Sudden Infant Death Syndrome (SIDS) Risks and Future direction for SIDS prevention in Jordan: Using Particepatory Action Research (PAR) to Create a Ripple of Change. Speaker: Shereen Hamadneh RN, PhD. ECU, WA Msc Maternal-Child Health, JUST Jordan

1. International Congress of Paediatrics -ICP 2013, Melbourne
Sudden Infant Death Syndrome (SIDS) Risks in Jordan: Using
Education to Create a Ripple of Change
Shereen Hamadneh
RN, PhD. ECU, WA
Msc Maternal-Child Health,
JUST Jordan

2. Background
SIDS “the sudden death of an infant less than year of
age that cannot be explained after a thorough
investigation is conducted, including a complete
autopsy, examination of the death scene, and review of
the clinical history”. [1]
While western countries are aware of SIDS risk
factors and many have implemented prevention
campaigns and improved infant care practice and
home environment. There has not been major
investment in educating Jordanians about SIDS risk
factors or prevention measures. Further Jordanian
parents are unaware about SIDS and associated risk
factors. [3, 4, 5, 6]

3. Aims & Significance
Develop and implement a SIDS education program using
current evidence of best practice for health care
providers tailored for the Jordanian context. Health
care providers then subsequently delivered the advice to
families.
 Identified health care providers' knowledge of SIDS in
Jordan, & their practical ability to educate parents.
 identified cultural barriers which made the translation of
SIDS prevention advice problematic.
 Generate a SIDS education package for use in other
hospitals in Jordan, and possibly in the Middle East
region.
 Explore main areas of concern in educating Jordanian
families in the future.

4. Jordan
Jordan is a developing
country in the Middle East.
It is bordered by Saudi
Arabia, Iraq, Syria, Palestine
& Israel, & shares the Gulf
of Aqaba with Egypt. The
population is 6.4 million. It
expected to become higher
in the following years due
to increasing of Syrian
refugees [2].

5. Jordanian Desert & Bedouin areas

6. View from rural villages in North Jordan
in the borderline with Syrian villages
Jordanian rural area

7. SIDS Prevention advice: Have SIDS safe cot, SIDS
safe bedding and SIDS safe environment
beds & bedding
sleep environment
• Put infant to sleep in a separate cot next
•Avoid over or less heat
to parents bed; on the back; without
•Smoke free
hats or covering the face.
•Avoid mould.
• Place infant on a firm sleep surface.
• Keep soft objects, toys, and loose
bedding out of infant's sleep area.
Others
• Use infant sleep sack.
•Stop maternal smoking
• Create proper bedding for SIDS
•Maintain breastfeeding
prevention, 'SIDS Safe Crib'; do not use •Offer pacifier on the bed
the following mattresses: Sheepskin or
sheep fleece underlay, Moisture-resistant time
cot mattress protector, Any under blanket •Keep educating in terms
which is not made of pure cotton, Acrylic of the risk factors
blanket, Any blanket which contains
associated with SIDS.
polyester, Any bedding that is quilted,
padded, or filled, Sleeping bag, Duvet,
[7]
Pillows or cushions

8. Safe beds and beddings

9. Study method
Mixed method
using action
research
Educational
resources were
adapted from :
•American Academy
of Pediatrics (APA).
•National Institute
of Child and Human
Development
(NICHD).
•SIDS and Kids
Study setting at King Abdullah
University Hospital (KAUH)

10. Data Collection
Quantitative
Qualitative
Pre & post Infant Sleep Care
Practice Questionnaire (ISCPQ)
Stakeholders’ Feedback
oMeasured the changes of knowledge
and educating practices of 103 health
care providers from maternal/child
units(nurses, midwives, nursing &
midwifery students).
Infant Sleep Position
Observation Sheet (ISPOS)
oMeasured changes in positioning
practices, infants positions were
observed 400 times before and after
implementing the JSEPP.
o 8 Stakeholders provided their
thoughts and ideas for
planning and implementing the
appropriate SEPP.
Health care providers
focus groups. Three groups
included 18 health care
providers. Evaluated the
challenges and effectiveness of
the JSEPP

11. Qualitative Data Findings
Prevent SIDS risk in
Jordan.
Main area of concern:
 Infant sleep practice
 Infant sleep
environment
 Family awareness
High risk group
 Media & publication
Jordan

12. Sleeping position:
Side versus back
Infant sleep practice
“... Parents put their
babies on side to sleep
...some of the nurses put
the babies on the side
after a feed even weather
the babies sleep or not, to
prevent suffocation from
vomiting...also followed
the same practice with
their babies at home.”
Arabic parents and caregivers do not usually place their infants
on their stomachs to sleep. They also believe that in the first
few months of life, infants should be placed in a variety of
positions (back and sides) to prevent “flat head”.

