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Call To Refocus On Sids: A Kneejerk Reaction

Ministry Of Health's Call To Refocus On Sids: A Kneejerk Reaction

New Zealanders are becoming used to so-called "international studies" which get it wrong about conditions here. The latest is a study released this month by the Commonwealth Fund, which compared New Zealand's infant death rate with that of other countries, and ranked this country second worst in the industrialised world.

The statistics in the study (relating to 2001) were patently out-of-date and the conclusions were simplistic - a frequent outcome where an international comparison with a "one-size-fits-all" methodology fails to take account of inter-ethnic factors.

Now, however, the Ministry of Health has compounded the situation by its response to the study. Having criticised its simplistic methodology and conclusions, the Ministry's Chief Adviser on Child Health, Dr Pat Tuohy, has stated that New Zealand needs to refocus its efforts on cot death (SIDS) prevention because "the rate's dropping very slowly".

In saying this, Dr Tuohy repeats the errors of the Commonwealth Fund study: he has focused on a few statistics and used a "one-size-fits-all" approach.

In actual fact, New Zealand has been doing very well in cot death prevention. Since 2000 the nationwide cot death rate has fallen by around 40%. Certainly, our rate is still high relative to other countries; but the significant point is that cot death in New Zealand is now confined almost exclusively to Maori families. Among Pakeha families it is (as the Ministry of Health has stated) very rare.

Any assessment of New Zealand cot death rates which fails to take account of this huge inter-ethnic disparity is distorted and misleading: it masks the fact that since the mid-1990s, nationwide and Pakeha cot death rates have plummeted. However, the source of this inter-ethnic disparity must be faced and addressed, because it provides the solution to reducing Maori cot death.

The introduction of face-up sleeping (in 1989) reduced the New Zealand cot death rate by about 45%, but within a few years a plateau was reached: 2.1 deaths per 1000 live births in 1992, 1993 and 1994 (one cot death for every 476 live babies).

Then in 1995 the introduction of "mattress-wrapping" (the prevention method based on the toxic gas explanation for cot death) saw a fundamental change in outcomes. Following the introduction of mattress wrapping the nationwide and Pakeha cot death rates started to fall; and in addition - crucially - no cot death was reported on a "wrapped mattress". If mattress-wrapping did not prevent cot death, obviously a statistically significant number of babies would die on wrapped mattresses - but none did.

Nevertheless, the Maori cot death rate remained very high. Moreover, as the Pakeha rate fell, this resulted in the huge inter-ethnic disparity which exists today: the Maori rate is ten times the Pakeha rate. New Zealand now has the highest inter-ethnic disparity in cot death rates in the world.

Quite rightly, the Ministry of Health wishes to redress this situation and get the Maori rate down. The way to do this is obvious: advise Maori parents to adopt the preventive method which has resulted in the major reductions in the nationwide and Pakeha rates, namely mattress-wrapping.

There is no doubt that mattress-wrapping prevents cot death. During the nearly 12-year period since mattress-wrapping commenced, about 830 cot deaths have occurred in New Zealand, but none where the baby has been sleeping on a wrapped mattress. Put another way, all cot deaths occur where the baby is sleeping on an unwrapped mattress (or parallel bedding situation).

However, instead of focusing on this information, the Ministry of Health has fudged its response to the Commonwealth Fund study by going off on an irrelevant tangent: the fallacy that smoking causes cot death. Smoking does not cause cot death - as demonstrated by decades of statistics from countries where the incidence of smoking is very high (for example, Japan and Russia) but the incidence of cot death is very low.

With very little effort now, New Zealand could become the first country in the world to eliminate cot death. Following the success of the 12-year mattress-wrapping campaign, we have proved how it can be prevented. All that is needed is for the Ministry of Health to change its policy and tell parents to wrap babies' mattresses and stop bedsharing with babies in adult-sized beds.

That is the solution to cot death. Instead, the Ministry recently called a meeting to "refocus SIDS".

With nationwide promotion of mattress-wrapping by the Ministry of Health (and organisations such as Plunket), New Zealand could be at the forefront of cot death prevention internationally - and no longer the subject of misleading conclusions in "international studies" about infant death rates.


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