Epidemiology of sudden infant death syndrome (SIDS) in the Tyrol before and after an intervention campaign

Objective: We investigated the epidemiology of sudden infant death syndrome (SIDS) in the Tyrol before and after an intervention campaign. Patients and methods. Descriptive characteristics and risk factors of SIDS before the campaign were assessed in a retrospective case-control study (19 84 to 1994). in April 1994 a country-wide information campaign on modifiabl e risk behaviours was initiated. Thereafter we prospectively collected data on child care practices four to six weeks after birth for all infants born in the Tyrol (participation rate 72%; n = 28,361) and evaluated new SIDS c ases (1994 to 1998). For this purpose two questionnaires were used, one wit h 96 items for the evaluation of all SIDS cases and assessment of child car e practices before 1994, and the other with 24 items for prospective data c ollection. Results: The incidence of SIDS decreased from 1.83 (mean incidence, 1984-19 94) to 0.4/1000 live births immediately after the campaign and remained low until 1998. The frequency of maternal smoking during pregnancy declined (2 2.9% vs. 14.5%, p < 0.01), as did the prevalence of the prone sleeping posi tion (53.7% vs. 5.4%, p < 0.001) and of non-breastfeeding (21.3% vs. 6.7%, p < 0.001). All these variables were prominent risk factors for SIDS before the campaign and remained significant thereafter. On account of the marked ly reduced prevalence of the prone sleeping position, smoking became the mo st common SIDS risk factor. The prevalence of sleeping on the side signific antly increased (5.1% vs. 36.4%, p < 0.001) and the social status of mother s of SIDS infants tended to be tower than that before the campaign. The cle ar winter preponderance of SIDS which was evident before the campaign disap peared, or was even reversed. Conclusions: Our study documents the long-term efficacy of a low-cost inter vention campaign by way of health education. Further efforts must be direct ed toward lower social classes, thereby focusing on maternal smoking and av oidance of the side sleeping position.