13. At home
At hospital

14. Infant’s Bedding & clothing: Heavy versus light
A health care provider said: “In cold weather, mothers put
baby to sleep with heavy clothing, hat and use a number of
quilts to ensure the baby is kept warm. Having sheep skin
underneath of baby, is anther strategy used to keep the
infant bed warm”

15. Loose bedding

16. Smoking at homes
versus smoke-free
homes
Infant environment
Tobacco smoking
is very
common among men in
Jordan. More attention to
keep homes free of
smoke. Men need to be
deeply evolved in the SIDS
education in future.
A health care provider said: “I have a friend, her husband always
smoke inside home and in the car behind his baby and baby is
now less than 6 months age.” Another said: “My husband smokes
inside home around our kids and never minds ”. Another said:
“usually smoker husbands are not concerned about the risk of
SIDS or other risks caused by his smoking.”

17. Quantitative Results
Overall the quantitative study results
indicated statistically significant
improvements not only self-reported
knowledge & perceptions regarding SIDS
risk prevention and educating family
practices, but also independently observed
infant safe positioning practices.

18. SIDS risk in winter
versus the risk during
the rest of the year
Home environment
 Jordanian winter reality:
Basic method for heating.
Lack ventilation inside homes.
A health care providers
said: “During winter, when
the windows & doors are
closed. There is a wood or
kerosene heater in the
room this is extremely
dangerous the lack of
ventilation. Especially,
sometimes presence ne one
or more smokers in the
same room around the
baby”
Jordan

19. SIDS awareness
among families
Future of SIDS prevention in Jordan
Mostly
parents
receive advice on
infant care from their
female relatives;
especially
grandmothers. They
were unaware of
SIDS & they need to
be evolved in the
education in future.
Jordan

20. High risk groups
Future of SIDS prevention in Jordan
 infants
of less
educated families
 Infants of low
socio-economically
group families
 Infants of families
who live in highland
rural areas
Infants of Bedouins
& refugees who live
in desert.
Jordan

21. Conclusion
The qualitative study revealed two key areas of
concern for Jordanian infants: the home environment
and sleeping practices.
Health care providers found the JSEPP was very
important and helpful in the workplace. Action research
was seen as an effective method for implementing
change in the practical skills.
Health care providers felt empowered to initiate the
change in their practice, to be ‘SIDS safe’, and starting to
educate families.
The way of presented the health knowledge was
perceived as effective; however, the key to put this
knowledge into practice was motivation.

22. Key messages
Hope this finding will enable stakeholders, policy
makers, health care providers, and other
commissioners and users of health care services to
consider how their decisions affect the quality of
infant care.
This will enable the families to recognise the risk
practices and start changing to be low SIDS risk
practices.
This study provide a base for further research to
assist and monitor the process of implementing SIDS
prevention intervention in a variety places in Jordan
or in the Middle East.

23. References
1.
2.
3.
4.
5.
6.
CDC. (2013). Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected
Infant Death (SUID): Home. Retrieved 18 August 2013, from Department of
Health and Human Services, Centre for Disease Control and Prevention
1600 Clifton Rd. Atlanta, GA 30333, USA http://www.cdc.gov/sids/
DOS. (2013). The Demographic Profile of Jordan Population Trends. Amman,
Jordan.
Bataineh, H., Hussein Shawagfeh, & Twalbeh, A. (2008). The Infant Mortality
Rate in Irbid, Jordan. MIDDLE EAST JOURNAL OF INTERNAL MEDICINE 1(2),
9-10.
Abu-Baker, N. (2005). Environmental Tobacco smoke exposure and birth
outcomes. PhD, University of Cincinnati, 2005, 114 pages; , Ohio,
Cncinati.USA.
Azab, M., Khabour, O., Alzoubi , K., Anabtawi , M., Quttina , M., Khader , Y.,
et al. (2013). Exposure of pregnant women to water pipe and cigarette
smoke. Nicotine Tob Res, 15(1), 231-237.
Hawamdeh, A., Kasasbeh, F. A., & Ahmad, M. A. (2003). Effects of passive
smoking on children's health: a review. Eastern Mediterranean Health
Journal, 9(3), 441-447.
7. American Academy of Pediatrics, 2008; American SIDS Institute, 2010; Moon, 2010;
L'Hoir, et al., 2008; SIDS & Kids, 2013.

24. References
• Some photos are taken from SIDS & Kids
Australia
• Some photos are downloaded from Jordanian
multimedia
• Some photographs are taken in Jordan by the
researcher “Shereen Hamadneh”

25. Thank you