Download complete project material on Prevalence Of Gestational Diabetes Mellitus (Gdm) Among Pregnant Women Attending Public Hospital In Nigeria from chapter one to five
Abstract
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This study investigated the Prevalence of Gestational Diabetes Mellitus (GDM) among pregnant women attending Yusuf Dantsoho Memorial Hospital Kaduna from 2010 to 2015. Five specific objectives and five research questions were set, in order to achieve the desired result.
Literatures were extensively reviewed about the prevalence, causes, complications and preventive measures of GDM among pregnant women in both Nigerian context and international levels. Checklist was the instrument used for data collection, and the validation of the instrument was made through corrections and suggestions from the supervisor and other staff.
A sample of 192 pregnant women records was used and the generated data was analyzed and presented in tabular and figure forms. Findings showed that the prevalence of GDM rises to 15.6% in 2012 than in 2011 which is approximately 2.6%, but it is a decrease in the findings of 2010 which as almost 21.4% out of the total 100%. The prevalence rises to 48.4% out of the total 100% in 2015 and fall in 2015 to 7.3% as in 2013 which rates for only 4.7% out of the total 100%.
This implies that, the prevalence of GDM in the study area is dynamic due to some socio-economic and demographic factors. With these therefore, conclusions were drawn indicating the dangers associated with GDM to the pregnant women and their babies, as well as availability of necessary preventive measures. Recommendations were made requiring the pregnant women to patronize proper hospitals for Antenatal Care, control their dietary patterns, engage in regular, moderate physical activities, and in minimizing the occurrence of GDM in the study area.
TABLE OF CONTENTS
Title page
Declaration
Certification
Dedication
Acknowledgement
Abstract
Table of content
List of tables
List of figures
CHAPTER ONE
INTRODUCTION
Background of the Study 1
Statement of the Problem 2
Broad Objectives of the Study 3
Specific Objectives of the Study 3
Research Questions                        3
Significance of the Study 4
Scope of the Study 4
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CHAPTER TWO
REVIEW OF RELATED LITERATURES
Introduction 5
History of Gestational Diabetes Mellitus 5
Prevalence of Gestational Diabetes Mellitus 7
Causes of Gestational Diabetes Mellitus 9
Mechanism of action of insulin 10
2.5.1Â Â Â Insulin Receptor
2.5.2Â Â Â Insulin Action
2.5.2.2 Insulin Effect on glucose metabolism
2.5.3Â Â Â Insulin-Receptor Interaction Pathophysiology of Gestational Diabetes Mellitus 12
2.6.1Â Â Â The Role Foetus-Placental Unit in the Development of GDM
2.6.1.2 Diabetic Action of Steroid hormones (Cortisol, Estrogen, and progesterone)
2.6.1.3 Human Placental Lactogen (HPL), and human chorionic
Somatomammotropin (HCS)
2.6.2Â Â Â The role of adipose tissue in the development of GDM
2.6.2.1 Adipocytokines
2.6.2.2 Adiponectin
2.6.2.2.1 Functions of Adiponectin
2.6.2.2.2 Adiponectin and the pathophysiology of obesity and diabetes
2.6.2.2.3 Tumor necrosis factor-a (TNF-a)
2.6.2.2.4 The Diabetogenic action of TNF – a
2.6.2.2.4 Resistin
2.6.2.2.5 Leptin
2.6.2.2.6 Visfatin
2.6.2.2.7 Apelin
Signs and symptoms of Gestational Diabetes Mellitus 28
Risk Factors associated with Gestational Diabetes Mellitus 28
Complications of Gestational Diabetes Mellitus 28
2.9.1Â Â Â The complications of GDM to the Mother
2.9.2Â Â Â The Complications of GDM to the Baby
Diagnosis of Gestational Diabetes Mellitus 30
2.10.1Â Screening Glucose Challenge test (SGCT)
2.10.2Â Oral Glucose Challenge Test (OGTT)
2.10.3Â Glycated Hemoglobin (Gh)
Treatment of GDM 30
