Fetal and Infant Mortality Review: A Tool Communities Can Use to Address Disparities in SIDS Rates a

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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
• Chief, Perinatal and Womens Health
  BranchMaternal and Child Health Bureau

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What is Fetal and Infant Mortality Review (FIMR)?

• 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.

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FIMR Includes Key Informant Interviews

• The FIMR process also includes a standardized
  home interview with the mother who has suffered a
  SIDS loss, if she agrees and conveys the mothers
  story to the FIMR review members.
• This information is key to developing culturally
  sensitive SIDS risk reduction education and
  interventions.

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Johns Hopkins National Evaluation of FIMR

• 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.

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Disparities in SIDS Rates Persist

• 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).

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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
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US Infant Mortality 1990, 1998-2001 by Maternal
Race and Ethnicity Rates per 1,000 Live Births
Source National Center for Health Statistics,
Linked Birth/Infant Death Data Sets 1997, 1998,
1999, 2000,2001
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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 and
  other racial/ethnic groups, prone sleeping, the
  use of soft bedding and pillows, and some types
  of bed sharing should be reduced...

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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.

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Sheers NJ et
al. Where Should Infants Sleep? PEDIATRICS Vol.
112 No. 4 October 2003, pp. 883-889

• Data from NICHD showed
• Infant deaths in adult beds were 8.1 times more
  likely in the 1990s than in the 1980s.
• Infant deaths on sofas and chairs were 17.2 times
  more likely in the 1990s than in the 1980s.
• The risk of suffocation was approximately 40
  times higher for infants in adult beds compared
  with those in cribs.
• The authors conclude that reported deaths of
  infants
• who suffocated on sleep surfaces other than those
• designed for infants are increasing.

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Common SIDS Threads Emerging from 220FIMR
Programs In 42 States

• 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

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Can FIMR Make a Difference?

• YES! FIMR Can
• Increase community awareness about SIDS,
• Ensure that SIDS risk reduction messages are
  delivered by trusted messengers and
• develop culturally appropriate SIDS educational
  messages

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Increasing Community Awareness about SIDS
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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.
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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 did
not 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.
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Using Trusted Messengers
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• FIMR SIDS Intervention
• 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.

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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.
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Understanding Cultural Traditions
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• 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.

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Conclusion

• SIDS Risk Reduction Messages Work When
• They Are
• community specific,
• culturally appropriate and
• reinforced by respected messengers.
• FIMR CAN MAKE THAT HAPPEN!