The impact of implementing a sudden infant death syndrome education package in Jordan

Background: Sudden Infant Death Syndrome (SIDS) is a problem worldwide. In North Jordan, SIDS rate was high as 1.32 per 1,000 live births and contributed 6% to the infant mortality rate (Bataineh, Shawagfeh, & Twalbeh, 2008). However, SIDS risk factors are preventable and can be reduced by improving knowledge and changing relevant behaviours of parents and healthcare providers (American Academy of Pediatrics, 2013; American SIDS Institute, 2011; Bataineh, Hussein Shawagfeh, & Twalbeh, 2008; Bredemeyer, 2004; Grazel, Phalen, & Polomano, 2010b; Moon, Oden, & Grady, 2004; NICHD, 2010). Still educating Jordanians about SIDS has not been a national health policy priority. Currently, Jordanians demonstrate infant care practices that increase the risk of SIDS, such as side sleep position and excessive bedding and clothing being the most common practices. Commonly, home environments also are not SIDS safe because of smoking and poor ventilation. Healthcare providers can assume the role of information provider and change agent by working with mothers, families and the community to change practices. Aims: This study aimed to determine whether a hospital-based SIDS education intervention program, relevant to Jordanian settings, would encourage Jordanian neonatal healthcare providers to revise parent education and training practices regarding SIDS prevention. The long-term goal was to reduce the incidence of SIDS by influencing Jordanian lifestyles and infant care practices. Methods: This mixed method intervention study included both quantitative and qualitative data collection methods and was conducted at a major education hospital in Jordan, King Abdullah University Hospital (KAUH), over three phases. Phase-1 used two main surveys, an observation-survey explored baseline data on SIDS-safe sleeping positioning practices using an audit of sleeping positions of healthy and medically stable infants in open cots in the neonatal units. The questionnaire-survey explored baseline data on available SIDS teaching resources and staff knowledge and their parental/family instruction regarding SIDS and relevant prevention practices. Phase-2 investigated the development, implementation, and impact of a Jordanian SIDS Infant Education Package (JSEP) among a sample of neonatal healthcare providers at the hospital using the same tools as in the pre intervention phase. This phase examined the impact the JSEP on neonatal healthcare provider SIDS-knowledge, access to appropriate SIDS resources, SIDS-safe sleeping positioning practices in the neonatal units at KAUH. Phase-3 used focus groups of the JSEP participants to explore participants’ experience in undertaking the JSEP. Results: Phase-1 revealed that high proportion (47%) of a total of 403 infant positioning observations; infants were placed in a high SIDS risk sleeping position. In addition, 33% of a total 231 neonatal healthcare providers who completed the questionnaire-survey had never accessed information or resources for SIDS at baseline. Moreover, 40% of the 231 neonatal healthcare providers who completed the questionnaire-survey did not have any knowledge about national SIDS prevention guidelines released by the American Academy of Paediatrics. In addition, the neonatal healthcare providers had not played an active role in the education of parents and families in Jordan regarding SIDS prevention practices. Only 21% of neonatal healthcare providers sometimes provided SIDS information to parents and families and another 33% rarely advised them. The questionnaire-survey discovered that most advice provided for parents and families regarding infant sleep care practices were inappropriate and, in fact, could heighten the risk of SIDS. The JSEP in phase-2 resulted in significant improvement in infant positioning practices at KAUH. The proportion of infants who were placed in a high SIDS risk sleeping position decreased to only 21% of the total post-intervention infant positioning observations (N=400), and this change was statistically significant (Chi-square= 40.777; df= 1; p Conclusions: The SIDS education program targeted at neonatal healthcare providers within the Jordanian context was effective in improving staff knowledge, practices and preparedness to instigate parental/family education. Healthcare providers were identified as an effective education and training group for community health promotion. However, challenges were identified in achieving this goal, including overwork, time limitations, staff shortages, and hospitalisation policies, as well as resistance from Jordanian families to adopting SIDS-safe infant sleep care or having a SIDS-safe home environment. Recommendations: SIDS education programs for health care providers need to be extended, with continued research and evaluation on the effectiveness of specific initiatives in Middle Eastern countries. Further research is needed to explore the incidence of SIDS, SIDS risk factors and associated cultural issues. Furthermore, research need to targeted potentially high risk groups such as refugees, rural and remote residents, and Bedouin families living in isolated regions of Jordan