2.12Â Â Â Â Summary of Reviewed Literatures
CHAPTER THREE
METHODOLOGY
3.0 Â Â Â Â Â Introduction
3.1Â Â Â Â Â Â Description of the Study Area
3.2Â Â Â Â Â Â Research Design
3.3Â Â Â Â Â Â Research Population
3.4Â Â Â Â Â Â Sample Size and Sampling Technique
3.5Â Â Â Â Â Â Sample Size
3.6Â Â Â Â Â Â Instrument for Data Collection
3.7 Â Â Â Â Â Validation and Reliability of the Instrument
3.8Â Â Â Â Â Â Administration of the Instrument
3.9Â Â Â Â Â Â Method of Data Presentation and analysis
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
4.1 Â Â Â Â Â Introduction
4.2 Â Â Â Â Â Result Presentation
4.3Â Â Â Â Â Â Discussion of finding
CHAPTER FIVE
DISCUSSION OF FINDINGS, SUMMARY, CONCLUSION AND RECOMMENDATION
5.1Introduction
5.1Summary
5.2 Conclusion
5.3 Recommendation
References
Questionnaire (Appendix I)
Sample size table (Appendix II)
CHAPTER ONE
INTRODUCTION
Background of the Study
For more than a century, it has been known that diabetes antedating pregnancy can have severe adverse effects on foetal and neonatal outcomes. Gestational diabetes mellitus (GDM) appears to result from the same broad spectrum of physiological and genetic abnormalities that characterized diabetes outside of pregnancy (Ahmad and Shaleyel, 2009).
Gestational diabetes mellitus is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy which as a concept existed since 1946 (Metzger and Coustan, 1998). This definition acknowledges the possibility that patient may have previously undiagnosed DM or may have developed D.M coincidentally with pregnancy.
Gestational diabetes usually resolves after delivery and whether symptoms subside after pregnancy is also irrelevant to the diagnosis. The precise mechanisms underlying gestational diabetes remain unknown. The hallmark of GDM is increased insulin resistance. Pregnancy hormones and other factors are thought to interfere with the action of insulin as it binds to the insulin receptor.
Insulin resistance is a normal phenomenon emerging in the second trimester of pregnancy, which progresses thereafter to levels seen in non-pregnant patients with type 2 diabetes. It is unclear why some patients are unable to balance insulin needs and develop GDM, however a number of explanations have been given, similar to those in type 2 diabetes, autoimmunity, single gene mutations, obesity, and other mechanisms (Kuhl, 2005).
According to Al-Dahwi, et al., (2008), Gestational Diabetes Mellitus (GDM) is a condition where a person is found to have high blood glucose (sugar) levels and it happens for the first timing during pregnancy. It is also glucose intolerance of various degrees that is first detected during pregnancy (Baker, 2006).
Shao, et al., (2000) suggested that, Women with Gestational Diabetes Mellitus (GDM) are at high risk for having or developing diabetes when they are not pregnant. Thus, Gestational Diabetes Mellitus (GDM) provides a unique opportunity to study the early pathogenesis of diabetes and to develop interventions to prevent the disease (Barbieri, 2009).
The prevalence of GDM in the general population of British Columbia was estimated by acquiring 24,321 GDM screening tests performed by the major laboratories in the province. The result showed that; the prevalence of GDM among pregnant women was about 59% in the cohort and 68% in the screened general population (Barbour, Carrie, McCurdy, Teri, Hernandez, John and Kirwanet (2007),
Tsuchida, et al., (2005) GDM has become an increasingly prevalent and severe public health issue in Algeria. The national evidence suggests that the prevalence of GDM in Algeria has increased from 6.8%Â in 1990 to 12.29% in 2005. A total of 607 women participated in the study conducted on GDM at Ghana and GDM was diagnosed in 43 representing 7.1% women.
