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Greetings to the Manyata community!

The impact of COVID-19 on access to essential healthcare services is becoming increasingly evident. While this pandemic is affecting everyone, everywhere, there is a growing concern that the impact it has on different population groups is disproportionate.

It is deepening the already existing inequalities and vulnerabilities, particularly for women and girls. Limitations while accessing maternal healthcare services during pregnancies will have long term impact and therefore we must keep up our continued efforts in bridging this gap.

In this pursuit, we have our Rajasthan Champion, Dr. Lila Vyas contributing to our expert talk section. Dr. Lila is championing the quality care movement in Rajasthan under the world’s first health impact bond, Utkrisht. Through her piece, she reiterates the importance of Gestational diabetes screening during a pregnancy and shares protocols which will simplify the process for facility staff and ensure better quality of care services at facilities. 


Hope you enjoy reading it!
EXPERT OPINION
While we try to navigate the new challenges in pregnancy care and maternal health posed by COVID-19, we must retain our focus on existing complications that are critical for healthy pregnancy and childbirth but are, unfortunately, neglected. Significantly, it is imperative to detect and intervene early in cases of non-communicable diseases (NCDs) in pregnancy.
Globally, two of every three deaths in women can be attributed to NCDs, and this burden is heavily borne by low and middle-income countries.NCDs increasingly affect women and children across the reproductive, maternal, newborn and child health (RMNCH) continuum.[1] One of these NCDs in pregnancy is Gestational Diabetes Mellitus (GDM). Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance with recognition or first onset during present pregnancy.

Pregnancy induces progressive changes in maternal carbohydrate metabolism. A pregnant women who is not able to increase her insulin secretion to overcome the insulin resistance that occurs during normal pregnancy develops gestational diabetes mellitus. According to a February 2018 report by the Ministry of Health and Family Welfare, India is estimated to have a GDM incidence rate of 10-14.3%.
 
Indian women are particularly susceptible to GDM – they are 11.3 times more likely than Caucasian women to be diagnosed. This is because there are many women who have pre-existing diabetes but are unaware of their condition. A study, published in FOGSI Focus 2011, found that if women are screened for GDM in the first trimester itself, 17% more cases could be detected than if they are screened at the usual 24-26 weeks. Therefore, it is imperative to screen and detect GDM early in order to prevent issues like congenital malformation and passing on diabetes to the next generation. If implemented on a large scale, this could also potentially reduce the diabetes burden around the country.
 
If undetected, GDM can pose a plethora of risks to both mother and baby. It is associated with significant complications during pregnancy, including increased perinatal morbidity, and, possibly, mortality as well; increased rate of pre-eclampsia, pre-term labour and operative delivery; and diabetes-related complications such as hypoglycemia and ketoacidosis.
[2] A GDM diagnosis also puts the mother at high risk for developing Type 2 GDM in the future. Perhaps most importantly, the effects of maternal hyperglycemia are associated with development of metabolic problems including Type 2 diabetes in the offspring. GDM can affect the baby in many ways – it is responsible for many stillbirths and neonatal deaths, as well as congenital deformities.
 
In this context, the Manyata program offers great value to providers. The first clinical standard of quality maternal care under the program trains providers to screen for key clinical conditions that can lead to complications during pregnancy. This ensures that GDM is detected and treated early, so that the pregnancy can be safe for both mother and baby, and all future risk of Type 2 DM is significantly reduced. Manyata not only ensures the highest quality of maternal and neonatal care – it also saves lives.
Click here to read the overview of recommendations for screening procedures and diagnostic criteria for GDM
PROGRAM AT A GLANCE 
SENSITIZATION AND TRAININGS 
Quality Improvement (QI) Sessions
Manyata skilled experts are organizing extensive virtual trainings by leveraging Manyata ECHO platform in all the states. Apart from the regular module trainings, the team is also using the platform to conduct Mentoring Support Visits (MSVs) for facilities undergoing quality improvement trainings.
FOGSI ASSESSMENTS
Federation of Obstetric and Gynaecological Societies of India (FOGSI) has also been conducting virtual assessments in 5 states via Zoom platform. 22 facilities from 5 states have cleared their assessment and are now part of Manyata’s quality care movement.
Taking Manyata to Newer Territories 
Dr. Nandita Palshetkar, Association of Maharashtra Obstetric & Gynaecological Societies (AMOGS) President, has been actively holding meetings with zonal heads of Maharashtra OBGYN Societies One of the key agendas of these meetings has been to sensitize local providers on the benefits of the program and encourage them to become a part of the quality care movement in Maharashtra. 
EMBRACE | EMBARK | EMPOWER 
India records 7.3% reduction in maternal mortality in just two years
The Special Bulletin on Maternal Mortality in India 2016-2018 under the Sample Registration System, released by the Office of the Registrar General, declared that maternal mortality in India has dipped from 122 in 2015-2017 to 113 in 2016-2018. This is a 7.3% reduction from the previous bulletin. We would like to congratulate all our providers and their team members, whose collective efforts has contributed to this reduction. Such positive news fuels our resolve to continue the quality momentum and work towards attaining the National and Sustainable Goals target for maternal healthcare.
Uttar Pradesh is on a quality care revolution mission
Uttar Pradesh Champions are making concerted efforts towards improving access to quality maternal care services provided by OBGYNs in the state. Over the last month many sessions were conducted to sensitize private providers about the benefits of Manyata program.
 