Cultural beliefs and thermal care of infants: protecting South Asian and white British infants in Bradford from heat and cold

Maintaining an adequate body temperature is essential for human survival, yet infants are born with significant thermal challenges. Thermoregulation of infants is achieved through both physiological processes and through the thermal care behaviour of their caregivers. Little attention has been paid to infant thermal care beliefs and how thermal care is provided in practice. Thermal care beliefs vary across the world. Humoral beliefs that prescribe thermal balance to maintain health are extremely common globally, but less so in the UK. Methods This study primarily employed a mixed methods approach, using semi-structured and structured questions in interviews to explore ethnic differences in infant thermal care beliefs and practices of white British and South Asian mothers in the Bradford District, West Yorkshire, England. Results White British mothers were found to use significantly more bedding in winter for their infants than South Asian mothers (Man Whitney U p=<0.001). White British and South Asian infants were found to sleep in different environmental conditions. Mothers used several physical and behavioural cues to identify thermal stress in their infants and reported 24 different infant health problems caused by heat stress and 21 by cold stress. White British mothers were significantly more likely to be concerned about their infant getting too hot than too cold and South Asian mothers about both (Pearson Chi squared p=<0.001). Conclusions This thesis has demonstrated that thermoregulation of infants is achieved through internal physiological processes but also cannot be removed from the thermal care behaviour and beliefs of their caregivers. By exploring health beliefs and practices in other cultures, bias in the choice and focus of clinical research in the UK can be understood and addressed. Implications This thesis provides evidence to inform future directions for research, and policy on infant thermal care and manufacture of infant bedding in the UK

Retrospective analysis of infection-related deaths of sudden unexpected death in infancy cases at Salt River Mortuary

Sudden unexpected death in infancy (SUDI) remains a global concern and is a particular burden in South Africa. Infections have been previously linked to SUDI deaths, but empirical data in a South African context is lacking. This study aimed to explore the burden and risk factors of infection-related infant death at Salt River Mortuary (SRM). To identify the types of infections associated with SUDI in a local setting, medico-legal files from SRM between 1 January 2017 and 31 December 2018 were reviewed. Included cases involved infants between 1 day and 365 days old where an infectious cause of death was either suspected or confirmed (n=288). Variables pertaining to cause of death, scope of post-mortem investigation, clinical history and risk factors were collected from case files and assessed. Most infants (73.6%) demised within four months of age. The major modifiable risk factors were cosleeping (95.0%, n=264/278), side or prone sleeping position of the infant (73.3%, n=195/266), as well as tobacco smoke exposure (46.9%, n=122/260). Respiratory infection was the leading cause of death in this population, followed by gastroenteritis. Philippi area recorded the most gastroenteritis and respiratory infection-related deaths at 25.0% (n= 8/32) and 23.4% (n= 45/192), respectively. Milnerton and Gugulethu recorded 18.8% (n=6/32) and 15.6% (n=5/32) of gastroenteritis-related deaths, respectively. Nyanga and Mitchells Plain recorded 11.5% (n= 22/192) and 9.9% (n=19/192) of respiratory infection-related deaths, respectively. Despite infections being diagnosed as cause of death, microbial analysis was only requested in 22.9% (n= 66/288) and histology was only performed in 14.9% (n= 43/288) of the cases. Where microbial analyses were requested, Staphylococcus aureus bacteria was the most common organism found, followed by Cytomegalovirus. However, due to the small numbers of microbial analyses, geographical hotspots could not be identified at the pathogen level. There is therefore a need to adopt a standard protocol for the investigation of SUDI to optimise the translation of mortality data into targeted public health interventions. The promotion of awareness in at-risk areas should be harnessed in a local context to develop preventive strategies and ultimately reduce infant death

Voices for Change: A Taxonomy of Public Communications Campaigns and Their Evaluation Challenges

