Olivia Carville is an investigative reporter with the NZ Herald.

Ministry of Health defends decision not to fund pepi-pod safe-sleeping device

The Ministry of Health has defended its stance on refusing to fund a Maori safe-sleeping device and received backing from Health Minister Jonathan Coleman over its "evidence-based approach" to the issue.

But the ministry's defence is at odds with international infant death experts.

A lack of scientific research proving the safety of portable bassinets, called pepi-pods, meant the ministry had withheld funding, restricting their reach.

Dr Pat Tuohy, the ministry's chief adviser of child and youth health, said to invest in pepi-pods the ministry would need "a greater level of evidence of effectiveness and safety than is currently available".

In a written response to numerous Herald queries, Coleman said: "I support the Ministry taking an evidence-based approached and I'm advised that's what they've done in regards to this matter."

New Zealand, which has the worst rate of sudden infant death in the Western world, is leading the charge on safe sleep devices through grassroots funding and gaining the praise of international health networks at the same time.

Professor Jeanine Young, of the University of the Sunshine Coast, has worked in the sudden infant death area for 25 years and is now helping to distribute pepi-pods to at-risk Aboriginal families in Queensland.

"It will be 2 to 3 years before we start seeing the same sorts of [infant mortality] reductions that have been achieved in New Zealand," Young said.

"You've got four years of data showing a reduced infant mortality and I'm not sure how many years of data your Ministry of Health needs," she said, adding that funding this programme should be a "no-brainer".

Fourteen out of 20 District Health Boards currently shuffle their budgets to fund pepi-pods.

Hawke's Bay DHB has distributed more than 1500 pep-pods.

"While we agree with the ministry that the evidence on pepi-pods isn't settled yet, we do believe pepi-pods have a role to play in helping to prevent unexplained deaths in babies," a spokeswoman from the DHB said.

Child Youth Mortality Review Committee spokeswoman and public health physician Dr Gabrielle McDonald said "the Government likes to see some evidence of benefit before they invest."

"The difficulty with Sudi deaths is that the numbers aren't huge and proving that one particular thing is responsible is quite difficult," she added.

Stephanie Cowan, who has been leading the pepi-pod distribution through Change For Our Children, said it may have been appropriate for the ministry to be cautious about the pods four years ago.

But, various studies and feedback from communities show the devices have been preventing deaths, she said.

"In the absence of scientific evidence, you use the best evidence you have."

The Herald recently reported that the ministry has been restricting the reach of pepi-pods through a lack of funding.

The portable bassinets allow mothers to safely co-sleep with babies while preventing accidental suffocation.

The ministry's reponse

Following the Herald's recent stories, the Ministry of Health raised the following points. The Herald has summarised what pepi-pod proponents say below each point.

In 2014, the most recent year information is available, there were 40 Sudi (Sudden Unexpected Death in Infancy) deaths in New Zealand.

The Herald reported an average of 50 Sudi deaths a year based on figures obtained from the Child Youth Mortality Review Committee (CYMRC) that shows 209 babies died from Sudi between 2010 and 2014 - an average of 52 a year.

The most recent published study, referred to by the Herald as showing the first reduction in Maori infant death rates relies on a type of evidence rated internationally as scientifically weak.

The ecological study was peer-reviewed and published in the Acta Paediactrica Journal. It linked "in a circumstantial fashion" the observation of falling mortality rates with the roll-out of the pepi-pod programme. New Zealand's leading Sudi expert, Professor Ed Mitchell, was outraged by the ministry's response and labelled it "a personal slur".

The ministry said previous more scientifically robust research has shown no reduction in unsafe bed-sharing following provision of pepi-pods.

This research was a randomised control trial carried out at Counties Manukau DHB that has not been published or peer-reviewed.

The ministry said another study had found the drop in infant death was related to a Ministry of Social Development "Family Start" home visiting programme.

Pepi-pod supporters argue that both programmes have been targeting the same at-risk families and any evidence linking the "Family Start" programme to the reduction in Sudi would be observational and as equally scientifically weak as Mitchell's study.

International experts advise caution over pepi-pods, the ministry said, citing the American Academy of Pediatrics SIDS Task force 2011 which did not recommend in-bed co-sleepers because of a lack of safety evidence.

The chair of this American task force wrote about Sudi preventions and pepi-pods in a published report earlier this year, saying: "There is some indication that there is a greater reduction in SUIDs [sic] in DHBs with pepi-pod programmes, compared with those without such programmes."

New Zealand experts in this area also advise caution, the ministry said, citing a 2013 report from CYMRC that said it was "crucial that new solutions being considered" comply with standards similar to cots and bassinets.

That same report said: "The wahakura is a culturally appropriate solution and easily transportable, making it a potential solution to deaths occurring in makeshift bedding arrangements."

- NZ Herald

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