CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Gestational diabetes occurs as a result of insulin resistance during pregnancy.

Adequate blood glucose control is important in helping prevent complications in the

mother, such as pre-eclampsia, and in the fetus, such as macrosomia and

stillbirth(American Diabetes Association, 2017) . Nonpharmacologic measures,

including diet and exercise, are often sufficient for many women to maintain

appropriate glycemic control. However, some women may require additional

pharmacologic therapy including insulin, metformin, or glyburide. Additionally,

women with gestational diabetes should be screened postpartum because they are at

increased risk for developing overt diabetes after pregnancy, Garrison A. 2015.

For this reason, it is important that all pregnant women who have risk factors for

diabetes be tested in the first trimester to rule out the presence of overt or preexisting

diabetes.

The exact prevalence of gestational diabetes depends on the population and the

criteria used for diagnosis, but roughly 4% to 6% of all pregnancies are impacted by

gestational diabetes. In recent years, there has been an increasing incidence of

gestational diabetes that mirrors the trend of increasing obesity in the United States

McGraw-Hill Williams et. Al, 2015.

It is proposed that gestational diabetes is related to a change in the way a woman’s

body responds to insulin in pregnancy, Centre for disease control, 2020. Insulin is the

hormone that allows glucose to move from the bloodstream to the body’s cells so that

the glucose can be used for energy. In order to increase nutrients—including glucose

—available to the fetus during pregnancy, the body naturally becomes more resistant

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to insulin (Kasper D, Fauci A, Hauser S, et al, 2014). The body compensates for the

resistance by increasing insulin levels; however, in some women, this is insufficient to

maintain blood sugar control.

In addition to the health impact, gestational diabetes also has an economic impact,

resulting in longer hospital stays and higher hospital costs. While most cases of

gestational diabetes resolve after delivery, women with gestational diabetes are

estimated to have a seven-fold increased risk of developing overt diabetes at some

point post pregnancy, compared with women without gestational diabetes. Therefore,

these women should be screened initially for overt diabetes 4 to 12 weeks after giving

birth and at least every 3 years thereafter.

The World Health Organization (WHO) stated that the prevalence of diabetes rose

faster in low and middle-income countries over the past decade. Several years ago,

South Africa and Ethiopia were said to have more diabetes cases than Nigeria.

However, currently, Nigeria has the highest incidence of diabetes in sub-Saharan

Africa.

The WHO estimated a 4.3% prevalence of diabetes in Nigeria in 2016 Some local

studies conducted in Nigeria found a prevalence between 0.8% and 11% . A previous

study reported that about 4.7 million Nigerians had type 2 diabetes .

Type 2 diabetes mellitus (T2DM) is predominant among diabetes mellitus patients in

Nigeria, accounting for more than 90% of the total cases. It was estimated that

diabetes killed more than 40,000 Nigerians in 2015, and such a huge loss is due to the

lack of efficient and effective healthcare delivery. There are millions of Nigerians

who are diabetic but are yet to be diagnosed and treated. The International Diabetes

Federation (IDF) estimated that about two-thirds of people with diabetes in Africa are

undiagnosed. The complications of diabetes are very serious, including stroke, heart

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attack, kidney failure, blindness, etc. The WHO predicts diabetes to become the

seventh leading cause of death in the world by the year 2030.

1.2 Statement of the problem

Nigeria has one of the highest maternal mortality ratios in the world, estimated at

above 600 deaths per 100,000 live births. And about 25,000 women die every year

due to pregnancy and child birth complications: The GDM prevalence was 2.98 per

1000 pregnancies; 40% of gestational diabetes mellitus occurs as a result of lack of

knowledge about GDM among women of reproductive age in general, a lack of access

to and knowledge about how to maintain a healthy weight and diet during pregnancy.

Pre-eclampsia 26.7%, mid-trimester abortion 6.7%, intrauterine fetal death (IUFD)

6.7% were the major antenatal complications. Caesarean section rate was 10%,

gestational age at delivery - 37.55 ± 1.94 weeks and birthweight - 3.75 ± 0.55 kg,

(Dahiru T, Aliyu AA, Shehu AU, 2016).

Moreover, there is are but a few studies on the assessment of mother’s knowledge

and prevention practices towards gestational diabetes mellitus in Passo Community.

This study therefore sought to fill the gap.

