Sharon Osaji writes on how Sudden Infant Death Syndrome has claimed the lives of babies under the age of one and how society has responded to the condition
After 40 weeks and five days of gestation, Rebecca Obimah gave birth to a bouncing baby girl, who weighed 3.98kg at birth.
The delivery of the child wasn’t the Biblical Hebrew women kind. Rebecca, who was a 24-year-old first-time mum at the time, was in labour for 48 hours.
This culminated in a second-degree perineal laceration, commonly known as tear, as well as an episiotomy.
Her husband, Omoyemi, was by her side around 1.09pm on December 31, 2018, when she gave birth to her bundle of joy in a hospital in the Festac Town area of Lagos State.
The baby was examined for two days and afterwards, both mother and child were discharged.
Overjoyed friends and family members trooped to Rebecca’s family house to rejoice with her, as the child was named after the couple’s mothers: Grace, Chukwudumebi.
“I am the last born in my family, so when I had my daughter, people jokingly said, ‘Our baby has a baby now’,” Rebecca chuckled, as she spoke with this reporter and tried hard to conceal the painful memory.
The unexpected happened when Grace suddenly died when she was only three months old.
“She just slept and didn’t wake up. That’s basically what happened. She was healthy and still very active few days and even hours leading up to the incident.” Rebecca said, fighting back tears.
After some whimpers, she continued, “It was in the early hours of Thursday, April 4, 2019. I went to bed a few minutes to 11pm, but my husband had slept since around 10pm.
“Grace was asleep already by my side, so I just went to have a shower and say a quick prayer before going to bed.
“I woke up at 1:04am to breastfeed and change her diaper because I was surprised she didn’t even cry since she ate last around 8pm.
”I had turned to wake her up when I saw bloodstained foam from her nose to the bed. Her gum and tongue were already white and there wasn’t any heartbeat. But her body was still warm, so I knew it had just happened, maybe there was still a chance of saving her, I thought. So, I woke hubby up and we quickly ran to the nearest hospital to our home.
“I started administering CPR from the house and as I pressed her chest, more of the blood-stained foam would pour out from her nostrils until nothing was coming out anymore.
“We arrived at a hospital and we were rushed straight to the emergency unit. It was on that day I knew how terrible Nigerian hospitals were.”
Rebecca said there were two nurses and a doctor on duty.
She said one nurse immediately gave Grace oxygen, while the other gave her a shot of adrenaline.
But after a few minutes of no response from her, the doctor directed that another shot of adrenaline be given to the child.
“They couldn’t even find veins, so they just injected her in her leg,” she added.
“The nurses kept murmuring to themselves that the eyes of the child were already dilated, meaning she had died, but the doctor disagreed.
“They were doing this right in our presence. Next thing after keeping us from 1am till 4am, the doctor referred us to another hospital.
“He said she would need to be intubated and that they didn’t have the equipment for children; only the one for adults was available. So, they removed the oxygen and told us to carry her in our car by ourselves to the other hospital, not even in an ambulance.
“How can you keep an emergency patient for over three hours when you knew that you didn’t have the needed equipment for the patient?” Rebecca pondered.
“My baby was already turning blue and her body was already becoming cold. I knew already that she had died, but I was not ready to give up that easily.
“My heart was beating so fast I thought I would pass out as well. I didn’t allow anybody carry my baby; I held her close to my chest, singing her favourite song. Have you ever prayed to die, so that someone else can live? I prayed that prayer that day, but God had other plans,” she stated.
The young mother noted that upon arrival at the second hospital, which was about 15 minutes’ drive away, Grace was pronounced dead on arrival.
She said it was at the second hospital they were told that it was a case of Sudden Infant Death Syndrome since they could not pinpoint anything wrong with the child from her medical history and from questions thrown at her parents.
“The most painful thing at the time was that I didn’t know how we went wrong because I did everything I was told to do. She was sleeping on her back, exclusively breastfed, she ate about five hours before the incident, and I carried her for about an hour after feeding, so burping was even out of it; the temperature was normal, she was not previously sick, we even went for immunisation like two weeks before, and we saw the paediatrician, so she was fine. The only thing I noticed was that she was very sleepy that evening.
