Assessing infant sleep practices and other risk factors of SIDS in Zambia: a cross-sectional survey of mothers in Lusaka, Zambia

Safe Infant Sleep Practices and Associated Factors Among Mothers Attending Vaccination Service at Dessie Town Governmental Health Care Facilities, 2021

Background

Babies spend a lot of their time with sleeping thus they need to have a safe sleep. Inadequate sleeping arrangements might heighten the likelihood of Sudden Unexpected mortality in Infancy (SUDI), including SIDS and lethal sleeping mishaps, which continue to be the most prevalent cause of mortality for individuals aged 1 to 1 year.

Objective

The study aimed to assess safe baby sleep practices and associated factors among women receiving immunizations at government healthcare facilities in Dessie Town.

Design

An institution-based cross-sectional study.

Methods

We conducted interviews with a total of 392 mothers using semi-structured questionnaires at public health facilities of Dessie town, in 2021. After the data were entered into the EPI data version 3.1, SPSS 23 was utilized for the analysis. Additionally, multivariate and binary logistic regression analyses were carried out. In multivariate analysis, a P-value less than .05 indicate a significant association.

Results

About 38.3%, 21.9%, and 14.7% had safe infant sleep practice regarding sleep position, no soft-bedding and sleep arrangement respectively. Significant association was observed between safe infant sleep position with baby age less than 3 months (AOR = 2.96, 95% CI = 1.50-5.84), baby age of 7 to 9 months (AOR = 3.84, 95% CI = 2.15-6.85), maternal level of education(AOR = 4.48, 95% CI = 1.87-10.76), relative/friend as their source of information (AOR = 1.98, 95% CI = 1.14-3.44), grandmother as their source of information (AOR = 1.89, 95% CI = 1.00-3.57).Additionally, baby age 4 to 6 months (AOR = 0.93, 95% CI = 0.19-0.94) and maternal level of education (AOR = 0.19, 95% CI = 0.04-0.92) shows a significant safe infant bed arrangement practice. Furthermore, baby age of 10 to 12 months (AOR = 0.49, 95% CI = 0.25-0.98) and maternal education level of college and above (AOR = 3.44, 95% CI = 1.18-10.03) also shows significant association with safe soft-bedding practice.

Conclusion

Mothers' safe infant sleep practices were found to be low in Dessie town. Therefore, efforts should be made to enhance mothers' attentiveness and engagement. This will help them follow healthy infant sleep practices.

The Awareness of Sudden Infant Death Among Saudi Arabian Women in 2023

Background Sudden infant death syndrome (SIDS) refers to the unexpected and unexplained death of a child under one year old. The pathogenesis of SIDS remains unclear. However, certain factors such as the child's sleeping position, sleeping on a soft mattress, and maternal smoking have been suggested to contribute to its occurrence. The objective of this study was to evaluate the level of awareness of SIDS among Saudi Arabian women in 2023. Methodology A cross-sectional study was conducted among 300 mothers in Saudi Arabia, over a period of three months, from June to August 2023, using an online questionnaire to gather socio-demographic information from mothers of infants younger than one year old in Saudi Arabia, the sleeping practices of their infants, and their knowledge about SIDS risk factors. Data were coded using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY), and statistical significance tests were employed for data analysis. A p-value of <0.05 was considered significant. Results Among the 277 participating mothers, 44% were 31-40 years old, 93% were Saudi, 60% were employed, 65% were nonsmokers, and 64% placed babies in a supine position for sleep. About 37% of mothers used a duvet for bedding during summer, compared to 66% who used a duvet during winter, and 81% utilized a soft mattress cover in their children's beds. Additionally, 67% of mothers reported that their children used a pacifier while sleeping. More than half (54%) of mothers were aware of SIDS with media as their primary source of information. Among those under 21 years old, 50% demonstrated a high level of awareness, compared to 36% of those aged over 50. Conclusion Most women in this study were found to be unaware of SIDS. Among those who were aware, the media was the primary source of information. Higher educational attainment was associated with better understanding.

Qualitative assessment of infant sleep practices and other risk factors of sudden infant death syndrome (SIDS) among mothers in Lusaka, Zambia

BACKGROUND

There is very little information on the beliefs and perceptions of mothers about SIDS and its related risk factors in Africa. To better understand parental decisions about infant sleep practices and other risk factors for SIDS, we conducted focus group discussions (FGDs) with mothers of infants in Lusaka, Zambia.

METHODS

FGDs involved 35 purposively sampled mothers aged 18-49 years. FGDs were conducted using a semi-structured interview guide in the local language, Nyanja. These were translated, transcribed verbatim into English, and then coded and analyzed using thematic analysis in NVivo 12.

RESULTS

Six FGDs were conducted with 35 mothers in April-May 2021 across two study sites. FGD Participants were generally aware of sudden unexplained infant deaths, with several describing stories of apparent SIDS in the community. The side sleeping position was preferred and perceived to be safer for the infant with most believing the supine position posed an aspiration or choking risk to the infant. Bedsharing was also preferred and perceived to be convenient for breastfeeding and monitoring of the infant. Experienced family members such as grandmothers and mothers-in-law, and health care workers were frequently cited as sources of information on infant sleep position. A heightened awareness of the infant's sleeping environment was suggested as a mechanism to prevent SIDS and smothering.

CONCLUSIONS

Decisions about bedsharing and infant sleep position were guided by maternal beliefs and perceptions about what is convenient for breastfeeding and safer for the infant. These concerns are vital to designing tailored interventions to address sleep-related sudden infant losses in Zambia. Public health campaigns with tailored messages that address these concerns are likely to be effective at ensuring optimal uptake of safe sleep recommendations.

The apparent burden of unexplained sudden infant deaths in Lusaka, Zambia: Findings from analysis of verbal autopsies

Background: The contribution of sudden unexpected infant death (SUID) has received little attention in global health. The objective of this study was to estimate the burden of SUID in Lusaka, Zambia. Methods: Verbal autopsies were conducted on infants who died in Lusaka, between 2017 and 2020.  From these, we performed a qualitative analysis of the free text narratives of the final series of events leading to each infant’s death and classified these as symptomatic deaths or SUID. Any narrative that described an infant who was otherwise healthy with no antecedent illness prior to death and found dead in bed after a sleep episode was classified as SUID. We used logistic regression to test for statistical differences between asymptomatic deaths and SUIDs on key infant, maternal and other risk factors of SUIDs. Results: Eight hundred and nine verbal autopsies were conducted with families of decedent infants younger than six months of age. A total of 92.6% (749/809) had presented with symptoms prior to death, whereas 7.4% (60/809) died without preceding symptoms or obvious cause of death. Of these, 16/60 were compatible with accidental suffocation deaths, and 54/60 appeared to be sudden infant death syndrome.  SUID deaths were concentrated in infants younger than two months of age with peak age of one to two months. Age at death was the only significant factor in multivariate analysis. Infants aged between one and two months had 2.84 increased odds of suspected SUIDs compared to infants in the first month of life (aOR = 2.84, 95% CI: 1.31, 6.16). Conclusions: Our findings suggest SUID could be accounting for a significant proportion of infant deaths in Zambia, but this cause of infant mortality is going unrecognized. Public health interventions in Zambia, and Africa more broadly, are likely overlooking SUIDs as an important cause of infant mortality.