Optimizing screening practice for gestational diabetes mellitus in primary healthcare facilities in Tanzania

Introduction: Tanzania is facing a rising prevalence of obesity in the general population, including women in reproductive age. Excess weight pre-pregnancy is a risk factor for onset of gestational diabetes mellitus (GDM), a highrisk condition predisposing both the woman and the newborn to a number of complications during and after pregnancy, including an increased risk of developing type 2 diabetes. As a primary preventive modality, screening for GDM during pregnancy is critical to timely diagnosis and treatment. However, it is not well standardized in primary care facilities where the majority of pregnant women in Tanzania receive routine antenatal care, leading to missed or late diagnosis and suboptimal care during pregnancy and beyond.

Objective: I will explore the current practices of screening for GDM during routine antenatal care, estimate the prevalence of GDM in pregnancy, compare the performance of two commonly used GDM screening modalities, and explore best ways to institutionalize screening for GDM at primary level hospital setup in Tanzania using perspectives of health care workers, health managers and pregnant women. The main outcome will be a recommendation for a contextspecific structured screening modality for GDM at a primary level hospital setup in Tanzania.

Methods: This will be a sequential mixed-methods study [quan + QUAL] →[QUAN] → [QUAL] conducted in antenatal care clinics (ANC) of two health facilities: Kisarawe District Hospital (KDH) in Coast region and Mbagala Rangi Tatu Hospital (MRH) in Dar es Salaam region. Quantitative data will be collected to determine the current structural capacity and screening practices for GDM, prevalence of GDM among antenatal care users, and sensitivity and specificity of the two recommended screening modalities. Qualitative data will be collected through key informant interviews and focus group discussions with health care workers and managers to understand the rationale and benefits of the used screening modality and explore the meaning of screening/diagnosis to pregnant women, health managers and care providers.

Expected results: The research findings generated by the four studies will inform policy makers on the magnitude of GDM and recommend on the best screening modality at a primary health facility level in Tanzania.