Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study
| dc.contributor.author | Muhwava, Lorrein Shamiso | |
| dc.contributor.author | Murphy, Katherine | |
| dc.contributor.author | Zarowsky, Christina | |
| dc.contributor.author | Levitt, Naomi | |
| dc.date.accessioned | 2018-05-14T09:36:36Z | |
| dc.date.available | 2018-05-14T09:36:36Z | |
| dc.date.issued | 2018-05-10 | |
| dc.date.updated | 2018-05-13T03:29:13Z | |
| dc.description.abstract | Background Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders’ perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant’s first year of life. Methods Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa’s two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. Results The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. Conclusion Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided. | |
| dc.identifier.apacitation | Muhwava, L. S., Murphy, K., Zarowsky, C., & Levitt, N. (2018). Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/28046 | en_ZA |
| dc.identifier.chicagocitation | Muhwava, Lorrein Shamiso, Katherine Murphy, Christina Zarowsky, and Naomi Levitt "Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study." <i>BMC Health Services Research</i> (2018) http://hdl.handle.net/11427/28046 | en_ZA |
| dc.identifier.citation | BMC Health Services Research. 2018 May 10;18(1):349 | |
| dc.identifier.ris | TY - Journal Article AU - Muhwava, Lorrein Shamiso AU - Murphy, Katherine AU - Zarowsky, Christina AU - Levitt, Naomi AB - Background Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders’ perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant’s first year of life. Methods Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa’s two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. Results The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. Conclusion Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided. DA - 2018-05-10 DB - OpenUCT DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study TI - Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study UR - http://hdl.handle.net/11427/28046 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12913-018-3175-x | |
| dc.identifier.uri | http://hdl.handle.net/11427/28046 | |
| dc.identifier.vancouvercitation | Muhwava LS, Murphy K, Zarowsky C, Levitt N. Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study. BMC Health Services Research. 2018; http://hdl.handle.net/11427/28046. | en_ZA |
| dc.language.iso | en | |
| dc.publisher | BioMed Central | |
| dc.publisher.department | Department of Medicine | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights.holder | The Author(s). | |
| dc.source | BMC Health Services Research | |
| dc.source.uri | https://bmchealthservres.biomedcentral.com/ | |
| dc.subject.other | Gestational diabetes | |
| dc.subject.other | Type 2 diabetes | |
| dc.subject.other | Health services | |
| dc.subject.other | Health system | |
| dc.subject.other | Policy | |
| dc.subject.other | South Africa | |
| dc.title | Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study | |
| dc.type | Journal Article | |
| uct.type.filetype | Text | |
| uct.type.filetype | Image |