Rachel Ogumbo, Pharm D, MBS
Nominated From: Indiana University
Research Site:Moi University
Research Area: Maternal and Child heath, Non-communicable Diseases
Primary Mentor: Dr. Laura Ruhl
Research Project
Translating research into practice by utilizing the STRiDE risk prediction tool to screen for Gestational Diabetes in community-based pregnancy peer groups in rural western Kenya
Globally, Gestational Diabetes Mellitus (GDM) is a growing concern responsible for 17% of maternal and neonatal complications, such as pre-eclampsia, post-partum hemorrhage and still birth. 90% of these outcomes are disproportionately experienced in low-and-middle income countries (LMICs). Despite international guidelines recommending early GDM screening to reduce adverse outcomes, this practice is missed during most antenatal care (ANC) visits in LMICs. Challenges to adequate GDM screening in LMICs are limited access to primary care, lack of uniform screening strategies, complexity of performing guideline recommended oral glucose tolerance test (OGTT) and cost. To improve uptake of GDM screening, innovative approaches are needed to make this process simpler and more accessible. The Stratification Risk of Diabetes in Early pregnancy (STRiDE) risk predictor is a simple, easy to use tool derived and validated against a cohort of over 4,000 pregnant women that identifies patients at medium to high-risk for GDM in early pregnancy. Stratifying GDM risk helps optimize allocation of ANC resources effectively and decrease the burden of indiscriminate OGTT testing on women. Aims: This study seeks to: (1) Assess facilitators and barriers to using STRiDE tool for GDM screening in community-based peer groups (Chamas), (2) investigate implementation of the STRiDE tool by assessing acceptability, appropriateness, and feasibility, (3) assess the effectiveness of the STRiDE-GDM screening strategy to improve uptake of screening, and (4) conduct a qualitative analysis to understand barriers to completion of GDM screening or referral for GDM care to inform adaptability and future implementation of the STRiDE-GDM screening strategy in other settings. Methods: For the qualitative portion, we will start by enrolling 40 Chama participants for 4 focus group discussions (FGDs), and a combined (7 community health volunteers (CHVs) and 3 clinicians) for semi-structured interviews (SSIs). We will continue enrollment until thematic saturation. For the quantitative portion, we will conduct a pilot study to demonstrate feasibility of integrating the STRiDE-GDM strategy into Chamas with the FGD participants. We will utilize a mixed methods approach to achieve these aims. Analysis: The qualitative portion of the study will include surveys, SSIs, questionnaires, and FGDs. Data sources will include study participants, CHVs, clinicians and clinical encounter forms. Qualitative data from SSIs and FGDs will be analyzed using thematic analysis. We will run descriptive statistics to report means and standard deviations of responses for the quantitative component. Formative data will be reported to the team during the study to improve the implementation process. Summative data will be reported post implementation.
Research Significance
Innovative community based GDM screening strategies are crucial in decreasing adverse maternal and neonatal outcomes especially in LMICs who suffer a disproportionate burden. Effective implementation of GDM screening therefore requires increased reach to vulnerable rural women who lack access to primary care at the community level with innovations such as the STRiDE risk prediction tool that are simple, acceptable, and cost effective. This proposed study will have a significant impact on (1) increased GDM screening uptake, and (2) will facilitate efficient resource allocation of screening services in an overburdened health care system. In addition, this study will provide generalizable knowledge that can be adapted to other low-resource settings.
Mentors
