KNOWLEDGE AND PERCEPTION OF GESTATIONAL DIABETES MELLITUS AMONG WOMEN ATTENDING ANTENATAL CLINIC IN IFAKO AND ISLAND MATERNITY GENERAL HOSPITAL

Abstract

This study investigated the knowledge and perception of gestational diabetes mellitus (GDM) among pregnant women attending antenatal clinics in Ifako and Island Maternity General Hospitals using a quantitative survey research design. A structured questionnaire was designed to collect data from a sample of 120 respondents. The collected data were presented and analyzed using SPSS27, and hypotheses were tested using t-tests. The findings revealed a high level of knowledge about GDM among pregnant women in the study settings, with significant associations between education level and knowledge, as well as perceptions and attitudes towards GDM. Pregnant women with higher education levels demonstrated greater knowledge about GDM compared to those with lower levels of education. Additionally, perceptions and attitudes towards GDM were influenced by socio-demographic factors and the level of knowledge about the condition. In conclusion, the study highlights the importance of educational interventions aimed at enhancing knowledge about GDM among pregnant women, particularly those with lower education levels. Healthcare providers should play a crucial role in providing accurate information and support to pregnant women to improve their understanding of GDM and promote positive health behaviors. Recommendations include the development of tailored educational materials and programs, as well as the implementation of community-based initiatives to raise awareness about GDM and its implications for maternal and child health. Overall, this study contributes to the existing literature on GDM by providing insights into the knowledge and perception of the condition among pregnant women in specific healthcare settings. Further research is recommended to explore additional factors influencing GDM awareness and management and to validate the findings in larger and more diverse populations.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Gestational Diabetes Mellitus (GDM) is a significant public health concern, characterized by glucose intolerance with onset or first recognition during pregnancy. GDM poses risks to both mother and child, potentially leading to complications such as preeclampsia, cesarean delivery, and future type 2 diabetes for the mother, as well as macrosomia, neonatal hypoglycemia, and childhood obesity for the offspring. The prevalence of GDM varies widely across different populations and is influenced by factors such as ethnicity, age, body mass index (BMI), and family history of diabetes. In Nigeria, the rising prevalence of GDM is attributed to increasing rates of obesity, sedentary lifestyles, and dietary changes (Casagrande, Linder, & Cowie, 2018).

Understanding and managing GDM requires a comprehensive approach that includes early detection, effective communication, and appropriate interventions. The knowledge and perception of GDM among pregnant women play crucial roles in the management and outcomes of the condition. Pregnant women who are well-informed about GDM are more likely to adhere to screening recommendations, lifestyle modifications, and treatment regimens, thereby reducing the risk of adverse outcomes (Coustan, Carpenter, O’Sullivan, & Carr, 2021).

The importance of early detection in the management of GDM cannot be overstated. Screening for GDM is typically conducted between 24 and 28 weeks of gestation, using either a one-step or two-step approach. The one-step approach involves a 75-gram oral glucose tolerance test (OGTT), while the two-step approach starts with a 50-gram glucose challenge test followed by a 100-gram OGTT if the initial test is abnormal. Early detection allows for timely intervention, which can include dietary modifications, physical activity, and pharmacological treatments if necessary (Brown & Wyckoff, 2017).

Ethnic and racial disparities significantly affect the prevalence and outcomes of GDM. Studies have shown that women of certain ethnic backgrounds, such as African, Hispanic, and Asian, have a higher risk of developing GDM compared to their Caucasian counterparts. These disparities are attributed to genetic, environmental, and socio-economic factors. In Nigeria, for instance, the prevalence of GDM is increasing due to the westernization of diets, reduced physical activity, and increasing obesity rates (Jiwani et al., 2022).

The role of healthcare providers is crucial in the management of GDM. Effective communication between healthcare providers and pregnant women about the risks and management strategies for GDM is essential. This includes educating women about the importance of blood glucose monitoring, adhering to prescribed diets, and maintaining regular physical activity. Healthcare providers must also be culturally sensitive and consider the socio-economic challenges that may affect a woman's ability to manage her condition effectively (Schneider, Bock, Wetzel, Maul, & Loerbroks, 2022).

In Nigeria, the rising prevalence of GDM highlights the need for public health initiatives that address lifestyle changes and promote awareness. Interventions should focus on encouraging healthy eating habits, increasing physical activity, and providing education on the risks associated with GDM. These public health strategies are essential in preventing the onset of GDM and improving outcomes for both mothers and their children (Fawole et al., 2020).

