Predictors of breastfeeding duration in a predominantly Maori population in New Zealand.

BACKGROUND: Although breastfeeding duration in New Zealand's indigenous Maori is shorter than in non-Maori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Maori communities in regional Hawke's Bay. METHODS: Mother/baby dyads were recruited from two midwifery practices serving predominantly Maori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration. RESULTS: Maori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Maori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother's partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72). CONCLUSIONS: Breastfeeding duration in this group of mainly Maori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.

The Pepi-Pod study: Overnight video, oximetry and thermal environment while using an in-bed sleep device for sudden unexpected death in infancy prevention.

AIM: The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pepi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet. METHODS: Forty-five mostly indigenous Maori mothers who were referred by local health providers to receive a Pepi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures. RESULTS: When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pepi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head covering or prone/side sleep position. Differences in oxygen saturation were not significant, but heart rate was higher in the Pepi-Pod infants by 8.37 bpm (95% confidence interval 4.40, 12.14). Time in the thermal comfort zone was not different between groups despite Pepi-Pod infants being situated in significantly warmer rooms. CONCLUSIONS: Overall, we found that most differences in infant risk behaviours in a Pepi-Pod compared to a bassinet were small, with confidence intervals excluding meaningful differences. We noted poorer maternal sleep quality at 1 month. Higher infant heart rates in the Pepi-Pod group may be related to higher room temperatures. The Pepi-Pod appears physiologically safe but is associated with lower reported maternal sleep quality.

Methodology and recruitment for a randomised controlled trial to evaluate the safety of wahakura for infant bedsharing.

BACKGROUND: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Maori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device. METHODS/DESIGN: This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Maori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns. DISCUSSION: Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide. TRIALS REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010.

Breastfeeding knowledge and education needs of early childhood centre staff.

This survey investigated the breastfeeding knowledge, attitudes beliefs and education needs of supervisors and staff at 32 early childhood centres in New Zealand. This study explored numbers of mothers who breastfed at or supplied expressed breastmilk to the centres, and how breastfeeding education might enhance an increase in breastfeeding rates and child nutrition. Statistical analysis and open-ended questions revealed a positive attitude towards breastfeeding among staff. All centres recognised a need for breastfeeding education sessions and greater support for breastfeeding mothers. With increasing numbers of children attending early childhood centres, understanding the importance of and implementing support for mothers to continue to breastfeed is crucial.

A diagnosis of prediabetes when combined with lifestyle advice and support is considered helpful rather than a negative label by a demographically diverse group: A qualitative study.

AIMS: The aim of this study was to explore the experience and perceptions of a diagnosis of prediabetes among a demographically diverse sample of New Zealanders who had, and had not, regressed to normoglycaemia following participation in a primary care nurse-delivered intervention for 6 months. The sample included Indigenous Maori who have high rates of diabetes and associated co-morbidities. METHODS: A purposefully selected sample of 58 people with prediabetes and BMI >25 kg/m2, stratified by male/female, Maori/non-Maori, and those who had/had not regressed to normoglycaemia, after completing 6-months of a prediabetes intervention were interviewed. Interviews were audio-recorded and transcribed. Data were analysed by thematic analysis. RESULTS: Most participants recalled being shocked when told they had prediabetes, but they did not perceive the diagnosis to be a label in a negative sense, and some, described the diagnosis as helpful. Participants appreciated knowing that prediabetes could be reversed, and the opportunity to be able to take supported action and make lifestyle changes through the nurse-delivered prediabetes lifestyle intervention. Participants' clear preference was to take control and make dietary changes, not to take Metformin. CONCLUSIONS: Prediabetes was not considered a negative label, but an opportunity, when coupled with a primary care nurse-delivered dietary intervention.

Physiological stability in an indigenous sleep device: a randomised controlled trial.

OBJECTIVE: To compare overnight oxygen saturation, heart rate and the thermal environment of infants sleeping in an indigenous sleep device (wahakura) or bassinet to identify potential risks and benefits. DESIGN: Randomised controlled trial. SETTING: Family homes in low socio-economic areas in New Zealand. PATIENTS: 200 mainly Maori mothers and their infants. INTERVENTIONS: Participants received a wahakura or bassinet from birth. MAIN OUTCOME MEASURES: Overnight oximetry, heart rate and temperature at 1 month. RESULTS: Intention-to-treat analysis for 83 bassinet and 84 wahakura infants showed no significant differences between groups for the mean time oxygen saturation (SpO2) was less than 94% (0.54 min, 95% CI -1.36 to 2.45) or less than 90% (0.22 min, 95% CI -0.56 to 1.00), the mean number of SpO2 dips per hour >5% (-0.19, 95% CI -3.07 to 2.69) or >10% (-0.41, 95% CI -1.63 to 0.81), mean heart rate (1.99 beats/min, 95% CI -1.02 to 4.99), or time shin temperature >36°C (risk ratio (RR): 0.63, 95% CI 0.13 to 2.99) or <34°C (RR: 0.89, 95% CI 0.61 to 1.30). A per-protocol analysis of 45 bassinet and 26 wahakura infants and an as-used analysis of 104 infants in a bassinet and 48 in a wahakura found no significant differences between groups for all outcome measures. CONCLUSIONS: This indigenous sleep device is at least as safe as the currently recommended bassinet, which supports its use as a sleep environment that offers an alternative way of bed-sharing. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099.

Wahakura Versus Bassinet for Safe Infant Sleep: A Randomized Trial.

OBJECTIVES: To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue. METHODS: A total of 200 mainly Maori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed. RESULTS: An intention-to-treat and an "as-used" analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location. CONCLUSION: There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.

SIDS-related knowledge and infant care practices among Maori mothers.

AIM: Maori have high SIDS rates and relevant information is needed to craft appropriate prevention strategies. The aim of the study was to determine what Maori mothers know about SIDS prevention, and to determine their SIDS-related child care practices. METHODS: Maori mothers who gave birth in the Counties Manukau District Health Board area were surveyed about their SIDS related knowledge, and infant care practices and their reasons for using and their concerns about these practices. Results were compared with a similar 2005 survey of a largely European sample. RESULTS: Knowledge of Maori mothers about SIDS prevention was much lower than for European mothers. More Maori infants slept prone and Maori mothers stopped breastfeeding significantly earlier. Although co-sleeping rates were similar, bedsharing increased to 65% for some part of the night. In addition, more than half of the Maori mothers had smoked in pregnancy and 21% of them were sharing a bed with their infant. Potentially unsafe soft objects such as rolled blankets or pillows were used by a third of mothers to help maintain the sleep position. CONCLUSIONS: Maori mothers have a poorer knowledge of SIDS prevention practices. The high rate of maternal smoking, the early cessation of breastfeeding, and co-sleeping where there was smoking in pregnancy were also areas of concern. Appropriate health promotion measures need to be developed for the high-risk Maori community.