will take place at different levels. Medical professionals in the project area will be trained for monitoring and guiding the field staff to run the project activities.
  • The Govt and Private sector Nursing/Health Educator/ ANM/CHF will be given trainings through District/state Trainers in order to be able to perform the activities, like Registering pregnant women, performing glucose tolerance test, Diagnosing & screening gestational diabetes during 3rd Trimester or throught pregnancy after Diagnosis & identifying high risk for GDM and post delivery Diabetes following intervention like medical nutrition therapy(MNT),Exercise,MNT+ insulin Titration and at least 2 follow up to be insured for better pregnancy outcome.

Project justification :

  • All 5500 women diagnosed with gestational diabetes will be adviced exercise and meal plan(MNT) through at least 3 visit for follow up by Nurse/ANM/Paramedical staff who received training under this project.They will be treated with meal plan to maintain their target blood glucose levels.Those GDM not controlled with meal and exercise plan, will be adviced Insulin therapy.
  • GDM women around 5500 will be followed up till deliveries and all the information about mother delivery status,complications and infant will be collected through Annex I.
  • State will make the efforts to Give orders to all Govt.PHC/CHC/Dist hospitals/Dispenseries/ICDS-CHV to make screening of Blood sugars at Ist Trimester ( overt Diabetes) and 24-28 weeks mandatory with Prevention and Control Guidelines.
  • 1000 Health Professionals Doctors from PHC/CHC/Dist Hospitals/Private Nursing home/Maternity home will be given training on GDM by 15 trainers trained in State TOT, in the field and 3000 Medical and Paramedical staff from Govt and Pvt Hospitals will get training on Diagnosis and Control, Management of GDM and will be Demostrated Abnormal Glucose tolerance in Pregnant women and Preventive and Control measure to follow.
  • Health care personnel will be involved in maternal and child health care in the diagnostic procedures of screening, diagnosis and proper management of gestational diabetes using appropriate simple cost effective techniques.
  • A surveillance system will be established in the District area and registry will be established to determine Prevalence rate among Urban, Periurban slums and rural pregnant women
  • For the same all PHC/CHC/Urban health center/Dist women hospital/Private maternity/clinic will be a reporting unit & they will be authorised and responsible to register pregnant women and do screening and Diagnosis of GDM.150 reporting unit in Govt Health facility and 100 reporting units in Private facilities will be made.Every day they will register Antenal mothers and report to District GDM Surveillance unit which will compile the report daily.
  • Public health Nurse/ANM will be trained to communicate report of Antenatal Pregnant women from each surveillance unit daily and disseminate preventive behavioral lifestyle changes to the target population and community at large.
  • 10 Field Monitors will supervise & Monitors GDM activities of Reporting units and give feedback of Reporting units in predesigned Monitoring Format.

Objectives:

The project seeks to create awareness,screening,,preventon,control and management of gestational diabetes mellitus (GDM) and to build Technical knowledge and skills in the Government health care system & Privatehealth sector to improve pregnancy outcome.

