Assessment of the quality of care provided to women with gestational diabetes mellitus by different hospitals in Karachi, Pakistan.

Background: Since gestational diabetes mellitus (GDM) prevalence is increasing in Pakistan, the quality of care provided to women with GDM is crucial for improving maternal and neonatal outcomes. Therefore, our study aimed to assess the quality of existing healthcare services related to GDM management across different hospitals in Karachi, Pakistan.

Methods: We used Donabedian's model to evaluate the input, process and output phases. The first two phases were assessed through a cross-sectional design, while the output was evaluated via in-depth interviews. The study included six hospitals, one public and five private. We interviewed department heads (n=6) to assess the workforce and facilities (input) and nurses (n=17) and doctors (n=8) to examine qualifications for GDM management protocols (process). The output phase involved interviewing postpartum women with GDM (n=6) about their understanding of GDM, its complications and lifestyle modifications. We report frequencies and percentages for quantitative and thematic analysis for qualitative data.

Results: Monthly, 9000 women sought antenatal care (ANC) services, with 500 deliveries in public hospitals, while 2000-5500 sought ANC services, with 160-461 deliveries in private hospitals. All hospitals, except the public one, had standard GDM protocols. Three hospitals had neonatal intensive care units, six employed an endocrinologist, three had a dietician and only one appointed nursing staff as GDM counsellors. Two hospitals provided blood glucose monitoring charts, three offered diet charts and five gave breastfeeding instructions. While all doctors attended GDM education, no nurses participated. Thematic analysis highlighted postpartum women's lack of knowledge about GDM, its complications and the importance of lifestyle modification postdelivery.

Conclusion: Our study identified gaps in GDM care and highlighted the need for policies to develop and implement standardised GDM screening and management protocols, ensure mandatory training for healthcare providers and integrate multilingual educational material in healthcare settings to improve health outcomes for mothers and children.