P0264 - Infant sleeping practices in a suburban community of Santo Domingo, Ecuador.

Background
Ecuador’s annual mortality rate from SIDS is 0.4 per 100,000 people, twice the global rate of 0.2. Bed-sharing and non-supine positioning are the most common risk factors associated with sudden unexplained infant death and sudden infant death syndrome (SIDS). Healthcare staff at the Centro Medico Hombro a Hombro (CMHH), a health center affiliated with the University of Kentucky and located in Santo Domingo, Ecuador, report a high proportion of bed-sharing and unsafe positions for infant sleep in their community. There are no studies reporting infant sleep practices in this community. We want to investigate the local social and cultural behaviors associated with infant sleeping practices to inform cost-effective, culturally acceptable solutions.
Methods
We conducted a cross-sectional descriptive study in Santo Domingo, Ecuador, surveying 100 voluntary women in their third trimester of pregnancy who received care at CMHH from May 2018 to September 2019. The survey inquired about demographic information and their knowledge and intentions regarding safe infant sleep environments, and their past practices in the case of multiparous women. All women received a gift of baby care items for their participation.
Results
The mean age of participants was 24.2 years at a mean gestational age of 32.1 weeks. 35% were primiparous. 37.5% of mothers lived in households of 6 or more inhabitants, and 89% reported household income less than one minimum wage. 99% intended for the baby to sleep in their room, with 75.8% intending to bed-share. Reasons for choosing the baby’s sleeping location included proximity to care for the baby, safety/protection, comfort, and lack of a crib, space, or money. 28.3% believed that a baby should sleep supine, 20.2% prone, and 51.5% on their side. Reasons for choosing sleeping position included safety, comfort and better/longer sleep. 23% intended to let their baby sleep with loose blankets/pillows, for reasons including baby’s comfort, safety, protection or warmth. 87.9% reported that their previous baby always slept in their room, while 90.7% always or very often slept in the mother’s bed. Bassinets/cribs were used rarely or never by 97.3% and 92.5% respectively. 35.4% of babies were placed prone compared with 38.1% on their side, and 33.3% supine to sleep.
Conclusions
The majority of women reported either past bed-sharing and/or intention to bed-share with their infants. The results suggest that poverty, lack of space and mother’s convenience could be contributing factors. There is also widespread perception that bed sharing improves safety, comfort, and protection. Awareness and creation of infant sleeping environments in accordance with the AAP recommendations (room-sharing without bed-sharing, supine positioning, no loose items) is overall rare in this population. The results of this study suggest that this community is in need of specific interventions to address safe infant sleep practices.