1.3 Objective of the study

The main objective of this study is to assess the mother’s knowledge and prevention

practices towards gestational diabetes mellitus in Passo Community.Specific

objectives includes;

i. To assess the level of knowledge of Gestational Diabetes Mellitus among

mothers in Passo Community.

ii. To determine harmful practices of mothers in Passo Community that causes

Gestational diabetes mellitus.

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iii. To assess the prevention practices of mothers in Passo Community towards the

Gestational diabetes mellitus

1.4 Research questions

The study sought to answer the following research questions

1. What is the level of knowledge of Gestational diabetes mellitus among mothers

in Passo Community

2. What are the causes of Gestational diabetes among mothers in Passo Community.

3. What are the prevention practices of mothers in Passo Community towards

Gestational Diabetes mellitus?

1.5 Significance of the study

Measuring the level of knowledge and the prevention practices of gestational diabetes

mellitus among mothers’ provides a useful measure for screening, education and

preventive measures for gestational diabetes mellitus and also help to identify the

gaps that need to be filled in primary health care. This study will be of immense

benefit to other researchers who intend to know more on this study and can also be

used by non-researchers to build more on their research work. This study contributes

to knowledge and could serve as a guide for other study.

1.6 Scope of the study

This study is on the assessment of mother's knowledge and prevention practices

towards gestational diabetes mellitus in Passo Community. The research study

covered mothers in Passo Community. The study also covered a fair balance of

women of reproductive age.

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1.7 Operational definition of terms

Knowledge: Knowledge is a familiarity or awareness, of someone or something, such

as facts, skills, or objects contributing to ones understanding.

Prevention practice: Prevention practice means any action taken to keep people

healthy and well, and prevent or avoid risk of poor health, illness, injury and early

death.

Assessment: It is the process of defining, selecting, designing, collecting, analyzing,

interpreting, and using information to increase students' learning and development.

Gestational diabetes mellitus: A form of high blood sugar affecting pregnant

women.

Gestation: Gestation is the period of time between conception and birth.

Diabetes mellitus: A disease in which the body does not control the amount of

glucose (a type of sugar) in the blood and the kidneys make a large amount of urine.

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 LITERATURE REVIEW

2.0 INTRODUCTION

This chapter gives an insight into various studies conducted by outstanding

researchers, as well as explained terminologies with regards to investigating the

assessment of mother’s knowledge and prevention practices towards gestational

diabetes mellitus in Passo Community. The chapter deals with the conceptual

framework, overview of related literature, empirical review and conclusion.

Conceptual Review

2.1.1 Brief History of Gestational Diabetes

Gestational diabetes is a medical condition that causes blood sugar levels to become

abnormally high, which manifests for the first-time during pregnancy and typically

disappears immediately after birth for around ninety percent of affected women.

While many women with the condition do not experience any noticeable symptoms,

some may experience increased thirst and urination. Although gestational diabetes is

treatable, if left unmanaged, the resulting fetus is more likely to have elevated risks of

increased birth weight, birth injuries, low blood sugar, stillbirth, and later

development of type 2 diabetes.

The International Diabetes Federation estimates that worldwide in 2019, gestational

diabetes affected one in six pregnant women, with many cases occurring in women

living in low and middle-income countries. Despite the prevalence and risks

associated with gestational diabetes, as of 2020, researchers have yet to reach a

unified consensus on the best guidelines for diagnosis and treatment.

Although evidence of non-gestational diabetes dates back to 1500 BC, there was no

evidence or documentation of gestational diabetes until the early 1800s. In 1824,

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Heinrich Bennewitz, a medical doctor who worked in Berlin, Germany, was one of

the first physicians to record and publish a case of gestational diabetes. Bennewitz

was caring for a twenty-two-year-old woman during her fifth pregnancy, who

according to Bennewitz, suffered from unquenchable thirst and cloudy, stale-smelling

urine. When it came time to give birth, Bennewitz and another doctor who specialized

in childbirth helped deliver the fetus. Bennewitz described the neonate as being

Herculean, with a weight of twelve pounds, and that the birthing process ultimately

ended in stillbirth. Bennewitz’s case report and description of the woman’s symptoms

correlated with modern understandings of gestational diabetes. Although people with

gestational diabetes oftentimes do not exhibit symptoms, they sometimes suffer from

increased thirst like the woman in the case report. Urination increases when the

kidneys cannot keep up with filtering glucose, causing the body to excrete excess

sugar into the urine. The expulsion of urine pulls away fluids from other tissues in the

body, leaving the individual feeling dehydrated and thirsty.