  • To establish a well managed GDM Surveillance in Govt health system which delivers more effective services through policy reforms, new institutional and human resource sustainable development.
  • Building Capacity at District & State to analyse policy issues and undertake reforms for establishing well managed GDM Health & social system at village, block & district level.
  • Developing successful health services models which can be replicated throught state/District/block/PHC level through first ever initiative in GDM.
  • Initiating actions for targeting the BPL( Below poverty line),Slums & Periurban population & bring them in main stream through Screening & control of GDM women & child.
  • Supporting implementation of Central Govt NRHM scheme in state by providing demonstration models for the new approaches in the mission through GDM Project in Uttar Pradesh.
  • This Project will be initially for 2 years as pilot in Kanpur district comprising 5 million population including 3.2 million urban(2.6 million) and periurban slums(0.6 million slums) and 1.8 million Rural Population and Positive output of this project will help the state Govt to extend and implement it in the whole the state by April/2014 & incorporating GDM screening mandatory in all Pregnant women in 24-28 weeks of gestation under National Rural health Mission of Govt of India.
  • Presently we will do screening of 50% pregnant women of District i.e 55,000(2.2% of 5 million=0.11 million,55000) and at least 2 follow up to All patients detected for GDM ( BSPP 2 hr>140 Mg/dl and High Risk(where BSPP after 2 hr >120 mg/dl- <140 mg/dl).These follow up will be done by health care professional who got trained under this project.
  • Technical & skills upgradation needed for the Medical Proffessional and Paramedical staff like nurses,ANM,CHV Capacity will take place at PHC/CHC/District hospital/private hospital building as part of tarinings will take place at different levels. Medical professionals in the project area will be trained for monitoring and guiding the field staff to run the project activities.
  • The Govt and Private sector Nursing/Health Educator/ ANM/CHV will be given trainings through District/state Trainers in order to be able to perform the activities, like Registering pregnant women, performing glucose tolerance test, Diagnosing & screening gestational diabetes during 24-28 wks of Gestation, after Diagnosis & identifying high risk for GDM and post delivery Diabetes following intervention like medical nutrition therapy(MNT),Exercise,MNT+ insulin Titration and at least 2 follow up to be insured for better pregnancy outcome.
  • Diabetes Educational Module 2011 from IDF will be used for trainings of Primary Care physician/Obs & Gynaecologist and Paramedical staff with changes according to Area specific.
  • Trainings Session will be taken by State/District trainers ,15 trainers 10 from Govt.& 5 Private will be trained through TOT(Training of Trainers),3 Days Trainings at the Kanpur by National trainer on Diabetes, 5 trainers in different speciality like GDM, MNT,Diabetes overall,Exercise and Communication.
  • Trainings Session will be taken by State/District trainers ,15 trainers 10 from Govt.& 5 Private will be trained through TOT(Training of Trainers),3 Days Trainings at the Kanpur by National trainer on Diabetes, 5 trainers in different speciality like GDM, MNT,Diabetes overall,Exercise and Communication.
  • GDM Workshop will be organized in DM(District Megistrate) Auditorium ,Kanpur where all the Govt and Key private hospital will be sensitized about GDM Project in the District under the chairmanship of District Megistrate and whole the Govt Functionaries like CDO(Community Development officer,CDPO(child development Project officer under ICDS(intergrated child development scheme,SDM(subdivisional Megistrate),CMO(chief medical officer,ACMOs,Commissoner,NGOs like Care,UNICEF,Rotary,WHO,local NGO,PRI(panchati raj institution member,Civil defence head will be invited.This will be 2 hrs workshop where GDM Project preparation and start of project will announced.
  • 5 National level trainers will be selected,These trainer will be mostly from north india as Kanpur is well connected to Capital area of New Delhi,They will be selected from Govt and Private Institutions who have experience more then 15 yrs in Diabetes and GDM with National & internationally Proven work in Diabetes,one of our expert will be a Certified Diabetes Educator(CDE) who has worked more then 10 years in Diabetes Education. Other expert Communication for behaviour change in health of National level will be called for.
  • 15 District trainers will be selected from 3 Nearby District Allahabad,lucknow and Kanpur and criteria for selection will be 1.10 year experience in Diabetes,2.Experience of a District or state level Speaker in diabetes for last 5 years.3.Any other Qualification in Diabetes and those area of interest in GDM.
  • 1000 Doctors and 3000 Para Medical Professonal will be trained in a year in batches of 25 Doctors and 40 Para Medical batches,therefore 40 batches of Doctors and 75 batches of Paramedics will be trained two times a year.
