Barriers to screening, diagnosis and management of hyperglycaemia in pregnancy in Africa: a systematic review

Abstract

Gestational diabetes mellitus (GDM) complicates pregnancies in Africa. Addressing the burden is contingent on early detection and management practices. This review aimed at identifying the barriers to diagnosing and managing GDM in Africa. We searched PUBMED, Web of Science, WHOLIS, Google Scholar, CINAHL and PsycINFO databases in May 2020 for studies that reported barriers to diagnosis and management of hyperglycaemia in pregnancy. We used a mixed method quality appraisal tool to assess the quality and risk of bias of the included studies. We adopted an integrated and narrative synthesis approach in the analysis and reporting. Of 548 articles identified, 14 met the eligibility criteria. Health system-related barriers to GDM management were the shortage of healthcare providers, relevant logistics, inadequate knowledge and skills, as well as limited opportunities for in-service training. Patient-related barriers were insufficient knowledge about GDM, limited support from families and health providers and acceptability of the diagnostic tests. Societal level barriers were concomitant use of consulting traditional healers, customs and taboos on food and body image perception. It was concluded that constraints to GDM detection and management are multidimensional. Targeted interventions must address these barriers from broader, systemic and social perspectives.

Screening and nursing management of gestational diabetes in Ghana: Evidence-based recommendations

“…Addressing socio-economic challenges of the woman with GDM is crucial to the achievement of positive outcomes when managing GDM, as a commonly cited barrier to GDM management includes financial difficulties [ 51 , 52 ]. In Ghana and similar low-income settings, financial considerations are mainly related to the cost of healthcare, treatment (e.g.…”

“…In Ghana and similar low-income settings, financial considerations are mainly related to the cost of healthcare, treatment (e.g. insulin), medical supplies (blood glucose test strips), transport to access healthcare, and the inability to access healthy food [ 51 ], which further underlines the importance of involving members of the woman's close support network in GDM management [ 53 ]. Further, midwives have a responsibility to use the available resources, such as medical consumables, wisely [ [54] , [55] , [56] ] and should be trained to educate the women with GDM as well as significant others on how to use these consumables in such a way that efficiency is enhanced.…”

“…This lack of emphasis can be explained by the fact that they were clinical guidelines which focused on the clinical aspects of screening and management of GDM as opposed to non-clinical aspects, such as social, cultural or socioeconomic aspects. , with the exception of one guideline [ 20 ], the guidelines supporting the recommendations were developed mainly in high-income countries and did not consider the socio-economical challenges and cultural aspects of management of GDM, the former which are experienced in many low-incomes countries, such as Ghana [ 40 , 51 , 57 ]. Globally, the socio-economic and cultural aspects need further exploration and consideration in guidelines related to screening and management of GDM.…”

Gestational diabetes screening and management: the issues of GDM risk factors and phone number documentations

“…15 Further, a recent systematic review of "Barriers to screening, diagnosis and management of hyperglycaemia in pregnancy in Africa" had echoed that the limitations to GDM screening are multifaceted but including the healthcare systems and every facet requires its targeted intervention. 26 What this paper contributed to the discourse was empirical and epidemiological data that could serve as evidence-base for retraining of healthcare professionals regarding patients' telephone numbers and telehealth potentials. The observations highlight behavioural change wheel issues on GDM screening and primary healthcare that need concerted focus on antenatal health services and policy improvement.…”

Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies

“…Awareness of risk factors such as family history of diabetes is as low as 30% in most sub-Saharan African settings ( 11 ). Moreover, diagnosing GDM requires the resource- and labor-intensive oral glucose tolerance test (OGTT), which is seldom performed in African settings due to many constrains ( 12 , 13 ). Consequently, GDM is either not screened at all or is screened using urine glucose, which has been demonstrated to be inaccurate compared to the OGTT ( 14 ).…”