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The Reduce the Risk campaign in the Tuscany
Regionevaluation of Sudden Infant Death Syndrome
awareness R.Piumelli,L.Landini,N.Nassi,R.Gini
, A. Macchiarini,P.M.Morello.
Florence SIDS Center,Meyer Children
Hospital Tuscany Health Agency
Seeds for SIDS,Parents Association
General Director, Meyer Children Hospital
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Whats Sudden Infant Death Syndrome (SIDS)

• SIDS is defined as the sudden unexpected death
  of an infantlt1 year of age,with onset of the
  fatal episode apparently occurring during
  sleep,that remains unexplained after a thorough
  investigation,including performance of a complete
  autopsy and review of the circumstances of death
  and the clinical history. (Pediatrics-2004)
  

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Reducing the risk of SIDS

• SIDS represents the leading cause of infant
  mortality between one month and one year of age
  in developed countries
• Reduce- the-risk campaigns (the so-called back to
  sleep campaigns) aimed at preventing prone
  sleeping,cigarette smoke exposure during and
  after the pregnancy,and overheating,are capable
  of producing a dramatic fall in the SIDS rate
  with a significant drop in infant mortality

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Background

• 1996 Institution of the Regional SIDS Center
  involved in
• Reduce the Risk (RTR) programs
• Home Monitoring
• Clinical management of infants with Apparent
  Life- Threathening Events (ALTE)
• Counseling
• 1996 first attempt of RTR campaign
• distribution of the leaflet
• For them its better

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2003 RTR-Regional Campaign Plan of action
1-Organization of a consensus conference with
the directors of the three Vast Health Areas of
our Region, referees of family paediatricians,
referees of the nurses association, and referees
of the Parents Association Seeds for SIDS
2-Organization of meetings with selected family
paediatricians, district health managers,
paediatric and obstetric hospital staff
3-Data collection of data about SIDS awareness
prior to beginning the campaign
4-Distribution of printed material (booklets and
posters) and diffusion of a short
educational documentary by the regional network
5- Data collection of SIDS awareness after
the campaign
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The survey methods

• Distribution of the questionnaire in 74 selected
  immunization centers (25 of all those in our
  Region) between January 7th / February 28th
• Periodical reinforcement telephone calls from a
  skilled communicator to the paediatricians
  involved in data collection at least five calls
  per center
• Percentage of responders 99
• Total number of questionnaires returned 1,427

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STUDY POPULATION
800
600
400
200
0
1
2
3
4
5
6
7
10
11
12
AGE OF THE INFANTS (months)
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The results of the Survey Degree of awareness
of the booklet among the population
YES 22
NO 78
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Degree of information per nationality
Italy
High Migration Groups (HMGs)
No answer (NA)
Other countries (OC)
0
20
40
60
80
100
No indications
Media, friends, others
HS Indications
Early HS indications
No indications
Other HS indications
Early HS indications
(CI 95) (CI 95)
(CI 95) (CI 95) Italy
17.32(14.43-20.20) 5.54(4.11-6.98)
18.35(15.76-20.95) 58.79(55.22-62.36) HMG
42.08(34.09-50.07) 6.96(4.05-9.88)
20.00(13.21-26.80) 30.95(24.34-37.57) NA
30.61(6.18-55.03) 4.96(0.00-14.51)
5.03(0.00-14.42) 59.41(33.67-85.15) OC
11.75(0.00-32.24) 0.00(0.00-0.00)
5.91(0.00-15.47) 82.34(63.09-101.6)

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Sleeping position
Prone
Side
Back
POSITION Prone 6.39
(CI 95 5.15-7.64) Back
55.09 (CI
95 51.08-59.10) Side
38.23 (CI 95
34.44-42.02) No answer 0.28
(CI 95 0.00-0.61)
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Sleeping position
Sleep indications
No indications
HS Health System
Media, friends, others
Early HS indications
HS indications
No indications 20.71
(CI 95 18.36-20.05) Other
5.66 (CI 95
4.41-6.90) HS indications 18.23
(CI 95 15.87-20.60) Early HS
indications 55.41 (CI 95
52.27-58.55)
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Sleeping position
Sleeping Position
per type of information
No indication
Other
HS indications
Early HS indications
0
20
40
60
80
100
Prone
Side
Back
Indication type Prone (CI 95)
Back (CI 95) Side (CI
95) No indication 17.99 (13.78-22.20)
36.56 (31.27-41.84) 45.11
(38.64-51.57) Other
9.73 (3.78-15.67) 22.31 (14.26-30.36)
67.96 (58.96-76.97) HS indications
2.74 (0.52-4.96) 62.58
(56.73-68.42) 34.29 (29.14-39.45) Early
HS indications 2.92 (1.77-4.08) 62.90
(57.11-68.69) 33.92 (28.13-39.72)
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Sleeping position
Sleeping position depending on booklet awareness
NO
YES
0
20
40
60
80
100
Prone
Side
Supine
Booklet awareness Prone (CI 95) Back
(CI 95) Side (CI 95) NO
6.20 (4.69-7.70) 51.31
(47.29-55.34) 42.13 (38.37-45.88) YES
7.10 (4.03-10.16)
68.43 (63.48-73.37) 24.47 (19.42-29.53)
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Cigarette smoking Smoking during pregnancy
More than 5 a day
Not specified
Less than 5 a day
No
Not specified 1.95
(CI 95 1.21 - 2.70) None
85.90 (CI 95 83.94
- 87.96) Less than 5/day 8.02
(CI 95 6.65 - 9.39) More than 5/day
4.13 (CI 95 2.96
- 5.30)
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Smoking in the presence of the infant
Every day
Not specified
Rarely
Never
Not specified 3.14
(CI 2.34 - 3.94) Never
81.65 (CI 79.09 -
84.20) Rarely 14.04
(CI 11.59 - 16.48) Every day
1.18 (CI 0.52 -
1.83)
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Mothers nationality and temperature during sleep
Italy
HMGs
NA
OC
0
20
40
60
80
100
Too hot
Right temperature
Too hot (CI 95) Right
temperature (CI 95)
Italy 8.68 (7.19 - 10.16)
91.32 (89.84 - 92.81) HMGs 35.10
(25.17 - 45.04) 64.90 (54.96 -
74.83) NA 5.17 (0.00 - 15.65)
94.83 (84.35 - 105.31) OC
23.43 (10.01 - 36.86) 76.57
(63.14 - 89.99)
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• CONCLUSIONS
• The first back to sleep campaign was ineffective
  if we consider the degree of awareness of the
  booklet however a certain degree of information
  has been spread about
• Based on our data the main targets of the 2003
  RTR are
• side-sleeping avoidance
• getting through to high migration groups

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• SIDE SLEEPING AVOIDANCE
• Via education of health professionals by
  exploiting their authority and impact on parents

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• GETTING THROUGH TO HMGs
• By overcoming cultural and language barriers via
  the translation of the booklet into different
  languages, and adequate distribution of the same