In the late 1800s, James Matthews Duncan, a physician from Scotland, helped to

further establish gestational diabetes with clinical observations that continue to hold

true in the twenty-first century. Duncan learned from James Young Simpson, who

was a prominent professor of midwifery, or the occupation of helping women during

childbirth, at the University of Edinburgh, Scotland, in Edinburgh, Scotland. After

completing his apprenticeship with Simpson, Duncan continued studying pregnancy

and childbirth in London, England. In 1882, he monitored and observed the

pregnancies of sixteen diabetic women and came to the conclusion that women can

develop diabetes during pregnancy, but that it can go away once the pregnancy is

over. Duncan also concluded that women who develop diabetes during pregnancy

might be at higher risk of developing the condition again later in life.

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In 1924, researchers discovered insulin a chemical messenger that allows cells to

absorb glucose, a sugar, from the blood. The pancreas being an organ behind the

stomach that is the main source of insulin in the body. Clusters of cells in the pancreas

called islets produce the hormone and determine the amount based on blood glucose

levels in the body.

A normally functioning pancreas produces insulin to regulate blood sugar levels.

Diabetics struggle to regulate their blood sugar, either because they cannot produce

enough insulin, or because their bodies are resistant to insulin, as is the case for

gestational diabetics. A physician named White created a classification system in

1924 that not only helped physicians distinguish between gestational diabetes and

diabetes that exists before pregnancy, but categorized those women according to their

age, disease duration, and other health factors. Many physicians adopted that

classification system because it helped them more accurately predict pregnancy

complications for each gestational and non-gestational diabetic patient, resulting in

more tailored treatment plans and better health outcomes for both the fetus and

pregnant woman.

Risk factors for gestational diabetes mellitus

 Women with prediabetes identified before pregnancy should be considered at

extremely high risk for developing gestational diabetes mellitus during

pregnancy.

 Having previous pregnancy affected gestational diabetes mellitus

 Materal age

 Obesity

 Not being physically active

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 Having previously delivered baby weighing more than 9pounds (4.1kg).

Classification of Gestational diabetes mellitus

i. Gestational diabetes managed without medication and responsive to nutritional

therapy(A1 GDM): is diet controlled gestational diabetes.

ii. Gestational diabetes managed with medication (A2 GDM): Gestational diabetes

managed insulin or oral medications to achieve adequate glycemic control.

Prevention and Management for gestational diabetes mellitus includes:

a. Lifestyle changes

b. Blood sugar monitoring

c. Medications

d. Follow-up after delivery

e. Management of neonate

Lifestyle changes

Lifestyle changes: is an important part of keeping the blood sugar levels in a healthy

range. Health care providers usually don't advise losing weight during pregnancy.

But the health care provider can help set weight gain goals based on the mother’s

weight before pregnancy.Lifestyle changes include:

Healthy diet: A healthy diet focuses on fruits, vegetables, whole grains and lean

protein — foods that are high in nutrition and fiber and low in fat and calories and

limits highly refined carbohydrates, including sweets. A registered dietitian or a

certified diabetes care and education specialist help to create a meal plan based on

the mother’s current weight, pregnancy weight gain goals, blood sugar level, exercise

habits, food preferences and budget.

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Staying active. Regular physical activity plays a key role in every wellness plan

before, during and after pregnancy. Exercise lowers the blood sugar. As an added

bonus, regular exercise can help relieve some common discomforts of pregnancy,

including back pain, muscle cramps, swelling, constipation and trouble sleeping.

Blood sugar monitoring

During pregnancy period, the health care team checks the mother’s blood sugar four

or more times a day I.e first thing in the morning and after meals to make sure the

level stays within a healthy range.

Management of the neonate

Current recommendations for infants of diabetic mothers the most critical metabolic

problem for whom is hypoglycemia includes; the employment of frequent blood

glucose checks and early oral feeding (ideally from the breast) when possible, with

infusion of intravenous glucose if oral measures prove insufficient,Centres for disease

control 2021.

