An Assesment Of The Prevalence Of Gestational Diabetes In Nigeria
[A STUDY OF PREGNANT WOMEN IN MAIDUGURI METROPOLIS]

1.1 STATEMENT OF THE PROBLEM

GDM is estimated to occur in about 5.5-8.8% of all pregnancies, associated with both morbidity and mortality in both mother and child. It may also damage the health of the fetus or the mother. Another major concern is that about 20 to 50%of women with GDM develop type 2 diabetes and obesity later in life.

1.2 RESEARCH OBJECTIVES

The main aim of the project therefore is to access critically the prevalence of gestational diabetes mellitus and its complications among pregnant women in Maiduguri metropolis and its burden on public health. Specifically, the objectives of the project are to:

Determine the effects of GDM on pre-natal complications.

Discuss the pattern, risk factors, morbidity/mortality, and complications of gestational diabetes.

To propose strategies for prevention of GDM among pregnant women.

The study will also facilitate further study from where this project paused for academic excellence.

1.3 RESEARCH QUESTIONS

1. Does GDM affect pre-natal complications?

2. Does GDM affect the morbidity and mortality rate of pregnant women      and their babies?

3. Are there strategies  for the prevention GDM among pregnant women?

1.4 RESEARCH HYPOTHESIS

The hypothesis of this study is that Gestational Diabetes Mellitus is given as:

NULL HYPOTHESIS (Ho):

GDM does not significantly impact on pre-natal complications

ALTERNATIVE HYPOTHESIS (Hi):

GDM significantly impact on pre-natal complications.

1.5 SIGNIFICANCE OF THE STUDY

The health system is faced with an increase in Gestational diabetes mellitus. Therefore, pregnancy complication will require increased resource to manage appropriate glycemic control during pregnancy and reduce adverse prenatal outcomes (Crowther et al; 2005). In addition ~50% of women with GDM are expected to develop type 2 diabetes within 5years of index pregnancy (Kim et al; 2002). Recent clinical trials have shown that health behaviours such as diet and physical activities prevent or delay onset of diabetes (Tuomilehto et al; 2001, knowler et al; 2002). Such behaviours interventions have been shown to be cost effective at a higher level than a pharmacological intervention (Hernan et al; 2003). Therefore, clinicians will increasingly have to primate plasma glucose testing and improved health behaviours at post-partum visits of women who had GDM to prevent development of diabetes and recurrent GDM. Also, some physicians may not recognize that women with GDM are at risk of diabetes.

1.6 DELIMITATION OF THE STUDY

The delimitations of this study significantly narrow the scope of the research. Some of these delimitations include:

Participation in this study is voluntary.

The population is restricted to pregnant women in Maiduguri.

The sample is limited to pregnant women with gestational diabetes mellitus.

Only few hospitals (antenatal clinics) are involved in the study out of many clinics in Maiduguri metropolis.

Religious and cultural belief affects women participation in the study.

Present insecurity challenges in the region limits access to relevant information especially at the University of Maiduguri Teaching Hospital (UMTH) and University of Maiduguri libraries.

1.7 OPERATIONAL DEFINATION OF TERMS

Gestational diabetes mellitus:

Gestational diabetes mellitus is defined by the world health organization as being “any degree of glucose intolerance with onset or first recognition during pregnancy” and should therefore include glucose readings that fall within diagnostic ranges for diabetes.

Prevalence:

Refers to the total number of cases of a disease in the given statistical population at a given time. According to Wikipedia free encyclopedia, in epidemiology, it is the proportion found to have a condition (typically a disease or risk factor). It arrived by comparing the number of people found to have a condition with the total number of people studied. Usually expressed as a fraction, percentage or as a number of cases per 100,000 people. 

Risk factors:

This refers to something that increases a person’s chances of developing a disease eg. Cigarette smoking is a risk factor for lung cancer, and obesity is a risk factor for heart disease.

Glucose tolerance (impaired):

Is a situation whereby blood glucose is raised beyond normal range but not high to cause diabetes. It is a risk factor for diabetes.

Insulin resistance:

Is a condition in which the body produces insulin but does not use it effectively.

Morbidity:

The incidence of a disease and the rate of a population affected. Or the quality of being unhealthful, morbid.

Mortality:

This is the condition of being susceptible to death or the death rate of a population.

Prenatal care:

Refers to the care given to pregnant woman before birth. Also known as antenatal care.

Perinatal outcomes:

These are outcomes pertaining to the time around birth.

1.7 LIMITATIONS OF THE STUDY

The limitations of the study are real or perceived problems which have been identified in the course of the study. They are almost beyond our control and are associated with the design and methodology which will have impact or influence on the application or interpretation of the result of this study. Some of these limitations are:

Limited funds and resources: because of severe resource constraints, the study focuses on few antenatal clinics. This limits the extent to which other data sources are explored which may provide additional information for this study.

Small sample size: A sample size for the survey in this study was limited to only 250 participants.

Short period for the research: The period within which the study was conducted is restrictively short. More time is required to ensure wider coverage.

Language barrier:

Though the questionnaire was designed in English language, with little or no contributions from the research assistants that volunteered in administering it , the research assistants were given short training on how to administer it. Languages were still a challenge as most interactions were done in local languages ( kanuri and hausa). Few reported having difficulty with the participants understanding some of the questions.

Security challenges:

Due to the security challenges of boko haram insurgency, some of the volunteers have raised security concerns during the  data collection.