International Congress of Paediatrics -ICP 2013, Melbourne

Shereen HamadnehRN, PhD. ECU, WA

Msc Maternal-Child Health, JUST Jordan

Sudden Infant Death Syndrome (SIDS) Risks in Jordan: Using Education to Create a Ripple of Change

BackgroundSIDS “the sudden death of an infant less than year of

age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history”. [1]

While western countries are aware of SIDS risk factors and many have implemented prevention campaigns and improved infant care practice and home environment. There has not been major investment in educating Jordanians about SIDS risk factors or prevention measures. Further Jordanian parents are unaware about SIDS and associated risk factors. [3, 4, 5, 6]

Aims & SignificanceDevelop and implement a SIDS education program using current evidence of best practice for health care providers tailored for the Jordanian context. Health care providers then subsequently delivered the advice to families. Identified health care providers' knowledge of SIDS in

Jordan, & their practical ability to educate parents. identified cultural barriers which made the translation of

SIDS prevention advice problematic. Generate a SIDS education package for use in other

hospitals in Jordan, and possibly in the Middle East region.

Explore main areas of concern in educating Jordanian families in the future.

Jordan is a developing country in the Middle East. It is bordered by Saudi Arabia, Iraq, Syria, Palestine & Israel, & shares the Gulf of Aqaba with Egypt. The population is 6.4 million. It expected to become higher in the following years due to increasing of Syrian refugees [2].

Jordan

Jordanian Desert & Bedouin areas

Jordanian rural area

View from rural villages in North Jordan in the borderline with Syrian villages

beds & bedding• Put infant to sleep in a separate cot next

to parents bed; on the back; without hats or covering the face.

• Place infant on a firm sleep surface. • Keep soft objects, toys, and loose

bedding out of infant's sleep area.• Use infant sleep sack. • Create proper bedding for SIDS

prevention, 'SIDS Safe Crib'; do not use the following mattresses: Sheepskin or sheep fleece underlay, Moisture-resistant cot mattress protector, Any under blanket which is not made of pure cotton, Acrylic blanket, Any blanket which contains polyester, Any bedding that is quilted, padded, or filled, Sleeping bag, Duvet, Pillows or cushions

SIDS Prevention advice: Have SIDS safe cot, SIDS safe bedding and SIDS safe environment

sleep environment•Avoid over or less heat•Smoke free•Avoid mould.

Others•Stop maternal smoking•Maintain breastfeeding•Offer pacifier on the bed time•Keep educating in terms of the risk factors associated with SIDS.

[7]

Safe beds and beddings

Study method

Study setting at King Abdullah University Hospital (KAUH)

Mixed method using action researchEducational resources were adapted from : •American Academy of Pediatrics (APA).•National Institute of Child and Human Development (NICHD).•SIDS and Kids

Quantitative QualitativePre & post Infant Sleep Care Practice Questionnaire (ISCPQ)oMeasured the changes of knowledge and educating practices of 103 health care providers from maternal/child units(nurses, midwives, nursing & midwifery students).Infant Sleep Position Observation Sheet (ISPOS)oMeasured changes in positioning practices, infants positions were observed 400 times before and after implementing the JSEPP.

Stakeholders’ Feedbacko 8 Stakeholders provided their thoughts and ideas for planning and implementing the appropriate SEPP.Health care providers focus groups. Three groups included 18 health care providers. Evaluated the challenges and effectiveness of the JSEPP

Data Collection

Qualitative Data Findings

Jordan

Prevent SIDS risk in Jordan. Main area of concern: Infant sleep practice Infant sleep environment Family awarenessHigh risk groupMedia & publication

Sleeping position: Side versus back

Arabic parents and caregivers do not usually place their infants on their stomachs to sleep. They also believe that in the first few months of life, infants should be placed in a variety of positions (back and sides) to prevent “flat head”.

Infant sleep practice

“... Parents put their babies on side to sleep ...some of the nurses put the babies on the side after a feed even weather the babies sleep or not, to prevent suffocation from vomiting...also followed the same practice with their babies at home.”

