Pēpē-Infant sleep and sudden unexpected death in infancy in Māori

Abstract

Aotearoa-New Zealand has one of the highest rates of sudden unexpected death in infancy (SUDI) among developed countries. Indigenous New Zealand Māori are disproportionately affected by SUDI (1.36 deaths for every 1,000 births). In wealthier countries, and in New Zealand, SUDI mortality decreased dramatically following high-profile risk-reduction campaigns for modifiable risk factors, such as prone sleep position, and smoking in pregnancy. SUDI remains preventable if infant exposure to such known modifiable risks continues to reduce. Improvements in Māori SUDI have not kept pace with non-Māori. This thesis investigated factors contributing to the inequitably high Māori SUDI rate by examining risks in the infant sleep environment, their relative effect on Māori and non-Māori infants, and the drivers influencing mothers’ infant sleep decision-making. This research drew on the New Zealand SUDI Nationwide case-control study (2012-2015), and a separate, locality-specific qualitative study. Kaupapa Māori methodologies were incorporated into each study. The SUDI Nationwide Study enrolled n=132 case infants and n=258 controls. Data collection was implemented using a project management approach. The initial results, particularly the dangerous combination of smoking in pregnancy and bed sharing, informed this PhD research. We confirmed the combined effect of these factors was the same for Māori and non- Māori. The difference was specifically in the prevalence of smoking in pregnancy. We also examined other hazards in the infant sleep environment. A qualitative study, based in the culturally and socioeconomically diverse region of Counties-Manukau, Auckland, New Zealand, was implemented from June to August 2019. Thirty mothers of infants aged 5-weeks to 5-months were interviewed at home about their infant sleep practices and the reasons for these. Two-thirds of mothers reported previous or current bed sharing. The need for adequate sleep motivated half the mothers, particularly Māori mothers, in the study to bed share. This research has strengthened and informed our understanding of SUDI in New Zealand, especially for Māori. Smoking remains a modifiable behaviour. These findings highlight the need for the continued availability of effective, appropriate smoking cessation programmes, and the continued promotion of safe sleep, and supply of safe sleep beds for infants who need them.