Feasibility, acceptability and experiences of intrapartum fetal monitoring by caregivers using the Moyo device at Mbale regional referral hospital:

Abstract

Background: Intrapartum fetal heart rate monitoring (FHRM) is essential for identifying fetal distress and preventing asphyxia-related complications. However, inadequate FHRM due to staffing shortages is a critical issue in low-resource settings such as Uganda, where intrapartumrelated

neonatal deaths are high. The Moyo device, a portable fetal heart rate (FHR) monitor, reduced perinatal morbidity and mortality in a recently conducted trial in Mbale. However, its potential remains underutilized due to a high patient-to-midwife ratio. Recent evidence suggests that task-sharing FHRM with caregivers may address poor fetal monitoring practices, enabling non-clinical individuals to support the timely identification of fetal distress. Objective: This study assessed the feasibility, acceptability, and caregivers' experiences with intrapartum FHRM using the Moyo device at Mbale Regional Referral Hospital (MRRH), Eastern Uganda. Methods: A pilot quasi-experimental study design was used employing a sequential explanatory mixed-methods approach at MRRH. Caregivers of labouring women were consecutively enrolled, trained, and guided to monitor FHR every 30 minutes using the Moyo device. Feasibility was defined as achieving a mean monitoring interval within 30 ± 5 minutes, while acceptability was assessed using a five-point Likert scale converted into percentage scores and categorized using Bloom’s criteria. Experiences of caregivers who used the Moyo were explored through structured, in-depth interviews. Quantitative data were analysed using Stata version 17, and qualitative data were analysed thematically using Atlas. ti. Results: A total of 75 caregivers participated, with a median age of 32 years (IQR: 25–42). Most were female (n=70, 93.3%) and had primary-level education (n=35, 46.7%). The majority of participants (n=74, 98.7%) were able to use the Moyo device to check and document FHR, with 65 (86.7%) reporting no technical issues. However, only 34.7% (n=26) of caregivers were able to monitor FHR at 30-minute intervals, and 65.3% (n=49) of readings within 60 minutes. The median number of FHR recordings was 3 (IQR: 1–10), and the mean duration of the active stage of labour was 10.9 ± 9.7 hours. Feasibility was higher among caretakers who were first or second-degree relatives (61.5%; p = 0.037). The majority of the caregivers (n=70, 93.3%) found FHRM using the Moyo device acceptable. Caregivers reported positive experiences with the Moyo device, driven by curiosity, reassurance about fetal safety, and a desire to learn. Conclusion: Intrapartum FHRM by caregivers using the Moyo device was highly acceptable, and most caregivers correctly used the device. However, adherence to the recommended 30-minute monitoring interval remained low. Similar initiatives involving caregivers should prioritize practical support systems like reminders and workflow integration to enable timely recordings and improve adherence to recommended FHR monitoring.