Title: Combating Gestational Diabetes Mellitus (CGDM): A Nation Wide Project in Bangladesh
Rowshan Ara Begum, Nasreen Nahar , Bilkis Banu, Fatema Jebunnesa, Liaquat Ali 

Abstract
Background: Gestational diabetes mellitus (GDM) is a major health challenge for developing countries. Data from small scale hospital-based studies show that about 10% - 13% of pregnant women in Bangladesh suffer from GDM.1 Women with GDM are mostly managed through diverse screening, diagnosis and management protocols. The guideline for the management and prevention of GDM needs customization and adaptation in the context of specific ethnicity, environment, culture and socio-economic condition. Aim: To develop capacity in terms of human resources, well-formulated policies, standardized protocols, culturally sensitive behavior change communication (BCC) tools and organized awareness/advocacy campaigns. Methodology: The project is being implemented through few steps:
Step 1: Development of consensus documents on screening and management of GDM
An expert panel has been formed to review the existing guidelines and a few workshops were conducted with the relevant stakeholders.
Step 2: Training of human resources
Training materials have been developed with ongoing training programs involving both vertical (specialists, general physicians, nurses & health educators, nutritionists, community based health workers) and horizontal (grouping 4 districts together) clustering. Dividing 64 districts of Bangladesh, 16 training sessions for each of the 4 horizontal clusters will be conducted during the project period (2012-2018).
Step 3: Promotional and advocacy campaigns
Activities (BCC tools, meeting/seminars, and individual level advocacy/counseling) are continuing to mobilize the community, policy makers, pregnant women and their families.
Step 4: Workshop to design national policies, strategies and work plan on GDM 
With feedback from the project, national level policies, strategies and guidelines will be developed and finalized through a workshop. 
Regarding training sessions, each trainee will be assessed for their baseline knowledge and skill through a simple survey (data collection from records and a short questionnaire) .The data from the pre- and post-training evaluation will be compiled and compared and it will be used as an evaluation tool for the future monitoring and supervision.
Results:
Activities of the project are summarized in Tables 1 and 2.
Table 1: Activities at a glance (40 Districts Covered)
Activities	Targeted programs
 (in numbers)	Completed (in numbers)
		Programs	Participants
1. Development of Consensus
Document	02	01	165
2. Training	18	11	2129
3. Advocacy Meeting	64	40	1810
4. Awareness Symposium	24	11	3400
5. Mass Awareness Campaign by Traditional Folk Song	33	20	10000
6. Day Celebration	16	10	900
7. Provider awareness by cell phone text message	15552	8532












Table 2: Group wise trained persons: at a glance
Types of Health Care Professionals	Targeted
(Numbers)	Trained
(Numbers)
1. Physicians (specialists in Gynecology/
Neonatology/ Endocrinology as well as GPs)	1296	614
2. Nurses & Health Educators	864	653
3. Nutritionist	864	776
4. Paramedical staff and Community Health
Workers	864	086
Total	3888	2129

Discussion:
Bangladesh Diabetic Association (BADAS) has been working for quite a long time on diabetes mellitus including GDM. But the approach of management of GDM mainly focused on clinical rather than public health approach of prevention. There were no uniform criteria and methods for diagnosis of GDM. Additionally lack of standard protocol or guidelines created great variation in clinical management of GDM. Considering the situation, a project was launched with the support of World Diabetes Foundation implemented by Bangladesh University of Health Sciences in collaboration with BADAS for better management of GDM by developing a standard guideline emphasizing more on public health approach.     
To date the project has achieved the desired targets in most of the indicators such as trained health care providers from national to local community levels (government and non-government) through consensus guidelines, advocacy meetings for policy makers and opinion leaders, producing BCC materials, organizing mass community campaign with folk songs. We are proud that this is the first ever and the largest project of this kind covering whole of Bangladesh addressing the management and prevention of GDM comprehensively.
In the long-term we aim to achieve a national level standard guideline for management and prevention of GDM endorsed by the Government of Bangladesh. After successfully implementing the project it is hoped that GDM among Bangladeshi women will be combated, the adverse consequences in women and children will be reduced which in turn will improve the quality of life. 
Reference:
1. Jesmin S, Akter S, Akashi H, et al. Screening for gestational diabetes mellitus and its prevalence in Bangladesh. Diabetes Res Clin Pract. 2014;103(1):57-62

Combating gestational diabetes mellitus (CGDM): a nation wide project in Bangladesh