Follow-up after delivery

Health care providers assess the blood sugar level after delivery and again in 6 to 12

weeks to make sure that the level has returned to within the standard range. If the tests

are back in this range and most are the mother will need to have diabetes risk assessed

at least every three years.

Medications

If diet and exercise aren't enough to manage the blood sugar levels, the pregnant

mother may need insulin injections; Three main groups of insulin are available.

Fast-acting insulin

The body absorbs this type into the bloodstream from the subcutaneous tissue

extremely quickly.

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People use fast-acting insulin to correct hyperglycemia, or high blood sugar, as well

as control blood sugar spikes after eating. This type includes:

Rapid-acting insulin analogs: These take between 5 and 15 minutes to have an effect.

However, the size of the dose impacts the duration of the effect. Assuming that rapid-

acting insulin analogs last for 4 hours is a safe general rule. Examples: Aspart

(Novolog), Lispro (Humalog).

Regular human insulin: The onset of regular human insulin is between 30 minutes and

an hour, and its effects on blood sugar last around 8 hours. A larger dose speeds up

the onset but also delay the peak effect of regular human insulin. Examples: Humulin

R, Novolin R.

Intermediate-acting insulin

This type enters the bloodstream at a slower rate but has a longer-lasting effect. It is

most effective at managing blood sugar overnight, as well as between meals.

Options for intermediate-acting insulin include:

Neutral protamine hagedorn (NPH) human insulin : This takes between 1 and 2 hours

to onset, and reaches its peak within 4 to 6 hours. It can last over 12 hours in some

cases. A very small dose will bring forward the peak effect, and a high dose will

increase the time NPH takes to reach its peak and the overall duration of its effect.

Examples: Humulin N, Novolin N.

Pre-mixed insulin: This is a mixture of NPH with a fast-acting insulin, and its effects

are a combination of the intermediate- and rapid-acting insulins. The mixtures can be

in various combinations from 50:50 to 75:25 or 70:30. An example includes Novolog

70/30.

Long-acting insulin

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While long-acting insulin is slow to reach the bloodstream and has a relatively low

peak, it has a stabilizing “plateau” effect on blood sugar that can last for most of the

day. Glargine (Lantus) is an example.

In brief, Insulin remains the standard of care for the treatment of gestational diabetes

mellitus. Tight control maintained in the first trimester and throughout pregnancy

plays a vital role in decreasing poor fetal outcomes, including structural anomalies,

macrosomia, hypoglycemia of the newborn, adolescent and adult obesity, and

diabetes.

INTERNATIONAL COVERAGE ON GESTATIONAL DIABETES

MELLITUS

Gestational diabetes mellitus (GDM) affects up to 8.7% of all pregnancies in the

United States . The Centers for Disease Control and Prevention reports that these

numbers are still on the rise . As the age of diabetes diagnosis decreases in U.S. youth,

the prevalence of pregestational diabetes is likely to increase in the pregnant

population .

Maternal diabetes causes complications in the embryo/fetus that start in the uterus, are

present immediately after birth, and could potentially last a lifetime. Women with

type 1 diabetes or type 2 diabetes diagnosed before or during the first trimester of

pregnancy are at the greatest risk for fetal congenital anomalies and spontaneous

abortions Whitt E, Burgess J, Elixhauser A. et al 2017.

. GDM develops and is diagnosed later in pregnancy, at 24–28 weeks’ gestation, when

impaired glucose tolerance is detectable. Therefore, women with GDM are most

likely euglycemic during organogenesis and have a decreased risk for structural

anomalies (American Diabetes Association, ADA).

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However, glucose control remains paramount in later stages of pregnancy for women

diagnosed with GDM. Hyperglycemia after organogenesis is a risk factor for large-

for-gestational-age babies, macrosomic babies (>4,500g), shoulder dystocia (birth

injury), neonatal hypoglycemia, hyperbilirubinemia, and admission to the neonatal

intensive care unit. Maternal outcomes include a higher risk for preeclampsia, primary

cesarean section, and preterm labor . (the American Association of Clinical

Endocrinologists/American College of Endocrinology (AACE/ACE)

Finally, long-term effects of maternal hyperglycemia on the child include a higher

risk of childhood obesity and adult diabetes.(American College of Obstetricians and

Gynecologists, 2016 (ACOG).