Dr. Priti Kumar, with support from Jhpiego, hosted a webinar which brought together eminent leaders from FOGSI, Manyata and Uttar Pradesh OBGYN Societies. Fruitful discussions were held on the need and benefits of a program like Manyata, to improve the overall maternal healthcare outcomes in the state. The interactive session was held on June 21 and had 95+ participants.
 
Another session was held on June 26 by Kanpur OBGYN Society to discuss the significance of Manyata program in context of giving Respectful and Compassionate care to expecting mothers.
Following the success of LaQshya-Manyata, FOGSI’s Public-Private partnership venture with the Government of Maharashtra, FOGSI led discussions with the Health Minister of Uttar Pradesh, Hon. Jai Pratap Singh on proposing a similar model for UP.
 
Our Manyata champions from UP, Dr. Chandrawati and Dr Priti, steered the discussions on behalf of FOGSI. They have been consistently following up with the ministry since All India Congress of Obstetrics and Gynaecology (AICOG) 2020 to secure the follow up meeting. A big shout out to the UP team and we wish them all the best!
WHAT'S NEW?  
UPDATES FROM WORLD HEALTH ORGANISATION
Latest India Situation Report – 23Summary:  Union Ministry of Home Affairs (MHA) issued guidelines for Unlock 2 to open up of activities in areas outside the Containment Zones into effect from July 1, 2020; WHO collaborating Centers have come together to standardize the reporting and management of COVID-19 and pregnancy across 20 high case-load facilities across the country.               
Read more
Maintaining essential health services: operational guidance for the COVID-19 context - Interim guidance report
Summary:
This document expands on the content of the essential health services and systems pillar of the COVID-19 strategic preparedness and response plan. The report supersedes the earlier Operational guidance for maintaining essential health services during an outbreak.
Read more
WHO AIIMS- Telemedicine series for Obstetrics and Gynecology
Summary: Series of videos on hospital preparedness during COVID-19 especially while providing quality maternal and newborn care.
Watch here
UPDATES FROM MINISTRY OF HEALTH AND FAMILY WELFARE (MoHFW)
MoHFW l Guidance Note on Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) services during & post COVID-19 Pandemic
Summary: In India, with the second largest global population, the growing epidemic of Coronavirus requires special efforts to continue the essential routine RMNCAH+N services. Therefore, MoHFW released the guidelines on “Enabling Delivery of Essential Health Services during the COVID 19 Outbreak” dated 14th April 2020 for provision of essential services.
Read more
MoHFW | Updated Clinical Management Protocol for COVID-19
Summary: The Ministry shared the latest clinical management protocols to tackle COVID-19. The recommendations include Infection Prevention and Control Practices, Laboratory Diagnosis, and Management of Mild Cases among other sections.
Read more
RECENT STUDIES AND RESEARCH
Med India l Coronavirus: Mother-to-Child Vertical Transmission Routes Identified
Summary: The study highlights the importance of understanding the timing and route of mother-fetal transmission for the better clinical outcome by applying investigational therapies that could potentially decrease or eliminate transmission risk.
Read more
Frontiers in Global Women Health l Moms Are Not OK: COVID-19 and Maternal Mental HealthFull
Summary: The study revealed that the number of pregnant and postpartum women suffering from depression and anxiety have increased during the health crisis. For new moms, these stressful situations come with side effects resulting in premature delivery, reduced mother-infant bonding, and developmental delays in infants.
Read more
Who to follow

MS. K. K. Shailaja, Minister for Health, Social Justice & Woman & Child Development - Government of Kerala
Twitter: @shailajateacher
Facebook: @kkshailaja

Ms. KK Shailaja, the Health Minister of Kerala, was invited by the United Nations to participate in a panel discussion on World Public Service Day 2020, for her efforts to fight Coronavirus in her state. Kerala's strategy of aggressive testing, contact tracing and quarantining helped slow the spread of the deadly virus in the state after an early spurt in cases, according to experts, and Minister KK Shailaja was even consulted by states like Maharashtra.
MANYATA VOICES
Through flexible training sessions & 1:1 on-site mentoring, Manyata ensures private providers are constantly updated on standard maternal care protocols. Dr. Santvana Sharan from Jharkhand shares her experience on how this has prepared her staff during #COVID19 #DontForgetMoms

Happy to help.

Please reach out to us at npmu.fogsi@gmail.com for queries/information.






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