During her third pregnancy, Eden Bihon visited the Mekelle Health Center in Tigray, Ethiopia. Although a routine prenatal visit, it held great importance for Eden, as she had recently lost her second child, who died from unknown causes at the age of just one year.
Unknown to her at the time, this visit would have lasting implications for Eden and her baby. A 23-year-old mother, Eden, like most Ethiopian women, had concerns about her pregnancy and well-being. But gestational diabetes was not one of them.
Without proper care, gestational diabetes mellitus or GDM can cause serious complications during pregnancy and childbirth, endangering the life of a woman and her baby. GDM occurs when a woman develops high blood sugar during pregnancy, and increases risk of infection and obstructed labor. Furthermore, pre-eclampsia is three times more likely to occur in women with GDM. An Ethiopia Network for HIV and AIDS Treatment, Care and Support study led by Management Sciences for Health revealed that about 11 percent of women in Mekelle have GDM — high even for Africa with a rate of about 5 percent.
Since GDM is associated with an increased risk for Type 2 diabetes for both the woman and child, it can also lead to serious health problems later in life. This can initiate a vicious cycle where the child will go on to have an increased risk of GDM, and may very well pass this risk onto yet another generation.
Very few health care providers in Ethiopia offer routine diabetes screening to pregnant women. When Eden visited Mekelle, it happened to be one of three primary health centers in Tigray where MSH was working with the regional health bureau to roll out World Health Organization guidelines on universal screening of pregnant women for GDM, in collaboration with the Ethiopian Diabetes Association. This initiative was supported by MSH’s Innovation Challenge Fund — a means to identify promising solutions with potential to improve health outcomes — and carried out by the USAID-funded, MSH-led ENHAT-CS program.
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Even though Eden’s mother had recently been diagnosed with diabetes, Eden had never been tested prior to her antenatal visit to Mekelle. At 25 weeks, her blood glucose was found to be high, and she was diagnosed with GDM.
She was fortunate to have been screened: An estimated 80 percent of cases in Ethiopia remain undiagnosed. Universal or selective screening is routine in most high-income countries. But in Ethiopia, as in most lower-income countries, screening is the exception and not the rule.
With a proper diagnosis, Eden was able to receive the care she needed to keep herself and her baby healthy. Over the course of a weeklong session with trained midwives, she learned how to eat and exercise properly throughout her pregnancy. The majority of women with GDM see significant improvements in their blood sugar levels with this simple, behavioral intervention. To complement the lifestyle modification, Eden was also prescribed an anti-diabetic medication to help keep her blood sugar under control, and had regular follow ups to monitor her blood glucose levels.
More women like Eden could benefit, too. International GDM guidelines were successfully adapted and implemented within the local context in Tigray, providing the basis for scale up across Ethiopia. Effective training tools and materials from the EDA already exist and can be readily used in health centers.
Eden gave birth last June to Honolyat, a healthy baby girl who is now four months old and has had no complications. Eden’s blood sugar has returned to normal and she continues to visit Mekelle for regular follow-up visits.
“I learned on importance of having controlled blood glucose level during my pregnancy for myself and my daughter’s health,” Eden reflected. “It helped me to be aware of my condition and take care of my health in the future. It would have been nice had I received this chance in my earlier pregnancy.”
We think that all women should have this chance. The universal health coverage agenda in Ethiopia provides a distinct opportunity for the inclusion of GDM screening within an essential package of services. And since UHC schemes typically place a strong emphasis on maternal and child health from their nascent stages, it should be an easy sell: Screening for gestational diabetes is a simple, cost-effective solution for preventing illness among women and children.
Once scaled up, Ethiopia could serve as an example for other countries moving toward UHC and working to improve maternal and child health. With these two goals in mind, it would be incongruous not to adopt this model. Expanded GDM screening means safer pregnancies and deliveries. It means a healthier start for more infants, and the prevention of Type 2 diabetes for current and future generations. In other words, it’s the opportunity for healthier, longer lives. That’s our vision for Eden and Honolyat.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.