Prevalence of Gestational diabetes in Nigeria

Diabetes Mellitus (DM) is a chronic disorder that is not only assuming pandemic

proportions worldwide but also poised to affect the developing countries of the world

much more than their developed counterparts. Nigeria, with a population of 158

million people, is the most populous country in Africa and accounts for one sixth of

Africa’s population. Approximately 50% of Nigerians are urban dwellers and the

country has a cultural diversity and 398 documented ethnic groups Dahiru T, Aliyu

AA, Shehu AU et al. 2016.

Studies by the Medical Women Association of Nigeria 2016(MWAN) a non-

governmental organization and professional body of female medical and dental

doctors. Most women [5683 (61.0%)] were aged 25–34 (mean 29.60 ± 5.64) years.

The prevalence of GDM in this study was 5.2% with a prevalence of GDM in the

first, second and third trimesters of 4.9%, 4.2% and 6.7%, respectively. The

prevalence of GDM among persons with a family history of diabetes was 13.2% (97

persons) while 4.6% (391 persons) without family history were diagnosed with GDM.

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Gestational age, family history of diabetes and age group were found to be significant

predictors of GDM among the study participants after adjusting for confounding

variables.

2.1. CONCEPTUAL FRAMEWORK

Concept of Assessment

Health assessment denotes the process by which a nurse seeks to gain relevant

information about a patient and their condition. This information may provide insight

into not just the patient’s physical condition but also the state of their mental and

emotional health. Health Personals arrive at this information by applying a

combination of clinical skills, medical knowledge, and critical thinking abilities. It is

also a form of a dialogue between client and practitioner, in which they discuss the

needs of the former to promote their well being and what they expect to happen in

their daily life . According to National Institute for Health and Care Excellence

(NICE), 2021. Nursing assessment involves collecting data from the patient and

analyzing the information to identify the patient's needs, which are sometimes

described as problems.

These process employs different strategies to resolve the needs identified as part of an

assessment. Ideally, this will include the selection of appropriate evidence-based

nursing interventions. When planning care, the patient's needs and wishes should be

prioritized, and the individual must be involved in the decision-making process to

ensure a person-centered approach. The planned care must take into account the

patient's conditions, personal attributes and choices. It is worth noting that the

principles of care planning are transferable between hospital, home and care home

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settings. Health professionals should endeavor to involve the patient in decision-

making and enable them to make choices as much as possible, using a range of

approaches to achieve this (Lloyd, 2010). Unless proven otherwise, a nurse must

assume that a patient has the capacity to make their own decisions, Mental Capacity

Act 2018.

2.2 CONCEPT OF KNOWLEDGE

The facts, concepts, theories and principles that are taught and learned rather than

related to skills such as reading, writing, or researching that student also learns in

academic

More than half of pregnant women have insufficient knowledge about GDM.

Significant association between GDM knowledge and women’s age, women’s and

partners’ educational status, preconception care, history of GDM and hypertension,

and the number of pregnancies were detected. Therefore, to increase pregnant

women’s GDM knowledge, health education programmes in the community and

healthcare facilities should target the identified factors.

2.3 THEORETICAL REVIEW

Theoretical Review

The health belief model was used for the study. The health belied model health

behavior change model developed to explain and predict health-related

behaviors, particularly in regard to the uptake of health services. The Health

belief model which was developed in the 1950s by social psychologists at the

U.S. Public Health Service and remains one of the best known and most widely

used theories in health behavior research. The Health belief model suggests that

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 people's beliefs about health problems, perceived benefits of action and barriers

to action and self-efficacy explain engagement (or lack of engagement) in health-

promoting behavior. A stimulus, or cue to action, must also be present in order to

trigger the health-promoting behavior. Health Service in order to understand the

failure of people to adopt promotive strategies or screening tests for the early

detection of disease, later uses of Health belief model were for women responses

to symptoms and compliance with medical treatments. The Health belief model

suggests that a person's belief in a personal threat of an illness or disease together

with a person's belief in the effectiveness of the recommended health behavior or

action will predict the likelihood the person will adopt the behavior.

The Health belief model derives from psychological and behavioral theory with

the foundation that the two components of health-related behavior are

a. The desire to avoid illness, or conversely get well if already ill; and,

b. The belief that a specific health action will prevent, or cure, illness.

