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Fetal and Infant Mortality Review: A Tool Communities Can Use to Address Disparities in SIDS Rates and Improve Risk Reduction Activities. Kathleen Buckley, MSN,CNM National Fetal and Infant Mortality Review Program Ellen Hutchins, MSW, ScD
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Kathleen Buckley, MSN,CNM
National Fetal and Infant Mortality Review Program
Ellen Hutchins, MSW, ScD
Chief, Perinatal and Women’s Health BranchMaternal and Child Health Bureau
FIMR is a type of continuous quality improvement that uses local, de-identified review of cases as a springboard to improve services and resources for women, infants and families.
The FIMR process also includes a standardized home interview with the mother who has suffered a SIDS loss, if she agrees and conveys the mother’s story to the FIMR review members.
This information is key todeveloping culturally sensitive SIDS risk reduction education and interventions.
“[The FIMR program] …also creates a setting and a set of concrete activities wherein everyone has a contribution to make and everyone learns from the process. The case study findings indicate that because the FIMR process extends beyond problem identification to promote problem solutions, observable changes in practice and programs occur; ‘things get fixed’ and participants are inspired to take further action.”
The evaluation of FIMR programs nationwide: early findings. [Online, 2002]. Available from: http://www.jhsph.edu/wchpc/pub/Brochure.pdf.
While the overall SIDS rates have declined in all populations throughout the United States, disparities in SIDS rates and prevalence of risk factors remain in certain groups. SIDS rates are highest among African Americans and American Indians and are lowest among Asians and Hispanics (NICHD 2001).
SIDS Deaths by Race and Hispanic Origin of Mother, 2001 Rate (NCHS 2003)All races 55.5White 45.6 African American 113.5American Indian 145.7Asian/Pacific Isl. 18.5Hispanic 27.1
US Infant Mortality 1990, 1998-2001by Maternal Race and Ethnicity Rates per 1,000 Live BirthsSource:National Center for Health Statistics, Linked Birth/Infant Death Data Sets: 1997, 1998, 1999, 2000,2001
Hauck, FR et al. Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study. PEDIATRICS Vol. 111 No. 5 May 2003, pp. 1207-1214
“…to lower further the SIDS rate among black andother racial/ethnic groups, prone sleeping, the use of softbedding and pillows, and some types of bed sharing should bereduced...”
Rasinski KA et al. Effect of a sudden infant death syndrome risk reduction education program on risk factor compliance and information sources in primarily black urban communities.PEDIATRICS. 2003 April Vol 111(4 Pt 1):e347-354.
“…our findings suggest that cultural explanations for specific infant care practices must be more clearly understood to close the gap between SIDS risk factor compliance and apparent knowledge about SIDS risk factors.”
Data from NICHD showed:
The authors conclude that reported deaths of infants
who suffocated on sleepsurfaces other than those
designed for infants are increasing.
In general, families most at risk for SIDS may not:
Know about SIDS risk reduction messages
Know that SIDS messages relate to them
Trust SIDS reduction messages
Trust the SIDS risk reduction messengers
YES! FIMR Can:
FIMR SIDS Intervention: In Oakland California, the FIMR team found that SIDS risk reduction literature was available only in English. The primary language of their community residents included not only English but also Chinese, Vietnamese, Spanish, Amharic, Thai, Croatian and Laotian. FIMR team members worked together to produce SIDS educational materials in all eight languages, along with minimal reading materials and a special message for grandparents and made them available for distribution throughout the community.
FIMR SIDS Intervention:After reviewing many African-American SIDS deaths, the Richmond VA FIMR found that many new mothers, family members and some community day care providers didnot know about SIDS risk reduction practices. FIMR worked with the Health Department to design culturally appropriate materials and developed a door hanger with the "back to sleep" message with a picture of an African American baby. The Healthy Start Consortium and the regional perinatal council distributed the hangers “door to door” throughout the community. This campaign is being continued today and has been adopted in several other states.
In the sections of Milwaukee, WI chosen for FIMR reviews, FIMR noted that families – including African American, Latino and Hmong residents - were less likely to place their infants on their back to sleep.
The Health Department asked faith communities in
these sections of Milwaukee to help them reach families
with SIDS risk reduction messages.
Nineteen parish nurses agreed to coordinate a church-based "Back to Sleep" campaign. These nurses also integrated the SIDS message into their ongoing teaching plans, thus the message will continue.
] FIMR SIDS Intervention: Palm Beach County, FL FIMR found an increase in SIDS deaths. FIMR worked with the Medical Examiner and the Health Alliance on Safe Infant Sleeping Programs to identify messages about safe sleeping environments. A public education media campaign, spearheaded by Chief ME said: "The survival of your child will depend more on where and how he or she sleeps during the first year of life than any other action or care issue during childhood!“Palm Beach's coalition has developed an ongoing strategy to institutionalize SIDS education for child care workers, hospital staff, physicians, their office staff, prenatal and postnatal care agencies, parents and family members.
FIMR SIDS Intervention: The Siouxland IA Health Department serves diverse residents including Native American families. FIMR found that many families did not have a crib at home for the newborn. FIMR also learned that local Native Americans believe that a pregnant woman should not make plans for the baby or buy a crib until after birth. It is considered unlucky and is forbidden by tradition.
The local hospitals and the home visit agencies developed a postpartum nursing protocol to ask each new mother, Where will your baby sleep? A local foundation provides cribs for needy families.
Knowing the traditions helps nurses to provide culturally relevant education, support and resources, including a new crib to families, as needed.
SIDS Risk Reduction Messages Work When
FIMR CAN MAKE THAT HAPPEN!