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CC BY 4.0 · Journal of Health and Allied Sciences NU 2023; 13(03): 410-415
DOI: 10.1055/s-0042-1757732
Original Article

Knowledge and Self-Reported Practice of Postnatal Mothers on Sudden Infant Death Syndrome Prevention: A Cross-Sectional Study

Roseline Kallakavumkal Antony
1   Department of Child Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
,
Sandra Jyothi Saldanha
2   Department of Child Health Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
› Author Affiliations
Funding This project was undertaken as a part of fulfilment of MSc. Nursing in Pediatrics and was self-funded.
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Abstract

The word “Sudden Infant Death Syndrome (SIDS)” is used for a sleeping infant, who has apparently been quite well, is found unexpectedly dead. There are varied discussions throughout the world trying to find the possible reasons and preventive measures toward these sudden deaths. However, limited studies are undertaken regarding knowledge of mothers related to SIDS. The present study aimed at identifying the knowledge gaps present among the postnatal mothers toward SIDS and assess their practices that may influence SIDS among infants. The research design was a descriptive cross-sectional design and a 107 postnatal mothers were recruited focusing on the aim of the study through purposive sampling technique. A structured knowledge questionnaire and self-reported practice checklist was prepared and validated from experts.

The findings of the study revealed that the majority of subjects 57 (53.3%) had good knowledge with a mean score of 9.34 ± 1.83 (maximum score-15). The mean practice score on prevention of SIDS among subjects was 13.76 ± 1.13 (maximum score-16). There was no significant correlation between knowledge and practice (r = −0.38, p = 0.7). However, significant association was seen between knowledge on prevention of SIDS and baseline variables such as education (p = 0.001), occupation (p = 0.001), place of residence (p = 0.001), and family income (p = 0.01). Moreover, there was a significant association between self-reported practice and age of mothers (p = 0.03).

The study findings showed good knowledge level among majority of the mothers and executed good practice toward care of the infant. However, 30.8% of the mothers had average to poor level of knowledge, which is significant and needs attention.


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Keywords

descriptive study - knowledge - postnatal mothers - practice - sudden infant death syndrome - self-reported practice

Introduction

The infant mortality rate is an important marker of the overall health of a society. According to the Ministry of Health and Family Welfare, India, the infant mortality rate for 2021 was 30/1000 live births and in the state of Karnataka was 21/1,000 live births.[1] In the United States, about 3,400 infants die due to sudden infant death syndrome (SIDS) each year. In 2019, 1,250 deaths were reported due to SIDS.[2] Unfortunately, no data are available related to mortality caused by SIDS alone in India.[3]

SIDS is sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation, including a complete autopsy, examination of the death scene, and a review of the clinical history.[4] Although the direct cause of SIDS remains unknown, many doctors believe that there are several factors that put babies at an increased risk of SIDS, including babies sleeping on their stomachs, exposure to cigarette smoke in the womb or after birth, sleeping in bed with parents, premature birth, being a twin or triplet, being born to a teen mother, and also living in poverty settings. The common occurrence of SIDS is observed at 2 and 4 months of age and most death occur during winter time.[5]

Precautions include ensuring that infants sleep on their backs, controlling the temperature of the bedroom, employing a crib without toys or excess bedding, and breast feeding.[3] In November 2016, the American Academy of Paediatrics (AAP) Task Force on SIDS published an updated policy statement with guidelines to reduce the risk of SIDS and other sleep-related deaths. There were several recommendations given and the most prominent one was room-sharing without bed-sharing.[6]

There is limited research done in the area of public awareness toward SIDS in India. Understanding the knowledge of mothers on SIDS will help as a teaching guide in promoting knowledge in the communities. Self-reported practices include the information mother provides toward the methods used by the mother in caring for her neonate that may predispose to SIDS. Hence, the study intended to identify what mothers know about SIDS and what practices they follow in caring for their infants. The hypothesis set to evaluate was that there was a significant relationship between knowledge and self-reported practices related to SIDS among postnatal mothers.