Ultimately, an individual's course of action often depends on the person's perceptions

of the benefits and barriers related to health behavior. There are six constructs of the

Health belief model. The first four constructs were developed as the original tenets

of the Health belief model. The last two were added as research about the Health

belief model evolved and they are:

Perceived susceptibility - This refers to a person's subjective perception of the risk of

acquiring an illness or disease. There is wide variation in a person's feelings of

personal vulnerability to an illness or disease.

Perceived severity - This refers to a person's feelings on the seriousness of

contracting an illness or disease (or leaving the illness or disease untreated). There is

wide variation in a person's feelings of severity, and often a person considers the

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medical consequences (e.g., death, disability) and social consequences (e.g., family

life, social relationships) when evaluating the severity.

Perceived benefits - This refers to a person's perception of the effectiveness of

various actions available to reduce the threat of illness or disease (or to cure illness or

disease). The course of action a person takes in preventing (or curing) illness or

disease relies on consideration and evaluation of both perceived susceptibility and

perceived benefit, such that the person would accept the recommended health action if

it was perceived as beneficial.

Perceived barriers - This refers to a person's feelings on the obstacles to performing

a recommended health action. There is wide variation in a person's feelings of

barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the

effectiveness of the actions against the perceptions that it may be expensive,

dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or

inconvenient.

Cue to action - This is the stimulus needed to trigger the decision-making process to

accept a recommended health action. (e.g., advice from others, illness of family

member, newspaper article, etc.).

Self-efficacy - This refers to the level of a person's confidence in his or her ability to

successfully perform a behavior. Self-efficacy is a construct in many behavioral

theories as it directly relates to whether a person performs the desired behaviour.

2.4 Application of the Theory to the Study

Perceived Susceptibility: If the community perceived that the mothers’ are prone to

develop gestational diabetes mellitus during pregnancy that can be prevented through

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pre conceptional counselling they will accept to for the mothers to go for screening

for conception

Perceived Severity: The community perceives that the consequence of gestational

diabetes mellitus is life threatening or can cause disability they will engage in health

promotion behaviour.

Perceived Benefit: The benefit insulin shots is that it is an important part of diabetes

treatment. It helps keep blood sugar under control and prevents diabetes

complications.

Perceived Barrier: There are obstacles to behaviour change which prevent

individuals to engage in health promoting behaviour. In the community they may be

faced with some obstacles like cultural foods which is rich in carbohydrates .

Modifying Variables: Personality, educational level, religion are some of the

modifying variables that affect health related behaviour. A community that is well

educated will perceive that it is necessary to prevent a gestational diabetes mellitus.

Self-Efficacy: A competent community will be able to encourage every family to

carry out glucose blood test on women of reproductive age thereby protecting the

mother and baby.

Cue to Action: Triggers to action are what make an individual to adopt health

seeking behaviour. This can be internally for example, a person’s thoughts or

externally for example, information from neighbors, radio and television or from a

health provider.

2.5 EMPIRICAL REVIEW

Gestational diabetes mellitus is becoming more common as the epidemic of obesity

and type 2 diabetes continues . gestational diabetes mellitus provides a unique

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opportunity to screen for, identify and manage diabetes and potential diabetes whilst at

the same time, halt the escalation of diabetes that emerges as a result of the offspring

born to a woman with gestational diabetes and ensuring the next generation born to

women with gestational diabetes are spared from this medical condition. Although

there are few reports on the prevalence of GDM in sub-Saharan Africa, in Nigeria, the

reported prevalence among antenatal attendees shows a rise from 0.3% in the 1980s to

as high as 15.3% in 2014 . This translates to an absolute figure of about half a million

women with GDM in Nigeria. Women with hyperglycemia detected during pregnancy

are at greater risk of adverse pregnancy outcomes: these include very high blood

pressure and fetal macrosomia (birth weight greater than 4 kg), which can make

vaginal birth difficult and risky; a higher risk of developing gestational diabetes in

subsequent pregnancies; and type 2 diabetes later in life. Babies born to mothers with

gestational diabetes also have a higher risk of developing type 2 diabetes in their teens

or early adulthood. There is a tenfold increased perinatal mortality rate in pregnancies

complicated by GDM. These poor outcomes and the findings from various studies on

the benefits conferred by diagnosis and treatment make universal screening imperative

for all pregnant women as soon as they present at health care facilities. Screening for

