The MOMENTUM study: Putting the ‘Three Delays’ to work to evaluate access to emergency obstetric and neonatal care in a remote island community in Western Kenya

ABSTRACT

Despite worldwide improvements in maternal and infant mortality, mothers and babies in remote, low-resource communities remain disproportionately vulnerable to adverse health outcomes. In these settings, delays in accessing emergency care are a major driver of poor outcomes. The ‘Three Delays’ model is now widely utilised to conceptualise these delays. However, in out-of-hospital contexts, operational and methodological constraints present major obstacles in practically quantifying the ‘Three Delays’. Here, we describe a novel protocol for the MOMENTUM study (Monitoring of Maternal Emergency Navigation and Triage on Mfangano), a 12-month cohort design to assess delays during obstetric and neonatal emergencies within the remote villages of Mfangano Island Division, Lake Victoria, Kenya. This study also evaluates the preliminary impact of a community-based intervention called the ‘Mfangano Health Navigation’ programme. Utilising participatory case audits and contextually specific chronological reference strategies, this study combines quantitative tools with deeper-digging qualitative inquiry. This pragmatic design was developed to empower local research staff and study participants themselves as assets in unravelling the complex socio-economic, cultural, and logistical dynamics that contribute to delays, while providing real-time feedback for locally driven intervention. We present our methods as an adaptive framework for researchers grappling with similar challenges across fragmented, rural health landscapes.

KEYWORDS:

• Emergency obstetric care
• three delays
• rural health care
• health navigation
• Kenya

Acknowledgements

The authors would like to thank our international and local partners who have contributed to the realisation of the Mfangano Community Health Field Station. We want to thank the Ekialo Kiona Center and Research Department staff and volunteers, the Organic Health Response Board of Directors and Staff, University of Minnesota (UMN) Department of Family Medicine and Community Health, UMN Center for Global Health and Social Responsibility, Maseno University Department of Public Health, Makerere University School of Public Health, the Community Health Workers of Mfangano Island, and the Community Advisory Group. We thank the Kenyan MoH staff for their assistance in screening participants for this study and all Mfangano Island community members for their partnership. We would like to acknowledge Rotary International (specifically Fort Collins Breakfast Rotary Club) and Grand Challenges Canada ‘Stars in Global Health’ for financial support of the Health Navigation programme associated with this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the University of Minnesota Center for Global Health and Social Responsibility ‘Seed Grant Award’ and ‘Faculty Mentor Award’, as both grants are from the Center for Global Health and Social Responsibility (CGHSR). This work was also supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellowship at the University of Minnesota.