Crisis and curfew: Lived experiences of community members seeking emergency maternal and neonatal care before and during the COVID-19 pandemic on Mfangano Island, Lake Victoria, Kenya

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Prior to the COVID-19 pandemic, families in rural sub-Saharan Africa faced numerous well-documented barriers in accessing timely care during maternal and neonatal health emergencies. We are now beginning to further appreciate the complex impacts that global disruptions, like the COVID-19 pandemic, can have on access to maternal care across vulnerable health systems, particularly for mothers seeking care in remote settings. In 2021, we initiated a qualitative follow-up study to the MOMENTUM (Monitoring Maternal Emergency Navigation and Triage on Mfangano) cohort study conducted within the remote communities of Mfangano Island on Lake Victoria, in Western Kenya, in 2019 and early 2020. Given the timing of this follow-up study, we sought to further qualify the barriers previously identified during the initial MOMENTUM quantitative survey, as well as explore specific ways that the COVID-19 pandemic impacted these barriers. In September 2021, 4 Focus Group Discussions (FGDs), with a total of 44 participants, were conducted among patients and families who had recently experienced maternal and neonatal emergencies. Additionally, 15 Key Informant Interviews (KIIs) were conducted with community leaders and health-care providers to allow reflection more broadly on their local emergency health-care system. A grounded theory methodology was utilized to analyze respondent themes. The lived experiences reported here by FGD and KII participants substantiate and validate numerous challenges previously identified in our prior study. Importantly, participants also highlighted specific ways that the pandemic intensified each of these factors, through the spread of misinformation, restricted mobility due to government curfews and lockdowns, increased frequency of health worker strikes, and worsening financial and resource constraints across the health system. Participants also described creative ways in which contextually experienced providers (i.e., Mfangano Health Navigators) facilitated critical coordination to help patients access care during the chaotic circumstances generated by the pandemic. These findings suggest that trained community health workers can play an influential role in improving emergency care coordination, particularly during future pandemics and similar public health disruptions within extremely resource-limited environments.