GDM in UPTH is currently based on selective criteria: booking weight above 90kg;

family history of DM; previous GDM; previous macrosomic babies; history of

congenital abnormalities; intrauterine fetal deaths; recurrent miscarriages; or previous

unexplained stillbirths are eligible for 75 grams oral glucose tolerance test (OGTT)

which is done at booking and repeated at 28 weeks. It is crucial for health workers to

understand that the absence of GDM risk factors is not protective against GDM. This

knowledge will inform an improvement in the patient care practices. Learning from

this study may also be relevant to patient care practices in other health facilities. We

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present here a record based review of all eligible women who received antenatal care

and delivered at our center; with a view to providing evidence based indicators for

auditing practice aimed at aiding the design of a diabetes registry and implementing

GDM management protocols that are in line with international best practices.

A records-based survey of all women, who had antenatal care and delivered at the

University of Port Harcourt Teaching Hospital (UPTH), Nigeria between November

2014 and October 2015, was conducted in December 2015. UPTH is an 882-Ogu et

al.; BJMMR, 20(11): 1-8, 2017; Article no.BJMMR.31966 3 bed tertiary health

facility providing specialist care to the Niger Delta region of Nigeria. Obstetrics and

Gynecology occupies 18.6% of bed space in the hospital. The antenatal clinic is open

five days a week. It has an average monthly turnover of 3000 attendees with average

of 250 new bookings per month. Only about 50% of booked patients deliver in the

hospital. Staff of the records department retrieved all relevant patient folders while

trained data extractors reviewed each folder, confirmed eligibility and transferred

information onto pre-designed data extraction forms. The sample size for the study

was all booked pregnant women who delivered in the hospital and met the criteria for

eligibility. Only women who had a minimum of three antenatal care visits and

delivered in the teaching hospital were deemed eligible for the study. Data relating to

whether screening for GDM was done, maternal characteristics such as age, parity,

ethnicity, education, occupation, diagnoses of GDM, maternal & fetal outcomes of

gestational age at delivery, mode of delivery, pre-eclampsia, fetal distress, birth

weight, Apgar scores, stillbirth, neonatal hypoglycemia, jaundice and respiratory

distress were retrieved. Data analysis was done using the statistical package for social

sciences (SPSS) version 21. Tests of significance were carried out to compare the

values of selected variables amongst women screened for GDM and those not

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screened with p-value of less than 0.05 accepted as significant. Continuous variables

were presented using mean ± standard deviation while categorical variables were

presented as percentages. Continuous variables were compared using the student’s t-

test while proportions or categorical variables were compared using the chi-square

test. Multiple Logistic regression was used to determine the relationship between

socio-demographic and maternal characteristics and the presence and absence of

screening for GDM. Primary outcome was percentage screened for GDM while

secondary outcome was proportion of pregnancy related. fetomaternal complications

amongst women screened for GDM compared with women not screened.

The mean age of women whose records were included in the study was 30.67 4.55

years, with a range of 18 to 48 years. Majority of the women (604; 72.2%) were aged

between 30 and 39 years, had tertiary education (475; 60.2%). More than half (464;

55.4%) had one or two previous deliveries. Multiple logistic regression analysis

showed that for every unit increase in parity, women had a 63% greater odds of being

screened for GDM at the antenatal clinic. (Odds ratio = 0.63; p value= 0.00; C.I =

0.50 to 0.79). Of the 31 women who were screened for GDM, 28 women representing

3.3% of the study population were diagnosed as having GDM using the most recent

WHO screening criteria of fasting blood sugar or two-hour postprandial value of 5.1

or 8.5mmol/ respectively. However, using the old classification of GDM, only 15

women representing 1.8% would have been diagnosed as having GDM. A comparison

of feto-maternal outcomes between women screened for GDM and those not screened

for GDM showed comparable proportions for gestational age at delivery, mode of

delivery and foetal outcome relating to hypoglycaemia, respiratory distress and

neonatal jaundice. Also, a significantly higher proportion of babies born to mothers

who were screened for GDM were admitted into the Special Care Baby Unit (SCBU).