Makes the case that communications campaigns cover a broad range of different types and characteristics, and can be differentiated along the axes of purpose, scope, and maturity. Examines what communications campaigns that fall on different areas of these three axes look like, and how where they fall may affect the evaluation approach used and lead to distinct evaluation challenges and needs

Abstract book : poster week 3/15

Poster Week 3/15. ESTeSC – Coimbra Health School. May 18-22, 2015info:eu-repo/semantics/draf

Report of the CDC Working Group on Pulmonary Hemorrhage/Hemosiderosis

hemorrhage_report.pd

Sudden Unexpected Death in Infants (SUDI) and parental infant care: perspectives of general practitioners, nurses and parents living and working in the multicultural community of Western Sydney

For many years the major cause of infant mortality in NSW has been the result of Sudden Infant Death Syndrome (SIDS). Statistics show the area defined as 'Western Sydney' is no exception, and in 2002, a report prepared by the Epidemiology, Indicators, Evaluation and Research Unit (EIRE) in Western Sydney presented data indicating SIDS rates in the area were higher than the state average. In particular, two Local Government Areas (LGAs) had clusters of SIDS deaths. Previous Australian research identified a higher risk of SIDS and other causes of infant mortality in Aboriginal and Torres Strait Islander populations. The areas of Western Sydney where SIDS rates were higher than expected were home to Aboriginal, Torres Strait Islander and Pacific Island residents. The number of SIDS deaths in Aboriginal infants did not explain the higher than expected rate of SIDS in the areas under investigation. Studies undertaken in New Zealand and the Pacific Islands have identified higher than expected risk of SIDS in Maori and Pacific Island communities in those countries, although this has never been studied in Pacific Island residents living in Australia. The reasons for these communities exhibiting a higher than normal SIDS rate is not completely understood, but can be partially explained by behavioural practices which are known to impact adversely on the risk of SIDS. This study sought to investigate the level of knowledge concerning the prevention of sudden and unexpected death in infants (SUDI) in three key groups of infant caregivers: general practitioners, nurses and parents living or working in the area geographically defined by Sydney West Area Health Service (WSAHS). In addition, the study sought to identify any variation in knowledge of SIDS reduction strategies in the three groups under study, and to investigate factors influencing knowledge and practice in these participants. The study findings were then used as a basis on which to develop strategies and recommendations to enhance the delivery of safe sleeping messages through the health care system. Using a combination of qualitative and quantitative methods, this cross-sectional study highlights a number of issues around infant care practices and the major influences on new parents living in a multicultural community. Results of the study showed there is a large variation in knowledge around safe sleeping practices (including SIDS reduction strategies) in all the groups studied. Although educational campaigns are conducted regularly, many general practitioners and parents are confused about the key SIDS reduction messages and still place infants in sleeping positions considered unsafe. While nurses and midwives were aware of the SIDS reduction strategies, they still occasionally used infant sleeping positions considered unsafe. General practitioners born overseas in a country where English is not the first language were less likely to be familiar with safe sleeping messages, including SIDS reduction strategies. Families from a Culturally and Linguistically Diverse (CALD) background were less likely to have seen SIDS information in their own language than families who spoke English, and as a result were more likely to use traditional methods of infant care, including co-sleeping with siblings and parents and side or tummy sleeping. CALD parents were more likely to rely on herbal remedies and friends and family for assistance, than English speaking parents who accessed health professionals as the first point of call when infants were unwell. The study identified a relatively recent practice, which until reported in this study, has not been documented in the literature. The practice of draping infant prams with blankets originated from the Cancer Council of Australia guidelines which recommend covering a pram with a light muslin wrap to protect infants’ skin from the sun. It appears parents have misinterpreted this message and are covering infant prams with blankets to encourage sleep, even when sun exposure is not an issue. Research suggests that poor air quality around the head of an infant may affect an infant’s arousal response. While no research has been conducted on the air quality around an infants head when covered by a heavy blanket in a pram, it is possible based on research into air quality around infants, that that this practice may increase the risk of sudden and unexpected death in an infant. In conclusion, this study found that multiple changes to the SIDS reduction messages since the initial ‘Reduce the Risks’ Campaign have led to confusion about ways of preventing SIDS in GPs, nurses and parents in Western Sydney. The study makes seven recommendations aimed at improving knowledge of safe sleeping practices in these groups, and optimizing health outcomes for infants using a collaborative approach to service delivery and future initiatives