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Methods

A descriptive cross-sectional design was chosen for the present study. Ethical clearance was obtained from Father Muller Medical College Institutional Ethics Committee (FMMCIEC/CCM/101/2018). The present study was conducted in the postnatal ward of Father Muller Medical College Hospital, Mangalore. Father Muller Medical College Hospital is a multi-speciality hospital with a total of 1,250 bed strength, which includes 40 postnatal beds. Purposive sampling technique was used to derive 107 postnatal mothers. Researcher developed knowledge questionnaire and practice checklist with 15 and 16 items, respectively. This tool was validated by nine experts and modifications were made accordingly. The reliability was checked using Cronbach's alpha and split half technique and obtained scores were 0.92 and 0.80 respectively suggesting the tools were reliable. A formal written permission was obtained from the administrator of the hospital prior to the data collection. The investigator assured confidentiality and written consent was obtained.

Sample size was derived based on statistical formula n = Zα2PQ/d2at 95% CI and required sample was 97. However, considering 10% attrition in obtaining all information, 107 responses were collected. The obtained responses were then compiled and analyzed using inferential statistics.


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Results

Description of Baseline Variables of Subjects

Data in [Table 1] shows that the majority of mothers belonged to the age group of 21 to 30 years (84.1%) with a mean age of 25.61 ± 3.37 and having one to two living children (60.8%). Most subjects had high school education (57%) and only 18% of them were graduates and above. Most were home makers (90.7%) residing mostly in rural areas (78.5%) and drawing monthly family income between 5001 and 10,000 rupees (93.5%).

Table 1

Frequency and percentage distribution of subjects according to baseline characteristics n =107

Sl No.

Baseline variables

Frequency

Percentage

1

Age of mothers in years

(Mean ± SD = 25.61 ± 3.37)

 a) ≤20

6

5.6

 b) 21-30

90

84.1

 c) 31-40

11

10.3

2

Educational level (mothers)

 a) Primary

26

24.3

 b) High school

61

57

 c) Graduate

18

16.8

 d) Post graduate

2

1.9

3

Occupation (mothers)

 a) Home maker

97

90.7

 b) Self-employee

7

6.5

 c) Private employee

3

2.8

4

Number of living children

[Mean ± SD = 1.91 ± 1.08]

 a) 1-2

65

60.8

 b) 3-4

39

36.4

 c) >4

3

2.8

5

Type of family

 a) Nuclear

76

71

 b) Joint

31

29

6

Place of residence

 a) Rural

84

78.5

 b) Urban

23

21.5

7

Family income (per month in rupees) (Mean ± SD = 8093.46 ± 1993.08)

 a) 5,001-10,000

100

93.5

 b) 10001-20,000

7

6.5

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Assessment of Knowledge and Self-Reported Practices on Prevention of SIDS

The knowledge and practice on prevention of SIDS is given in the [Tables 2] [3] [4]. [Table 2] reveled that most mothers had average and good level of knowledge (29.9% and 53.3%, respectively). About 17 mothers (15.9%) had excellent knowledge on SIDS that influenced the mean knowledge score (9.34 ± 1.83, maximum score-15). Furthermore, knowledge scores specific to etiology and prevention of SIDS were analyzed. [Table 3] which showed that 45.8% had good and 30.8% had excellent knowledge in terms of prevention of SIDS and with regard to etiology of SIDS, only 29% had good and 26.2% of them had excellent knowledge.