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During implementation of their World Diabetes Foundation project, Sobngwi et al.

found that 55% of their cases were missed with selective screening and have thus

called for universal screening of GDM in antenatal populations (Fawole and

colleagues) similarly found that one third of the antenatal population are mis-

diagnosed as normal when selective screening for GDM is done compared to when a

checklist of risk factors is employed to screen pregnant women for GDM .The

importance of early and appropriate detection of GDM cannot be overstated. Evidence

abounds about the benefit of screening all pregnant women; the large-scale (25,000

pregnant women) multinational epidemiological study, demonstrated that risk of

adverse maternal, fetal, and neonatal outcomes continuously increased as a function

of maternal glycemia at 24–28 weeks, even within ranges previously considered

normal for pregnancy of higher stillbirth and asphyxia rates in the unscreened

population in this study may well buttress the fact that with selective screening, cases

of GDM are being missed and appropriate care is thus not been delivered. This is

further reinforced by studies that have severally highlighted the need for universal

screening and optimum care.

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 CHAPTER THREE

RESEARCH METHODOLOGY

3.0. Introduction

This chapter covers the description and discussion on the various techniques and

procedures used in the study to collect and analyze the data as it is deemed

appropriate

3.1 Research Design

For this study, the survey research design was adopted. The choice of the design was

informed by the objectives of the study as outlined in chapter one. This research

design provides a quickly efficient and accurate means of assessing information about

a population of interest. The study is aimed at assessing of mother’s knowledge and

prevention practices towards gestational diabetes mellitus in Passo Community.

3.2 Population of the study

The population of the study were mothers of Passo community FCT Gwagwalada

Abuja. A total number of 134 respondents were selected from the population figure

out of which the sample size will be determined. The reason for choosing Abuja

metropolis because of its proximity to the researcher.

3.3 Sample and Sampling Techniques

The researcher will use Taro Yamane’s formula to determine the sample size from the

population.

Taro Yamane’s formula is given as;

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n = N

1+N (e)2

Where N = Population of study (134)

n = Sample size (?)

e = Level of significance at 5% (0.05)

1 = Constant

.: n = 134 = 134 = 134

1 + 134 (0.05)2 1+134(0.0025) 1+0.335

n = 134 = 100

1.335

The sample size therefore is 100 respondents.

3.4 Research Instrument and Instrumentation

Data for this study will be collected from primary and secondary sources. The primary

source of data collected will be mainly the use of a structured questionnaire which is

designed to elicit information on assessment of mother’s knowledge and prevention

practices towards gestational diabetes mellitus in Passo Community.The secondary

source of data collections are from textbooks, journals and scholarly materials.

3.5 Validity of Instrument

The instrument of this study is subjected to face validation. Face validation tests the

appropriateness of the questionnaire items. This is because face validation is often

used to indicate whether an instrument on the face of it appears to measures what it

contains. Face validations therefore aims at determining the extent to which the

questionnaire is relevant to the objectives of the study. In subjecting the instrument

for face validation, copies of the initial draft of the questionnaire will be validated by

supervisor. The supervisor is expected to critically examine the items of the

24
instrument with specific objectives of the study and make useful suggestions to

improve the quality of the instrument. Based on his recommendations the instrument

will be adjusted and re-adjusted before being administered for the study.

3.6 Reliability of instrument

The coefficient of 0.81 is considered a reliability coefficient because according to

Etuk (1990), a test-retest coefficient of 0.5 will be enough to justify the use of a

research instrument.

3.7 Method of Data Collection

This study is based on the two possible sources of data which are the primary and

secondary source.

Primary Source of Data: The primary data for this study consist of raw

data generated from responses to questionnaires and interview by the

respondents.

Secondary Source of Data: The secondary data includes information

obtained through the review of literature that is journals, monographs,

textbooks and other periodicals.

3.8 Method of Data Analysis

The data to be collected will be analyzed with descriptive statistics and the results will

be presented in tables, percentages and charts.

3.9 Ethical Considerations

With the approval and consent of the village Chief for the researcher to carry out the

study in his community, the researcher informed the women leader who gave the final

25
approval for the research to go on. The researcher applied the principles of

confidentiality, voluntary participation and anonymity in the conduct of the research.

The researcher will make sure that there is no harm or risk on the respondents for

being participants of the research.

3.10. Study limitation and delimitation

The study will be carried out in only in Passo Community Gwagwalada, Abuja

Nigeria. thus the results therefore may not be generalized to the whole mothers in

Nigeria The study is based on self-assessment, self-knowledge, therefore dependent

on the respondent’s honesty.

26
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