Sudden Unexpected Death in Infants (SUDI) and parental infant care: perspectives of general practitioners, nurses and parents living and working in the multicultural community of Western Sydney

For many years the major cause of infant mortality in NSW has been the result of Sudden Infant Death Syndrome (SIDS). Statistics show the area defined as 'Western Sydney' is no exception, and in 2002, a report prepared by the Epidemiology, Indicators, Evaluation and Research Unit (EIRE) in Western Sydney presented data indicating SIDS rates in the area were higher than the state average. In particular, two Local Government Areas (LGAs) had clusters of SIDS deaths. Previous Australian research identified a higher risk of SIDS and other causes of infant mortality in Aboriginal and Torres Strait Islander populations. The areas of Western Sydney where SIDS rates were higher than expected were home to Aboriginal, Torres Strait Islander and Pacific Island residents. The number of SIDS deaths in Aboriginal infants did not explain the higher than expected rate of SIDS in the areas under investigation. Studies undertaken in New Zealand and the Pacific Islands have identified higher than expected risk of SIDS in Maori and Pacific Island communities in those countries, although this has never been studied in Pacific Island residents living in Australia. The reasons for these communities exhibiting a higher than normal SIDS rate is not completely understood, but can be partially explained by behavioural practices which are known to impact adversely on the risk of SIDS. This study sought to investigate the level of knowledge concerning the prevention of sudden and unexpected death in infants (SUDI) in three key groups of infant caregivers: general practitioners, nurses and parents living or working in the area geographically defined by Sydney West Area Health Service (WSAHS). In addition, the study sought to identify any variation in knowledge of SIDS reduction strategies in the three groups under study, and to investigate factors influencing knowledge and practice in these participants. The study findings were then used as a basis on which to develop strategies and recommendations to enhance the delivery of safe sleeping messages through the health care system. Using a combination of qualitative and quantitative methods, this cross-sectional study highlights a number of issues around infant care practices and the major influences on new parents living in a multicultural community. Results of the study showed there is a large variation in knowledge around safe sleeping practices (including SIDS reduction strategies) in all the groups studied. Although educational campaigns are conducted regularly, many general practitioners and parents are confused about the key SIDS reduction messages and still place infants in sleeping positions considered unsafe. While nurses and midwives were aware of the SIDS reduction strategies, they still occasionally used infant sleeping positions considered unsafe. General practitioners born overseas in a country where English is not the first language were less likely to be familiar with safe sleeping messages, including SIDS reduction strategies. Families from a Culturally and Linguistically Diverse (CALD) background were less likely to have seen SIDS information in their own language than families who spoke English, and as a result were more likely to use traditional methods of infant care, including co-sleeping with siblings and parents and side or tummy sleeping. CALD parents were more likely to rely on herbal remedies and friends and family for assistance, than English speaking parents who accessed health professionals as the first point of call when infants were unwell. The study identified a relatively recent practice, which until reported in this study, has not been documented in the literature. The practice of draping infant prams with blankets originated from the Cancer Council of Australia guidelines which recommend covering a pram with a light muslin wrap to protect infants’ skin from the sun. It appears parents have misinterpreted this message and are covering infant prams with blankets to encourage sleep, even when sun exposure is not an issue. Research suggests that poor air quality around the head of an infant may affect an infant’s arousal response. While no research has been conducted on the air quality around an infants head when covered by a heavy blanket in a pram, it is possible based on research into air quality around infants, that that this practice may increase the risk of sudden and unexpected death in an infant. In conclusion, this study found that multiple changes to the SIDS reduction messages since the initial ‘Reduce the Risks’ Campaign have led to confusion about ways of preventing SIDS in GPs, nurses and parents in Western Sydney. The study makes seven recommendations aimed at improving knowledge of safe sleeping practices in these groups, and optimizing health outcomes for infants using a collaborative approach to service delivery and future initiatives