The management of GDM often involves a multidisciplinary approach, including obstetricians, endocrinologists, dietitians, and diabetes educators. This team-based approach ensures that all aspects of a woman’s health are addressed, from dietary counseling and glucose monitoring to fetal monitoring and delivery planning. A comprehensive care plan can significantly reduce the risk of complications and improve the overall health of both mother and child (Xiang et al., 2021).

GDM also has long-term implications for both the mother and the child. Women who have had GDM are at an increased risk of developing type 2 diabetes later in life. Therefore, postpartum follow-up is crucial to monitor and manage blood glucose levels. Additionally, children born to mothers with GDM are at a higher risk of developing obesity and metabolic disorders, necessitating ongoing health monitoring and lifestyle interventions to mitigate these risks (Barker, 2021).

Community-based education and support programs can be effective in managing GDM. These programs can provide valuable resources and support for pregnant women, helping them understand the importance of managing their condition and providing practical advice on diet and exercise. Community health workers and peer support groups can play a pivotal role in these programs, offering culturally relevant education and emotional support (Owoaje, Onifade, & Desmennu, 2020).

Research and surveillance are also vital in understanding and addressing the challenges posed by GDM. Continued research into the genetic, environmental, and socio-economic factors contributing to GDM will help develop more effective prevention and management strategies. Surveillance systems can monitor trends in GDM prevalence and outcomes, informing public health policies and resource allocation (Onyenekwe et al., 2019).

The antenatal clinic setting provides an ideal opportunity for healthcare providers to educate pregnant women about GDM. However, there is limited information on the knowledge and perception of GDM among women attending antenatal clinics in Nigeria, particularly in urban settings such as Ifako and Island Maternity General Hospitals in Lagos. This study seeks to fill this gap by exploring the level of knowledge and perception of GDM among pregnant women attending these clinics.

1.2 Statement of Problem

Gestational Diabetes Mellitus (GDM) presents a growing public health challenge globally, and particularly in Nigeria, where its prevalence is rising due to increasing rates of obesity, sedentary lifestyles, and dietary changes. Despite extensive research on GDM, significant gaps remain in our understanding and management of this condition, particularly in the context of low- and middle-income countries.

One critical gap is the limited data on the prevalence and determinants of GDM in diverse Nigerian populations. Most studies have focused on specific urban areas, neglecting rural populations where healthcare access and lifestyle factors may differ significantly (Jiwani et al., 2022). Additionally, there is a paucity of research exploring the genetic and environmental interactions that contribute to the high prevalence of GDM among different ethnic groups within Nigeria (Xiang et al., 2021). This gap hinders the development of targeted prevention and management strategies that consider the unique risk profiles of various populations.

Moreover, there is insufficient knowledge about the perceptions and awareness of GDM among pregnant women in Nigeria. Understanding how women perceive the risks associated with GDM and their knowledge of its management is crucial for designing effective educational interventions (Onyenekwe et al., 2019). Current research often overlooks the socio-cultural factors that influence health behaviors and adherence to medical advice in pregnant women, leading to suboptimal outcomes (Owoaje, Onifade, & Desmennu, 2020).

Another significant gap is the lack of comprehensive and accessible screening programs for GDM in Nigeria. Many women do not receive timely screening due to limited healthcare infrastructure, particularly in rural areas. This results in delayed diagnosis and treatment, increasing the risk of adverse outcomes for both mothers and their children (Fawole et al., 2020). Research is needed to develop and implement cost-effective screening methods that can be integrated into existing healthcare systems in Nigeria.

Furthermore, there is a need for more longitudinal studies that track the long-term health outcomes of women and children affected by GDM in Nigeria. Such studies could provide valuable insights into the progression from GDM to type 2 diabetes and other metabolic disorders, informing strategies for long-term prevention and management (Barker, 2021). Addressing these gaps is essential to improve the health outcomes of women and children affected by GDM and to reduce the overall burden of diabetes in Nigeria.

1.3 Objectives of the Study

The main objectives of this study were:

1. To assess the level of knowledge about GDM among pregnant women attending antenatal clinics in Ifako and Island Maternity General Hospitals.

2. To evaluate the perceptions and attitudes towards GDM among these women.

3. To identify the factors influencing the knowledge and perception of GDM among pregnant women in these settings.

1.4 Research Questions

The study aimed to answer the following research questions:

1. What is the level of knowledge about GDM among pregnant women attending antenatal clinics in Ifako and Island Maternity General Hospitals?

2. What are the perceptions and attitudes of pregnant women towards GDM in these hospitals?

3. What factors influence the knowledge and perception of GDM among these women?

1.5 Research Hypotheses

The following hypotheses were tested in this study:

1. Pregnant women attending antenatal clinics in Ifako and Island Maternity General Hospitals have a high level of knowledge about GDM.