  • 1000 Doctors and 3000 Para Medical Professonal will be trained in a year in batches of 25 Doctors and 40 Para Medical batches,therefore 40 batches of Doctors and 75 batches of Paramedics will be trained two times a year.
  • 80 sessions of Doctors trainings and 150 sessions of Paramedical will be conducted in a year i.e every week there will 3 session of Paramedics trainings and 1.5 session a week for Doctorsl somewhere.
  • Each participants expenses will receive 2 session of training each year and per participant per year training expense is $20 for doctors & $10 for Paramedics per year.
  • New material for Education of ASHA/ANM/Paramedical will be developed for GDM Education in local hindi language from IDF(International Diabetes Federation) Module for health educator 2011
  • Diabetes Self management Education(DSME) Manual will be Prepared as per IDF Guidelines For Education of Gestational Diabetes patients 2011.
  • Training Module for health care Professional IDF 2011 Module will be taken as Gold standard for education of Doctors for training Purpose with changes will be done according to local conditions.
  • IDF published “Peer Leader Training Manual” for training for health professionals will be used.
  • 150 Govt Reporting units will be Medical college,Govt large hospital 5 Nos,UHFC(Urban health family centre 10,PHC & CHC and Subcenter around 200 functional health facility will be selected,About the selection of these facility CMO(chief medical officer) will issue orders.
  • 100 Private health facility will be our reporting units on voluntary basis,they will be specially Maternity home,ANC(antenatal clinics) and large hospitals where numbers of ANC are large. One nurse will be made incharge of reporting unit and she will be responsiable for Screening and reporting of all ANC in 3rd trimester of pregnancy.
  • Call centre for GDM awareness will available at Jain hospital where toll free number will available for contact and all the information related to GDM screeining will be given to caller free of cost 12 hrs of day all the 365 days a year.
  • Antenatal mother will be registered at all the reporting units and charges will be taken for screening,once she is diagnosed GDM,two follow up will be given by attending doctor of health facility with Counselling on Diet,Diet chart with exercise in a structure format will be adviced.all the data of patients will be filled up in a Demographic sheet,Age,Wt,Ht,BP,BMI,WHR,etc.
  • Demographic sheet of every ANC in 3rd trimester will reach to District head Quarter at Jain hospital through Block field Monitors and this will be compiled in District GDM software where we can see all the ANC registered,GDM diagnosed and there all demographic data.
  • 20% GDM may require Insulin for the Treatment at present there is no arrangement for free insulin delivery to patients but they will be encouraged to purchase and start treatment,In tamilnadu Govt of TN is providing free of cost to all GDM Patients but we have to see how we can implement the same in uttar Pradesh through motivational tool.Other funding agencies will be motivated for support for Insulins and other OAD.
  • Community camps have the key to success of this whole project as we will register our most ANC during these camps which will be complete check ups of women,Because location of camps will be near to them,it will be easily acessable,ASHA(Accrediated Social health activist) which is avaible for 1000 population under NRHM(national rural health scheme of GOI),they will bring them in camps in huge numbers,camps will be organised with the help of Govt Doctor,ANM and ASHA and local NGO,we will organise 450 camps in 2 years.all the Preparation of campswill start 15 days prior to camps date and ASHA’s of that area will visit house to house and inform all the pregnant women to come for ANC complete check up and for us this will be apportunity to check BSPP for women who are in 3rd trimester,Blood sugar screening at ist or iind trimester through project is not possible as it will shoot up expenses and other resourses,therefore we will make sure we screen all the women who came to us in 3rd trimester.
  • These type of camps are huge success in rural and periurban areas where we gets mostly BPL
  • The Population based awareness Campaign will be Introduced and Message will be tested before target group before mass Dissemination; then posters, handbills,Banners, pamphlets and stickers will be produced and Print media,FM radio,local channel will be used to Propagate the messages.
  • 4 Workshop of media personnel from print and Audio-visual will be conducted to brief them about this programme from the leading newpaper and channels. Local NGO’s,IMA,FOGSI,Physician forum and various professional bodies will be sensitise about the programme.Local channel like ABC & Surya TV channel will be selected for 1 hr programme on Kanpur GDM programme 4 times a year
  • Expert agencies with liason with Project Communication Coordinator for the mass Publicity, National , International local NGOs like Unicef,Care,Rotary,Govt Health system will play a key role in raising the awareness in the communities.