A single abnormal value was observed in additional 66 representing 10.87% women (Tsuchida, Yamauchi and Kadowaki, 2005). On bivariate analysis, risk factors found to be significantly associated with GDM were age, educational level, socio-economic status, pre-pregnancy weight and BMI (Body Mass Index), weight gain, family history of diabetes of hypertension, and past history of GDM (Weyer, et al., 2001).
In Nigeria, previous studies of the problem of pregnancy and diabetes in parts of Nigeria failed to distinguish between GDM and pregnancy occurring diseases in the previously diagnosed diabetics (Boney, Verma, Tucker an d Vohr, 2005).
World Health Organization (WHO) 2013, the prevalence of GDM in Nigeria remain sub optimal but within the global range of 0.15% to 3.0%. The overall care and metabolic control of GDM pregnancies in Nigeria’s population remain low with attendant poor foetus maternal outcomes (Church, Halsall, Meek, Parker, Murphy and Simmons 2011).
As Gestational Diabetes Mellitus (GDM) becomes an increasing problem to pregnant women all over the world, So far, there is no documented research on the prevalence of gestational diabetes in this community and that is why the study was thought necessary, the researcher is motivated to investigate the Prevalence of GDM among Pregnant Women attending Yusuf Dantsoho Memoria Hospital Kaduna from 2010 to 2015.
Statement of the Problem
Gestational diabetes mellitus has significant impact on birth outcomes. Children who are born to mothers with gestational diabetes mellitus are likely to have health-related complications later in life and are at risk of infant death (Kuhl, 2005).
Catalano, et al., (2009), the overall incidence and case fertility rates for GDM is a growing health concern in many parts of the world; some studies have shown that GDM occurs in 2.2%–8.8% of pregnancies (Cheung, 2009), depending on the ethnic mix of the population studied and the criteria used for diagnosis. Its incidence is increasing, in parallel with the increase in type 2 diabetes mellitus (Nolan, 2011).
In sub-Saharan Africa, the prevalence of GDM is variable, with a range of 0% to 13.9% in some areas. Women with GDM make up 61.0% of the total number of women with diabetes mellitus in pregnancy (Church, Halsall, Meek, Parker, Murphy and Simmons 2011).
- Broad Objective
This study is meant to investigate the prevalence of Gestational Diabetes Mellitus (GDM) among pregnant women attending Yusuf Dantsoho memorial hospital Kaduna from 2010 to 2015.
- Specific Objectives of the Study
- To identify the prevalence of Gestational Diabetes Mellitus (GDM) among pregnant women patronizing Yusuf Dantsoho memorial hospital from 2010 to 2015.
- To find out the possible causes of Gestational Diabetes Mellitus (GDM) among pregnant women in the study area.
- To identify the possible signs and symptoms of Gestational Diabetes Mellitus (GDM) among pregnant women in the study area.
- To find out the complications associated with Gestational Diabetes Mellitus (GDM) on the pregnant women attending the hospital.
- To suggest possible intervention measures of preventing Gestational Diabetes Mellitus (GDM) among pregnant women in the study area.
Research Questions
What is the prevalence of Gestational Diabetes Mellitus (GDM) among pregnant women patronizing Yusuf Dantsoho memorial hospital from 2010 to 2015?
What are the possible causes of Gestational Diabetes Mellitus (GDM) among pregnant women in the study area?
What are the possible signs and symptoms of Gestational Diabetes Mellitus (GDM) among pregnant women in the study area?
What are the complications associated with Gestational Diabetes Mellitus (GDM) on the pregnant women attending the hospital?
What are possible intervention measures of preventing Gestational Diabetes Mellitus (GDM) among pregnant women in the study area?
Significance of the Study
This findings from this research work will help create awareness on the risks associated with Gestational Diabetes Mellitus (GDM) among pregnant women.
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