Table 2

Frequency and percentage distribution of level of knowledge n = 107

Knowledge

level

Grading

Frequency

Percentage

Poor

0-5

1

0.9

Average

6-8

32

29.9

Good

9-11

57

53.3

Excellent

12-15

17

15.9

Note: Maximum score-15


Table 3

Area-wise level of knowledge scores n = 107

Knowledge level

Grading

Frequency

Percentage

Area 1: Etiology (Mean 2.7 ± 1.16)

Poor

0-1

16

15.0

Average

2

32

29.8

Good

3

31

29

Excellent

4-5

28

26.2

Area 2: Prevention (Mean 6.64 ± 1.46)

Poor

0-3

2

1.9

Average

4-5

23

21.5

Good

6-7

49

45.8

Excellent

8-10

33

30.8
Table 4

Knowledge and self-reported practice n = 107

Variables

Mean ± SD

SEM

Knowledge

9.34 ± 1.83

0.17

Self-reported practice

13.76 ± 1.13

0.11

Note: Knowledge maximum score-15; practice maximum score-16.


The data received from mothers with regard to their practices in caring for their neonate ([Table 4]) showed a mean of 13.76 ± 1.13 (maximum score-16), suggesting good practices were exhibited in caring for their neonates.


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Relationship Between Knowledge and Self-Reported Practices on Prevention of SIDS Among Postnatal Mothers

To find the correlation ([Table 5]), the r value was computed (r = −0.38), which showed a moderate negative correlation between knowledge and self-reported practice on prevention of SIDS among mothers. The practices used by the mothers were safe even though the knowledge level was average to good. However, no statistical significance was seen as the obtained p-value was 0.7. Hence, the study showed no relationship between the mothers' knowledge levels and their practices.

Table 5

Relationship between knowledge and self-reported practices on prevention of SIDS among postnatal mothers n = 107

Variables

Mean ± SD

r-Value

p-Value

Knowledge

9.34 ± 1.83

-0.38

0.7

Self-reported practice

13.76 ± 1.13

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Association between Knowledge and Self-Reported Practices on Prevention of SIDS Among Postnatal Mothers and Selected Baseline Variables n = 107

The analysis to determine the association between knowledge and self-reported practices of mothers with their baseline variables is shown in [Tables 6] and [7]. Statistically significant association was obtained between knowledge on SIDS and baseline characteristics of mothers such as education (p = 0.001), occupation (p = 0.001), place of residence (p = 0.001), and family income (p = 0.01).

Table 6

Association between knowledge on prevention of SIDS among postnatal mothers and selected baseline variables

Baseline variables

Poor

Average

Good

Excellent

χ2

p-Value

Age of mothers in years

 

 

5.83

 

 

0.52

 ≤20

0

2

4

0

 21-30

1

25

47

17

 31-40

0

5

6

0

Educational level (mothers)

 

 

55.31

 

 

0.001**

 Primary

1

19

6

0

 High school

0

13

42

6

 Graduate

0

0

9

9

 Post graduate

0

0

0

2

Occupation (mothers)

 

21.36

 

0.001**

 Home maker

1

32

54

10

 Self-employee

0

0

3

4

 Private employee

0

0

0

3

Number of living children

[Mean ± SD = 1.91 ± 1.08]

 

 

4.92

 

 

0.76

 1-2

1

19

36

9

 3-4

0

11

20

8

 > 4

0

2

1

0

Type of family

 

5.56

 

0.11

 Nuclear

1

24

43

8

 Joint

0

8

14

9

Place of residence

 

14.22

 

0.001**

 c) Rural

1

28

48

7

 d) Urban

0

4

9

10

Family income (per month in rupees)

 

12.96

 

0.01*

 c) 5,001–10,000

1

32

55

12

 d) 10001–20,000

0

0

2

5

*Significant.