2.4. Target Group:

This description should also include an indication of the health equity and poverty focus of the project.

  • GDM poses a risk to mother and child. Our Target is to safeguard outcome of Pregnancy which is translated into reduction in MMR & IMR and Prevention and Control of Diabetes after pregnancy in mother and infant both and further control of Diabetes in women& new generation.
  • The risk is largely related to high blood glucose levels and its consequences. The risk increases with higher blood glucose levels, Treatment resulting in better control of these levels can reduce some of the risks of GDM considerably.
  • The two main risks GDM imposes on the baby are growth abnormalities and chemical imbalances after birth, which may require admission to a NICU,Infants born to mothers with GDM are at risk of being both LGA and SGA. Macrosomia in turn increases the risk of instrumental Deliveries(e.g. Forceps,ventouse and caesarean section or problems during vaginal delivery (such as Shoulder dystocia). Macrosomia may affect 12% of normal women compared to 20% of patients with GDM. in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study for example, there was an increased risk for babies to be large but not small for gestational age. Labelling a woman as having GDM may in itself increase the risk of having a caesarean section.
Collaborating partners 1.Jain hospital,2. Ministry of health & Family welfare-Govt of Uttar Pradesh,India
Name:

Address:

Contact:

Person:
Dr Rachna Jain MBBS,DGO Proprietor Jain hospital

108 B Gandhi Gram,Harjinder Nagar,Kanpur-07,Uttar P ,INDIA

91+9236011900,jainhospitals@gmail.com, www.stopdiabesity.in

Dr Rachna Jain MBBS,DGO(Proprietor Jain hospital) will appoint DrRajesh Jain as Project Manager & who will Coordinate with Private Hospitals & CMO Kanpur in providing Technical,Logistic,Trainings,allnecessary support for meeting Goals of the Project.
Name:

Address:

Contact:

Dr Ram Ji lal

Director General Health & family welfare-Govt of UP

dgmed@up.nic.in, dgfw@up.nic.in www.uphealth.up.nic.in


2.4. TARGET GROUP:

  • An estimated 4000 health care including 1000 doctors, 3000 Asha,ANM,nurses, dieticians and extension educators will be trained directly or indirectly on symptoms, treatment and preventive/control measures
  • Screening of Pregnant women in 150 Facility of Govt. PHC/CHC/Urban health center/Dist Hospital/other Govt hospitals in District to be mandatory and routine part of ANC at 24-28 Weeks of gestation.
  • 100 Private hospitals in the District will do regular Screening of GDM and will report to district CMO office monthly in ANC registration proforma.
  • An estimated 2000 women with gestational diabetes will be treated and taught how to prevent subsequent type 2 diabetes for themselves as well as their families.
  • 3000 women at risk of gestational diabetes will be taught how to prevent subsequent diabetes for themselves as well as their families.
  • Through Media Coverage Project will cover 2 lakhs people in awarness and control programme on GDM in kanpur District.

INTENTED PROJECT RESULTS

  • 10 block field Monitor temporary staff for the project purpose will monitor the Project activities in 250 Surveillance & reporting units 150 in Govt facilities and 100 in Private hospitals.
  • Each block Field monitors will be given total 25 reporting units 15 Govt & 10 Private Hospitals reporting units.
  • Each Block field monitor will visit 5 reporting units in a day and thus each monitor will visit each Reporting unit 5 times in a month and will report Feedback on GDM screening, Registration, daily reporting Etc, through a one page performa specially designated for monitoring & supervision purpose.
  • Daily feedback will be given to Project Manager ,District Survaillance unit at Jain hospital through block monitors.
  • Once in a week Block Monitor will organize meeting with 25 reporting Paramedical staff, where their problems and feedback in screening will be discussed and to make reporting more affective action will be taken.
  • Each Block Monitors will Monitor & supervise Trainings of Doctors and Paramedical staff in their area of 25 reporting units on Saturday or Sundays,there will be involved with 4 trainings in a month=4x12=48 trainings in a year,Total trainings will be monitored by 10 monitors in a years,10x48=480 Trainings session in a years,each batch approx 25 participants are expected,and total 4 session of trainings will be organized in 25 batches and each participant will have 4 trainings in a year at 3 month intervals,480x25=12,000 /4=3000 Participants will be covered.
  • 1000 Doctors in batches of 25 will be covered,Total of 40 batches will received two training in a year,therefore 80 trainings session will be monitored & Supervised by 5 state level Monitors which will be appointed by Director General Medical health & Family.
  • Once the project will be over Monitors acquired skills & Technical knowledge will help them to gain jobs in Govt and with NGOs working in NCD prevention and control.

RESULT:

  • Improved GDM screening in 150 government primary healthcare centres, community healthcare centres, urban health centres, district hospitals, and other government hospitals.
  • 55,000 pregnant women screened for GDM
  • 5,000 diagnosed women received follow-up and counselling
  • 4000 healthcare providers trained, including 1000 doctors, 3000 nurses, dieticians, and educators
  • Training completed of 4,000 healthcare professionals using the training of trainers (ToT) model.
  • Screening and reporting at 100 private/charity based hospitals
  • 450 community camps established
  • Free telephone hotline established to provide information on GDM