“At first, I thought it was a ‘spiritual attack’ until about three months later, I started to research about SIDS. It was then I discovered that smoke and second-hand smoking were risk factors. It then dawned on me what could have killed her.” Rebecca added.
The teary mother said where her family lived when Grace was born, there was frequent bush burning behind their house.
She noted that at least twice a week, the dwellers burnt things close to their fence.
“The land was empty, so the owner just built a fence to separate his land and got some people to be living on it temporarily.
“The people living on my street then, we usually complained about the smoke but nobody really did anything about it.
“On the day the incident happened, they had burnt some items and there was no light. Unfortunately that evening, my husband went out to get fuel for the generator.
“It was already like 7 to 8pm; smoke had filled the house, so we had to open the windows for it to escape. An hour later, my husband was back and we put on the generator, put on the air conditioner, shut the windows and within minutes, everything was okay. But unknown to us, continuous inhalation of the smoke over time was killing our newborn,” she stated.
Rebecca noted that before her family moved out of the area, she and her husband stopped the bush burning, adding that they involved the estate security to ensure the intervention was permanent in order to save other children from such harm.
When our correspondent visited the Eti-Osa Maternal and Child Care Hospital at Ajah, the matron of the medical facility, who did not disclose her name, said since the hospital opened in 2019, they had not recorded any SIDS cases in the wards.
She, however, directed our correspondent to the emergency unit of the hospital, noting that if there were cases, they would be recorded there.
At the emergency unit, one of the doctors, who spoke with Sunday PUNCH on condition of anonymity, said there had been cases of SIDS at the hospital.
He said, “We have seen such cases before; maybe twice or so. But most times when such babies are rushed in, they are already dead and once we pronounce them dead, the mothers take them away, so we do not have data or record of it. But these things happen.”
When Sunday PUNCH reached out to some other mothers who had reportedly experienced inexplicable deaths of their babies, all, except Rebecca, declined to comment, saying they would rather not recall the incidents.
A Consultant Paediatrician at the General Hospital, Isolo, Dr Ayodele Renner, said it was not uncommon for mothers who had experienced such traumatic events to refuse to speak about them.
He said, “It is not entirely unexpected that mothers in this part of the world are reluctant to talk about SIDS. This is because it is an experience that most mothers will rather not want to recount or recall because it is nothing short of traumatising and to have to bring those memories back can be a little challenging for a lot of mothers.
“The second thing is our belief system, in which a lot of us think that when inexplicable things happen, they have a spiritual basis or a spiritual background and somehow, bringing those things back to the front burner can reignite or remind the ‘powers’ responsible for the event to remember them. So, they are a little reluctant to recall those things and believe that they have prayed them away. Just the belief that it is something spiritual makes them reluctant to talk about them.”
Sharing the experience of a 22-year-old single mother, Renner said the incident happened when he worked at the Lagos University Teaching Hospital some years back.
“She just fed her baby, who was doing quite well, no complaints whatsoever, no fever, quite a happy baby; she dropped the baby to sleep. Then, after about four hours, she went to check the child, because she felt it was unusual for the baby to have slept for that long and not woken up for another round of feeding.
“But when she went to the cot, she found that the baby was blue and not breathing. After alerting neighbours quite early around 6am, she rushed the child to a hospital but unfortunately, the baby had no sign of life; there was no breathing effort; the heart had stopped. And that was quite devastating, especially because she was only 22 years old, a single mother and that was her only child.
“This was a child that was born in LUTH and we managed the child. So, the baby had been cleared to go home; there were no health issues or complications when they were discharged. Then a few weeks after, this happened. It was quite tragic for everyone,” he added.
Renner said most times such babies would not survive long enough to make it to a teaching hospital or see experts because they would be dead before any intervention.
While insisting that SIDS had no known or definite cause, he stated that there were risk factors that could increase the chances of a child dying suddenly and unexpectedly.
According to him, the factors included being born prematurely or having a low birth weight; mothers who might have smoked during pregnancy; people who smoke around their infants; and people who put babies to sleep on their tummies and on their sides.
