Research for Improved Māori Child Health Outcomes

The Whakawhetu research plan seeks to source, review and disseminate SUDI related research to enable health professionals to support Māori whānau reduce the risk of SUDI for their babies. We do this through drawing on evidence based research that then informs key messages appropriately targeted to a wide range of stakeholders from whānau to health professionals.

Research Dissemination: Whakawhetu Newsletter

Access to the latest information on Māori infant health and SUDI can be obtained through our website, the SUDI Prevention Network and our quarterly Whakawhetu newsletter. To sign up to our SUDI prevention network and receive our newsletter, please add your email address to the blue box to the top right of the screen. Previous newsletters can be found below.

•  He Pitopito Koorero: Whakawhetu Newsletter for April 2011

Research on SUDI

Why Maori women continue to smoke while pregnant

Marewa Glover, Anette Kira

This paper investigates why some Maori women continue to smoke during pregnancy. The qualitative study was conducted with 60 pregnant Maori women aged from 17–43. Results showed there was a lack of understanding of the harms associated with maternal smoking. Additionally, over half of the participants (62%) predominantly socialised with people who smoked and nearly all said it was easy to smoke in their socialising and work environments. The study highlights the need to include family in cessation interventions.

Reference: NZMJ 29 July 2011, Vol 124

http://journal.nzma.org.nz/journal/124-1339/4784/content.pdf

Sudden unexpected infant death in Auckland: a retrospective case review

Lynne Hutchison, Rea C, Stewart AW, Koelmeyer TD, Tipene-Leach DC, Mitchell EA

This study reviewed autopsy reports of all SUDI deaths in the Auckland region, New Zealand, from October 2000 to December 2009. Information was extracted from autopsy and police reports from the National Forensic Pathology Service at Auckland Hospital. Of the 332 post-mortems in this period, 221 were classified as SUDI. Of these, 83% were Māori or Pacific infants. At the time of death, 64% overall were bedsharing; this was more common in 7-28 day olds (92%). Bedsharing infants were significantly younger at death than non-bedsharing infants. Where sleep position was known, 57% were placed in non-supine at the last sleep. There was no evidence of diagnostic shift and the prevalence of bedsharing did not change over the decade. The study concludes that bedsharing was associated with a high proportion of SUDI cases, especially in the youngest infants, and non-supine sleep positions were common. There is a need to enhance SUDI prevention messages and consider innovative ways of promoting safe sleeping environment and supine sleep position in Māori and Pacific communities.

Reference: Acta Paediatrica. 2011 Aug;100(8):1108-12.

Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis

Fern R. Hauck, MD, MS, John M. D. Thompson, PhD, Kawai O. Tanabe, MPH, Rachel Y. Moon, MD, and Mechtild M, Vennemann, MD, PhDd

June 2011

A recent meta-analysis on breastfeeding confirms breastfeeding as a protective factor against SIDS. The aim of the study, ‘Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis’ was to quantify and evaluate the protective effect of breastfeeding against SIDS, including the influence of exclusive breastfeeding and longer breastfeeding duration. The study also sought to make a recommendation on the potential utility of breastfeeding as a strategy for reducing the risk of SIDS.

The meta-analysis revealed that breastfeeding to any extent and of any duration is protective against SIDS. What’s more the protective effect is stronger for exclusive breastfeeding.  The authors conclude that the recommendation to breastfeed infants should be included with other SIDS risk-reduction messages to both reduce the risk of SIDS and promote breastfeeding for its many other infant and maternal health benefits. The study found that the best time to begin the dialogue with mothers about breastfeeding plans is the prenatal period, and that it should be included with other SIDS risk-reduction messages and materials that are traditionally given to expectant mothers during pregnancy. Moreover, the authors add that breastfeeding interventions target higher-risk populations.

Reference: Pediatrics. 2011 Jul;128(1):103-10. Epub 2011 Jun 13.

SIDS-related knowledge and infant care practices among Māori mothers

David Tipene-Leach, Lynne Hutchison, Angeline Tangiora, Charlotte Rea, Rebecca White, Alistair Stewart, Edwin Mitchell

Outcomes are reported from a survey of Māori mothers who gave birth in the Counties Manukau District Health Board area. This survey investigated what these mothers know about SIDS prevention, and sought to determine their SIDS-related child care practices. Results were compared with a similar 2005 survey of a largely European sample. Knowledge of Māori mothers about SIDS prevention was much lower than for European mothers. More Māori infants slept prone and Māori mothers stopped breastfeeding significantly earlier. Although co-sleeping rates were similar, bedsharing increased to 65% for some part of the night. In addition, more than half of the Māori mothers had smoked in pregnancy and 21% of them were sharing a bed with their infant. Potentially unsafe soft objects such as rolled blankets or pillows were used by a third of mothers to help maintain the sleep position.

Reference: N Z Med J. 2010;123(1326):88-96

http://www.nzma.org.nz/journal/abstract.php?id=4445

Te Piripohotanga Healthy Starts Trial

Whilst the main topic of a research project in Counties Manukau is reducing exposure of babies to environmental tobacco smoke, safe sleeping, breastfeeding and immunisation are three additional topics given attention as well. Te Piripohotanga/ Healthy Starts Trial is a collaboration between New Zealand and Australian researchers tackling the issue of smoking exposure of Indigenous populations. The study will assess a family-centred community health intervention to reduce respiratory illness in Indigenous infants (Māori and aboriginal) up to 12 months of age. The study involves 420 participants in a parallel, randomized controlled study design. A Māori model of health, Te Whare Tapa Wha (the four-sided house) was used to guide the design and delivery of the program. The study also delivers key health promotion messages on things such as safe sleeping, breastfeeding and immunisation in case they have been missed as part of
routine practice. More information on this project can be found at

http://www.ctru.auckland.ac.nz/index.php/researchprogrammes/addiction-research/225-healthy-starts

The Safe Sleep Study

In June 2010, the Health Research Council awarded funding to lead researchers Dr David Tipene-Leach and Professor Barry Taylor (Otago University Child Health) to determine the safety of the wahakura for babies to sleep in. The research team also includes Angeline Tangiora and Dr Sally Baddock (Otago University Midwifery).

Through midwifery services in the Hawkes Bay region, 240 mothers will be recruited and randomly allocated either a wahakura or portable cot. The sleep patterns of the babies will be monitored at one and three months. Safety and the effects of the wahakura on rates of breastfeeding, infant sleep duration and bonding between mother and baby will be investigated. This study will make an important contribution to our understanding of infant care practices and safety aspects of the wahakura. 

Māori Infant Care Practices: Implications for Health Messages, Infant Care Services and SIDS Prevention in Māori Communities

 Tipene-Leach D., S. Abel, J. Park, S. Finau & M. Lennan

 Pacific Health Dialog, vol 7, no 1 pp 29-37 (2000)

This paper uses findings from the Māori section of a multi-ethnic infant care practices study undertaken in 1998. It aims to increase understanding of present day Māori infant care practices to inform infant health messages and service delivery to Māori and to understand the context of practices that comprise modifiable risk factors for SIDS. Access the article here.