TY - JOUR
T1 - The MOMENTUM study
T2 - Putting the ‘Three Delays’ to work to evaluate access to emergency obstetric and neonatal care in a remote island community in Western Kenya
AU - DesLauriers, Nicholas R.
AU - Ogola, Evance
AU - Ouma, Gor
AU - Salmen, Marcus
AU - Muldoon, Lily
AU - Pederson, Ben L.
AU - Hines, Kelsi
AU - Ssenkusu, John M.
AU - Mattah, Brian
AU - Okeyo, Robinson
AU - Okinyi, Peres
AU - Magerenge, Richard
AU - Friberg, Nyika
AU - McCoy, Molly
AU - Prasad, Shailendra
AU - Ndunyu, Louisa
AU - Salmen, Charles R.
N1 - Publisher Copyright:
© 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/7/2
Y1 - 2020/7/2
N2 - 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.
AB - 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.
KW - Emergency obstetric care
KW - Kenya
KW - health navigation
KW - rural health care
KW - three delays
UR - http://www.scopus.com/inward/record.url?scp=85081904445&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081904445&partnerID=8YFLogxK
U2 - 10.1080/17441692.2020.1741662
DO - 10.1080/17441692.2020.1741662
M3 - Article
C2 - 32182159
AN - SCOPUS:85081904445
SN - 1744-1692
VL - 15
SP - 1016
EP - 1029
JO - Global Public Health
JF - Global Public Health
IS - 7
ER -