At home At hospital

Infant’s Bedding & clothing: Heavy versus light

A health care provider said: “In cold weather, mothers put baby to sleep with heavy clothing, hat and use a number of quilts to ensure the baby is kept warm. Having sheep skin underneath of baby, is anther strategy used to keep the infant bed warm”

Loose bedding

Smoking at homes versus smoke-free homes

Infant environment

Tobacco smoking is very common among men in Jordan. More attention to keep homes free of smoke. Men need to be deeply evolved in the SIDS education in future.

A health care provider said: “I have a friend, her husband always smoke inside home and in the car behind his baby and baby is now less than 6 months age.” Another said: “My husband smokes inside home around our kids and never minds ”. Another said: “usually smoker husbands are not concerned about the risk of SIDS or other risks caused by his smoking.”

Quantitative ResultsOverall the quantitative study results

indicated statistically significant improvements not only self-reported

knowledge & perceptions regarding SIDS risk prevention and educating family

practices, but also independently observed infant safe positioning practices.

SIDS risk in winter versus the risk during the rest of the year Jordanian winter reality: Basic method for heating. Lack ventilation inside homes.

Jordan

Home environment

A health care providers said: “During winter, when the windows & doors are closed. There is a wood or

kerosene heater in the room this is extremely dangerous the lack of ventilation. Especially,

sometimes presence ne one or more smokers in the same room around the

baby”

SIDS awareness among families

Mostly parents receive advice on infant care from their female relatives; especially grandmothers. They were unaware of SIDS & they need to be evolved in the education in future.

Jordan

Future of SIDS prevention in Jordan

High risk groups

infants of less educated families

Infants of low socio-economically group families

Infants of families who live in highland rural areas

Infants of Bedouins & refugees who live in desert.

Jordan

Future of SIDS prevention in Jordan

ConclusionThe qualitative study revealed two key areas of concern for Jordanian infants: the home environment and sleeping practices.

Health care providers found the JSEPP was very important and helpful in the workplace. Action research was seen as an effective method for implementing change in the practical skills.

Health care providers felt empowered to initiate the change in their practice, to be ‘SIDS safe’, and starting to educate families.

The way of presented the health knowledge was perceived as effective; however, the key to put this knowledge into practice was motivation.

Key messages

Hope this finding will enable stakeholders, policy makers, health care providers, and other commissioners and users of health care services to consider how their decisions affect the quality of infant care.This will enable the families to recognise the risk practices and start changing to be low SIDS risk practices.This study provide a base for further research to assist and monitor the process of implementing SIDS prevention intervention in a variety places in Jordan or in the Middle East.

References1. CDC. (2013). Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected

Infant Death (SUID): Home. Retrieved 18 August 2013, from Department of Health and Human Services, Centre for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA http://www.cdc.gov/sids/

2. DOS. (2013). The Demographic Profile of Jordan Population Trends. Amman, Jordan.

3. Bataineh, H., Hussein Shawagfeh, & Twalbeh, A. (2008). The Infant Mortality Rate in Irbid, Jordan. MIDDLE EAST JOURNAL OF INTERNAL MEDICINE 1(2), 9-10.

4. Abu-Baker, N. (2005). Environmental Tobacco smoke exposure and birth outcomes. PhD, University of Cincinnati, 2005, 114 pages; , Ohio, Cncinati.USA.

5. Azab, M., Khabour, O., Alzoubi , K., Anabtawi , M., Quttina , M., Khader , Y., et al. (2013). Exposure of pregnant women to water pipe and cigarette smoke. Nicotine Tob Res, 15(1), 231-237.

6. Hawamdeh, A., Kasasbeh, F. A., & Ahmad, M. A. (2003). Effects of passive smoking on children's health: a review. Eastern Mediterranean Health Journal, 9(3), 441-447.

7. American Academy of Pediatrics, 2008; American SIDS Institute, 2010; Moon, 2010; L'Hoir, et al., 2008; SIDS & Kids, 2013.

References

• Some photos are taken from SIDS & Kids Australia

• Some photos are downloaded from Jordanian multimedia

• Some photographs are taken in Jordan by the researcher “Shereen Hamadneh”

Thank you