Evidence map›Paper›PMID 33558349›Full record

ArticleBMJ open2021

Implementation of the Moyo fetal heart rate monitor in district hospitals in Bihar, India: a feasibility study.

Hanna Oommen, Kunal Ranjan, Sudha Murugesan, Aboli Gore, Sunil Sonthalia, Pradeep Ninan, Stine Bernitz, Ingvil Sorbye, Mirjam Lukasse

Open access · goldAbstract read
In one paragraph

Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

  1. The FemTech revolution: Unlocking the potential of new technology for optimizing pregnancy outcomes in low- and middle-income countries and remote areas.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 6 countries.

Hanna OommenDepartment of Obstetrics and Gynecology, South Norwegian Hospital SSHF, Kristiansand, Agder, Norway.ORCID 0000-0003-1810-9664
Kunal RanjanSolutions for Sustainable Development, CARE India, Patna, Bihar, India.
Sudha MurugesanSolutions for Sustainable Development, CARE India, Patna, Bihar, India.
Aboli GoreSolutions for Sustainable Development, CARE India, Patna, Bihar, India.
Sunil SonthaliaSolutions for Sustainable Development, CARE India, Patna, Bihar, India.
Pradeep NinanPaediatric Surgery, Madhipura Christian Hospital, Madhipura, Bihar, India.
Stine BernitzDepartment of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Akershus, Norway.
Ingvil SorbyeDepartment of Obstetrics and Gynecology, Oslo University Hospital HF, Oslo, Norway.
Mirjam LukasseDepartment of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Akershus, Norway Mirjam.Lukasse@usn.no.
Care India · INOsloMet – Oslo Metropolitan University · NOOslo University Hospital · NOUniversity of South Wales · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesGlobally, half of all stillbirths occur during birth. Detection of fetal distress with fetal heart rate monitoring (FHRM), followed by appropriate and timely management, might reduce fresh stillbirths and neonatal morbidity. This study aimed to investigate the barriers and facilitators for the implementation of Moyo FHRM use in Bihar state, and secondarily, the feasibility of collecting reliable obstetrical and neonatal outcome data to assess the effect of implementation.

settingCARE Bihar and the hospital management at four district hospitals (DHs) in Bihar state, each with 6500 to 15 000 deliveries a year, agreed to testing the implementation of Moyo FHRM through a process of meetings, training sessions and collecting data. At each hospital, a clinical training expert was trained to train others, while a clinical assessment facilitator collected data. METHODOLOGY: Observational notes were taken at all training sessions and meetings. Individual interviews (n=4) were conducted with clinical training experts (CTEs) on training experiences and barriers and facilitators for Moyo FHRM implementation. The CTEs recoded field notes in diaries. Descriptive analyses performed on pre-implementation and post-implementation data (n=521) assessed quality and completeness.

resultsMain barriers to implementation of Moyo FHRM were health system and cultural challenges involving (1) existing practices, (2) insufficient human resources, (3) action delays and (4) cultural and local challenges. Another barrier was insufficient involvement of doctors. Facilitators for implementation were easy use of the Moyo FHRM device and adequate training for staff.Electronic collection of obstetrical data worked well but had substantial missing data.

conclusionHealth system and cultural challenges are a major constraint to Moyo FHRM implementation in low-resource settings. Improvements at all levels of infrastructure, practices and skills will be critical in busy DHs in Bihar. Full-scale implementation needs doctor-led leadership and ownership. Obstetrical data collection for the purpose of scientific analysis needs to be improved.

Indexed as

Heart Rate, FetalHospitals, DistrictFeasibility StudiesFemaleFetal DistressHumansIndiaInfant, NewbornPregnancyeducation & training (see medical education & training)fetal medicineinternational health servicesneonatal intensive & critical careobstetrics

Identifiers

PMID33558349
PMCPMC7871681
OpenAlexW3129108314

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.