2. There is no significant relationship between the level of education and knowledge of GDM among pregnant women in these hospitals.

3. Perceptions and attitudes towards GDM among pregnant women are not influenced by their level of knowledge and socio-demographic factors.

1.6 Significance of the Study

The significance of this study on the knowledge and perception of Gestational Diabetes Mellitus (GDM) among women attending antenatal clinics in Ifako and Island Maternity General Hospitals is multifaceted, addressing critical gaps in research, healthcare practice, and public health policy. This study aims to contribute valuable insights into several key areas that can significantly improve maternal and child health outcomes.

Firstly, understanding the level of knowledge and perception of GDM among pregnant women is essential for developing effective educational interventions. Many women are unaware of GDM's risks and management strategies, which can lead to suboptimal outcomes (Onyenekwe et al., 2019). By identifying gaps in knowledge and misconceptions about GDM, this study can inform the creation of targeted educational programs. These programs can enhance awareness and understanding of GDM, encouraging pregnant women to adopt healthier lifestyles, adhere to screening recommendations, and comply with treatment regimens, thereby reducing the incidence of adverse outcomes such as preeclampsia, cesarean delivery, and neonatal complications.

Secondly, this study has significant implications for healthcare practice. Healthcare providers play a crucial role in managing GDM, and their ability to effectively communicate with and educate patients is vital (Schneider, Bock, Wetzel, Maul, & Loerbroks, 2022). The findings of this study can help healthcare providers identify common areas of misunderstanding and resistance among pregnant women, allowing them to tailor their communication strategies to better address patient concerns and improve compliance. Additionally, the study can highlight the need for continuous professional development and training for healthcare providers to keep them updated on the latest guidelines and best practices in GDM management.

Moreover, the study's findings can contribute to public health policy by providing evidence-based recommendations for screening and management programs tailored to the Nigerian context. The rising prevalence of GDM in Nigeria, driven by increasing obesity rates and lifestyle changes, necessitates effective public health strategies (Fawole et al., 2020). This study can support the development of policies that promote regular screening for GDM, particularly in high-risk populations, and ensure that adequate resources are allocated to antenatal care services. By advocating for policies that improve access to screening and management, this study can help reduce the overall burden of GDM on the healthcare system.

Additionally, this study can serve as a foundation for future research. While there is considerable research on GDM globally, specific data on the Nigerian population, particularly in diverse settings such as urban and semi-urban areas, is limited (Jiwani et al., 2022). This study can fill this gap by providing localized data that reflects the unique socio-cultural and economic factors influencing GDM in Nigeria. Future researchers can build on this study to explore longitudinal outcomes of GDM, investigate genetic and environmental interactions, and evaluate the effectiveness of various intervention strategies.

Furthermore, the study can have broader societal impacts by improving maternal and child health outcomes. GDM has long-term implications, increasing the risk of type 2 diabetes in mothers and obesity and metabolic disorders in children (Barker, 2021). By enhancing knowledge and perception of GDM among pregnant women, this study can contribute to healthier pregnancies and better long-term health for both mothers and their children. This, in turn, can reduce healthcare costs associated with managing complications of GDM and improve the quality of life for affected families.

1.7 Scope of the Study

The scope of this study was limited to pregnant women attending antenatal clinics in Ifako and Island Maternity General Hospitals in Lagos, Nigeria. The study focused on assessing their knowledge and perception of GDM, including their understanding of risk factors, symptoms, complications, and management of the condition. Data collection was carried out using structured questionnaires administered to a sample of women attending these clinics. The study did not include women with pre-existing diabetes or other chronic conditions that could influence their knowledge and perception of GDM.

1.8 Operational Definition of Terms

Gestational Diabetes Mellitus (GDM): A form of diabetes that is diagnosed for the first time during pregnancy, characterized by high blood glucose levels.

Antenatal Clinic: A healthcare facility that provides medical care and support to pregnant women throughout their pregnancy.

Knowledge: The level of information and understanding that pregnant women have about GDM, including its risk factors, symptoms, and management.

Perception: The attitudes, beliefs, and opinions that pregnant women hold regarding GDM and its implications for their health and that of their baby.

Risk Factors: Characteristics or conditions that increase the likelihood of developing GDM, such as obesity, advanced maternal age, and family history of diabetes.

Symptoms: Clinical manifestations of GDM, which may include excessive thirst, frequent urination, fatigue, and blurred vision.

Complications: Adverse outcomes associated with GDM, affecting both the mother and the baby, such as preeclampsia, preterm birth, and neonatal hypoglycemia.

Management: Strategies and interventions used to control blood glucose levels in pregnant women with GDM, including dietary modifications, physical activity, and medication if necessary.