Primary Health Care Staff Knowledge and Practices towards Gestational Diabetes Mellitus in Kuwait

Special Article – Primary Healthcare

J Fam Med. 2016; 3(8): 1083.

Primary Health Care Staff Knowledge and Practices towards Gestational Diabetes Mellitus in Kuwait

Carballo M1,2*, Al Wotayan R³ and Maclean EC²

¹Dasman Diabetes Institute, Kuwait City, Kuwait

²International Centre for Migration Health and Development, Geneva, Switzerland

³Kuwait Ministry of Health, Kuwait City, Kuwait

*Corresponding author: Carballo M, International Centre for Migration, Health and Development, 11 Rue du Nant d’Avril, Geneva, Switzerland

Received: September 01, 2016; Accepted: September 23, 2016; Published: September 26, 2016


This cross-sectional study of how gestational diabetes mellitus (GDM) is being dealt with in the PHC system in Kuwait highlights a number of important gaps in policy, guidelines and practices. It found important differences in how GDM is perceived in 24 primary healthcare centres in the country and how the lack of a national policy encourages individual PHC centres to develop their own approach to gestational diabetes. Most respondents said that screening for GDM is done during the first antenatal visit. Only 33% indicated that it is done at the recommended time, namely between the 24th and 28th week of pregnancy. When GDM is diagnosed, women are referred to specialised hospitals, and almost half of the respondents felt that GDM patients are subsequently lost to follow-up at the PHC level, because information is not routinely looped back to the PHC centres. Only 24% and 29% of PHC staff said that mothers are typically provided with GDM counselling or information, respectively in the PHC centres. PHC staff agreed that management of GDM at the primary care level could improve continuity of care, cost-effectiveness, and be psychologically better for women. At the same time they acknowledged that PHC centres do not currently have the capacity to take on this responsibility in the absence of more training.

If the Kuwaiti PHC system is to play a more important role in the management of GDM, more attention must be given to strengthening PHC staff knowledge and practices in this area.

Keywords: Gestational Diabetes; Primary Health Care


GDM: Gestational Diabetes Mellitus; PHC: Primary Health Care; IDF: International Diabetes Federation; T2DM: Type 2 Diabetes Mellitus; GCC: Gulf Cooperation Council; DDI: Dasman Diabetes Institute; ob/gyn: obstetric and gynaecological; GPs: General Practitioners; WHO: World Health Organisation; SOPs: Standard Operating Procedures.


Gestational Diabetes Mellitus (GDM) is a form of diabetes whose onset is usually diagnosed around the 25th week of pregnancy, and whose remission typically follows delivery [1]. GDM accounts for around 90% of all cases of diabetes in pregnancy [2] and presents a number of challenges for the health of the pregnant woman both during and after pregnancy [3] as well as for the foetus and the new born infant [4]. In the pregnant woman, there is a heightened risk of pre-eclampsia, premature labour and complicated delivery followed by a significant risk of developing type 2 diabetes mellitus (T2DM) in the subsequent ten years [5,6,7]. They are also likely to develop GDM in any subsequent pregnancies. In the case of the foetus, new born infant and young child, GDM is associated with macrosomia, foetal death, neonatal hypoglycaemia and hyperbilirubinaemia [8- 11]. GDM is also known to increase the risk of impaired glucose tolerance, childhood obesity and type 2 diabetes later in life [3,12,13]. Given that at any point in time approximately 113 million women in the world become pregnant, GDM constitutes a major global public health challenge.

The International Diabetes Federation (IDF) estimates the global prevalence of GDM to be 15% [14], but the precise prevalence of the condition remains poorly defined, in part because of the lack of epidemiological research and the tendency for different diagnostic methods to be used, even within countries [15-17]. Rates of GDM can nevertheless be expected to vary between countries in concert with the prevalence of T2DM in the larger population [13], and particularly among certain ethnic groups [18,19].

GDM has become a major problem in the Gulf Cooperation Council (GCC) countries [16] (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). In Saudi Arabia the prevalence of GDM has been estimated to be 12.5% [20], and in Bahrain 10.1% [21]. A higher prevalence range of 13% [22] to 24.9% [15] has been estimated for the United Arab Emirates. In a region characterised by a large expatriate labour force, there is also evidence of GDM patterns varying according to ethnicity; South Asian women are at a higher risk than women of other ethnic backgrounds [23-25].

In Kuwait, where almost all deliveries take place in hospitals [26], the policy is for pregnant women to be first seen at either a public health centre or at a private clinic. There are 94 Primary Health Care (PHC) centres in Kuwait, providing a range of services, including antenatal care. While all PHC centres provide obstetric and gynaecological services, women in need of specialized care are systematically referred to tertiary care hospitals. It is estimated that approximately 72% of all pregnant women are referred for tertiary level care at some point in their pregnancies; pre-eclampsia, hypertension, and GDM are the main causes for referral.


The proposal for this project was reviewed and approved by the Dasman Diabetes Institute (DDI) and the Kuwaiti Ministry of Health. In preparing the project, visits were made to Primary Health Centre Directors in all the six governorates to discuss the aim and proposed methodology of the project. The response of the Directors was unanimously positive and indicative of a perceived need to address the theme of GDM and the role of the PHC system in its management. A self-completed questionnaire was developed and draft versions were reviewed with researchers at the DDI before being pre-tested in four randomly selected PHC centres. A decision was taken to print the questionnaires in English given the high level of English fluency among both Kuwaiti and expatriate personnel working in the PHC system. In all, 24 Primary Health Care centres were selected from five of Kuwait's six administrative Governorates: Capital, Hawalli, Farwaniya, Ahmadi and Jahra. The PHC centre Directors distributed the questionnaires to 174 staff. All the PHC centres in the project were visited by the two main researchers to ensure that instructions for the survey were understood and being followed. Table 1 shows the number of healthcare staff who participated in each governorate. The introduction to the questionnaire made it clear that the survey was anonymous and confidential. Data were analysed using SPSS 21, taking significance levels at p=0.05. As the majority of results were nominal, or because some survey based data had few categories, Pearson's Chi Squared tests were employed where applicable for unpaired discrete data; otherwise simple descriptive frequencies and percentages were used.