**Highly significant.


Table 7

Association between self-reported practice on prevention of SIDS among postnatal mothers and selected baseline variables n = 107

Baseline variables

Median

χ2

p-Value

<14

≥14

Age of mothers in years

 

 

16.57

 

 

0.001*

 ≤20

2

4

 21-30

36

54

 31-40

3

8

Educational level (mothers)

 

 

5.989

 

 

0.112

Primary

10

16

 High school

20

41

 Graduate

11

7

 Post graduate

0

2

Occupation (mothers)

 

8.62

 

0.56

 Home maker

37

60

 Self-employee

4

3

 Private employee

0

3

Number of living children

[Mean ± SD = 1.91 ± 1.08]

 

 

12.08

 

 

0.23

 1-2

24

41

 3-4

17

22

 > 4

0

3

Type of family

 

2.39

 

0.81

 Nuclear

28

48

 Joint

13

18

Place of residence

 

6.16

 

0.26

 e) Rural

30

54

 f) Urban

11

12

Family income (per month in rupees)

 

4.04

 

0.49

 e) 5,001–10,000

38

62

 f) 10001–20,000

3

4

*Significant.


**Highly significant.


Further analysis to determine the association between self-reported practices of mothers and baseline variables showed a statistically significant association between practice scores and age of the mothers (p = 0.001).


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Discussion

The present study intended to identify the relationship between knowledge and self-reported practices of mothers. The baseline characteristics obtained by this study showed that most mothers were between the age group of 21 and 30 years (84.1%), and 60.8% of them had one to living children. The educational level was high school (57%) among the majority of the mothers, which might be because most of the them belonged to rural areas (78.5%). The study showed varied levels of knowledge, where the majority of mothers had average and good knowledge on SIDS. This might be due to the dissemination of proper information through family members in caring for their neonate as some cultural practices are known to also influence the knowledge of mothers.[7] A study done by Mohamed et al found that 75% of mothers had poor knowledge regarding SIDS, the majority of mothers belonged to rural areas (68.9%) and had secondary education (52.2%).[8] Another study conducted by Yikilkan et al to determine the knowledge and attitude of parents about SIDS found that only 39% of mothers were aware of SIDS.[9]

The self-reported practices followed by mothers in caring for their neonates were excellent in the current study ([Table 4]). The articles on Indian traditions describe that the family size and kinship bonds influence the practices on infant care.[10]

However, the study by Mohamed et al reported that nearly 50% of the mothers had unsatisfactory practices regarding SIDS.[7] The present study does not show a significant relationship between the knowledge and self-reported practices ([Table 5]) among the mothers, which may also suggest that the mothers reported some practices based on their experiences rather than knowledge alone. Also, a study by Chung-Park showed no correlation between knowledge of mothers on SIDS and their safe sleep position practices (p = 0.611).[11] On the contrary, Mohamed EWA in his study found that knowledge and practice on SIDS are in congruent to each other and showed statistical significance (r = 0.216, p = 0.004).[8]

The present study findings in [Tables 6] and [7] showed a significant association between knowledge level of the mothers and their education status (χ2-55.31, p < 0.001), occupational status (χ2-21.36, p < 0.001), place of residence (χ2-14.22, p = 0.001), and family income status (χ2-12.96, p = 0.01). The reported practices were found to be significantly associated with the age of the mothers (χ2-16.57, p = 0.001). Thus the findings mainly suggest that the level of education, occupational status, place of residence, and income status influence the knowledge levels of mothers; however, age and experience have better infant caring practices that help to prevent SIDS in infants. A study done by Chung-Park showed no association between baseline characteristics such as age, education, number of children, or ethnicity with the mothers' knowledge or their practices related to safe sleep positions to prevent SIDS in infants.[11]


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Conclusion

This research article found that practices toward the prevention of SIDS are better reported; however, knowledge regarding SIDS needs further improvement.


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Conflict of Interest

None declared.

Acknowledgments

The authors acknowledge the whole hearted participation of the postnatal mothers toward the study and the administrators of the hospital for providing permission to undertake the study.


Address for correspondence

Sandra Jyothi Saldanha
Master in Pediatric Nursing, Father Muller College of Nursing
Kankanady, Mangalore, 575002, Karnataka
India   

Publication History

Article published online:
22 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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