May 2011
Diabetes affects 1 in 10 Mexicans and is the leading cause of death nationwide. In an effort to improve prevention and treatment for women, 4th Sector Health is collaborating with Project HOPE, Bristol-Myers Squibb (BMS) and Johnson & Johnson (J&J) to improve prevention education, screening, and treatment for diabetes, pre-diabetes, and gestational diabetes among women in Mexico and Nicaragua. The partnership kicked off in March 2011 by training government health workers in Mexico.
All three types of diabetes are on the rise, with gestational diabetes cases doubling worldwide in the past 20 years. Although gestational diabetes abates at birth, it is a risk factor for developing type 2 diabetes for both mother and child, and can result in oversized babies, other birth complications, and increased maternal-child morbidity and mortality.
To strengthen providers’ knowledge and capacity to address diabetes, Project HOPE trained 23 Mexican health workers from Nezahualcoyotl and Iztapalapa districts representing five health centers and a non-governmental organization (NGO), collectively serving more than 150,000 area residents. Training focused on enhancing clinical and educational skills to increase screening efforts for diabetes, pre-diabetes, and gestational diabetes.
While Project HOPE provided training and educational materials, J&J donated glucose meters and nearly 150,000 diabetes test strips to support testing activities. Health worker teams received the training and materials to give two educational sessions to pregnant women in their respective health centers as well as outreach posters, a training manual, and materials to test 100 people. Participants agreed to put their newly developed knowledge to good use—with each health worker team agreeing to test 100 pregnant women for diabetes.
Testing protocol is being overseen by the National Institute of Nutrition (INN), using national guidelines congruent with WHO standards. To make the testing more efficient, INN and Project HOPE identified readily available food products (namely 250 ml of orange juice and three slices of white bread) that serve as an alternative for the 75 grams of glucose normally administered for testing. Regional referral mechanisms will ensure preliminary diagnosis at the primary care level is confirmed at a hospital, where treatment will continue if the pregnancy is reclassified as high risk. Data sheets provided by Project HOPE will collect and track information on patients to determine risk factors associated with gestational diabetes, as well as health outcomes for mother and child.
One of the participating centers, the Pirules health center, already delivered two educational sessions to 20 women in the community—with one woman testing positive for gestational diabetes. In response, the woman was referred to the regional hospital for confirmation and treatment. The trained nurse attending the woman remarked, “I am waiting to see if her diagnosis is confirmed at the regional hospital and will follow up with her closely. My colleagues are now asking me to train them so we can offer more education sessions.” The remaining four participating health centers offered their sessions in April.