Study Design
This study was a cross-sectional study in which all women of the reproductive age group (18–45) years encountered while seeking attention for other reasons were interviewed.
Setting
Healthcare in Trinidad and Tobago may be sourced via public or private health care facilities. About 30% of the population has private healthcare insurance and this group is more likely to seek attention from the private sector. [8] The public sector, governed by the Ministry of Health, comprises 5 regional health authorities within which there are various hospitals and district health facilities. Public health care is financed by the government and taxpayers and is available free of charge at point of service to all citizens on a walk-in basis [8]. Patients for this study were recruited from the public sector at the Arima District Health Facility, selected from the list of health centers serving the North Central Regional Health Authority (NCRHA) from December 4th 2016 to January 14th 2017. The population of this region consists of 20% females of the reproductive age group. The ethnic composition of the population is distributed among 3 major groups: African, South Asian and mixed ethnicity usually of the former two groups. Chinese, European and Middle Eastern populations together comprise a very small minority [9].
Participants
Subjects were included if they were female and between the ages of 18–45 years. Exclusion criteria were those who had completed their families and on contraception or those who were sterilized.
Data sources/Measurements
Following registration by a clerical officer, a de novo preconception care screening checklist (See Additional Files) was administered by RB. The patients’ blood pressure, weight, height and waist circumference were recorded using the WHO STEPS Protocol [10].
Measurements were repeated three times and the average value was used. A capillary blood sample was obtained for determination of random blood glucose and HbA1c. This was analyzed via DCA 2000® Analyzer, which is very useful for point-of-care testing [11].
All data was coded and stored in a password protected computer accessed solely by RB.
Preconception Care Screening Tool
To ensure face and content validity the preconception care screening tool was modeled after the recommendations by the WHO in 2013. [12]. RB created the first version, RGM and ST reviewed and edited the instrument for ease of use and flow of items. The following domains were assessed [13–15]:
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Intent of Pregnancy
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Gynecological History.
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Obstetric History.
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Medical History.
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Genetic History.
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Immunization History.
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Medication History
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Diet and Exercise.
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Lifestyle.
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Environmental Health.
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Emotional Health.
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Dental Health
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Partner’s History.
See Additional File 1 for in-depth description of these domains and the survey instrument. The screening tool took the format of a checklist to aid in efficient screening of the patient. If a risk to maternal health was identified, steps to cue further management based upon current guidelines were included on the form. In this study, impaired glucose tolerance (IGT) or prediabetes is defined by HbA1c range of 5.7 to 6.5, with diabetes (DM) being defined at HbA1c ≥ 6.5 [16–17].
Ethics approval
Approvals for conducting this study were provided by the Institutional Review Boards of The University of the West Indies (UWI), St. Augustine, Trinidad and the NCRHA, Trinidad. Informed consent was obtained from each patient, which was signed and witnessed. The patient’s autonomy was respected; they were informed that they can discontinue the study at any point in time without affecting the care they would receive and their participation was not coerced. Confidentiality was maintained at all times. The preconception care screening tool does not contain any identifying information. After the data was entered into statistical software and analyzed, all physical records were destroyed.
Statistical Methods
SPSS ver. 21.0 was used to construct various frequency tables.