Another paediatrician, Dr Olubunmi Salako, who practises at a private hospital in Surulere, said the most recent case she was aware of happened in February 2023.
Salako said, “According to what the mother told us, she had just fed the child and the baby slept off while eating. So, after she carried the child for a while, she put the child down to sleep. She returned like, an hour later, to check the baby and the child was dead. She rushed the baby to a hospital and there was no sign of life; the child was completely gone.
“This was a baby that was certified healthy and good to go home. We managed the child, ran a series of tests after birth and found no health challenge. In a case like this, people will be quick to point fingers at the feeding aspect, probably assuming that the child didn’t burp, or something, but there are people this happens to that did not feed their children before the babies die suddenly. So, SIDS is real.”
When Sunday PUNCH visited the Gbagada General Hospital, a nurse who had worked at the children’s clinic of the facility since 2016, said in her seven years there, they had never recorded any case of SIDS.
She said, “To an extent, we are enlightened about it here and we try as much as possible to enlighten our mothers as well. At first, they wouldn’t listen to us, especially when you tell them that the babies must burp before they are laid to sleep or are carried for at least one hour after feeding if they don’t burp. Also, when we tell them about not letting their babies sleep on their tummies, they would usually laugh and ignore us, saying ‘that is how their mothers trained them’.
“But when we had a few cases of aspirations, which could kill a baby very fast, they started seeing that what we were telling them was the truth and they started adjusting. Many of them now follow some paediatricians on social media to learn from them there.
“So, SIDS is real no doubt, but we are lucky that we have not had any case here so far, at least to the best of my knowledge.”
Facts about SIDS
The National Health Scheme in the United Kingdom defines SIDS, also known as cot death, as the sudden, unexpected and unexplained death of an apparently healthy baby.
The agency stated that around 200 babies die suddenly and unexpectedly every year in the UK from SIDS.
The United States National Library of Medicine noted that in 2019, SIDS accounted for 20.98 per cent of infant mortality rate globally, which was a 51 per cent decrease from 1990.
SIDS was most prevalent in western Sub-Saharan Africa, high-income North America and Oceania in 2019.
It further noted that the burden of SIDS was higher in males than females consistently from 1990 to 2019.
It revealed that higher socio-demographic index and income level were associated with lower burden of SIDS.
Furthermore, countries with higher socio-demographic index and income had greater decreases in SIDS burden from 1990 to 2019.
In another report, the National Library of Medicine stated that SIDS resulted in 15,000 deaths globally in 2013.
Experts believe SIDS occurs at a particular stage in a baby’s development and affects the child’s vulnerability to certain environmental stresses.
These stresses could include tobacco smoke, getting tangled in bedding, a minor illness or a breathing obstruction.
According to the NHS, there’s also an association between sleeping with your baby on a sofa or chair and SIDS.
Babies who die of SIDS are thought to have problems in the way they respond to these stresses and how they regulate their heart rate, breathing and temperature.
A 1999 study by Potter S., Berry PJ, Fleming P, titled, ‘Pulmonary haemorrhage in sudden unexpected death in infancy,’ found some intra-alveolar haemorrhage in more than 95 per cent of 151 cases of SIDS, but considerable haemorrhage in less than 27 per cent.
The report stated that infants dying suddenly and unexpectedly were often found with fresh haemorrhage or bloodstained secretions about the nose or mouth, but the incidents were not well documented.
The 2014 World Bank estimate of infant mortality rate in Nigeria was 72 per 1,000 live births, which the report tagged as “unacceptably high” adding that it had a proven association with SIDS.
Nigeria’s data problem
Unfortunately, there is no SIDS case registry in Nigeria.
Experts linked this to the absence of risk reduction campaigns, under-reporting and the dearth of literature on SIDS in Nigeria.
When asked the reason for the inadequate data on SIDS in the country’s medical space, Renner said awareness of SIDS was poor.
He stated further that culture made people reluctant to talk about their misfortunes.
According to him, when something unpleasant happens to Nigerians, especially if it involves a child, there is the tendency to conceal it, and so it goes unreported.
“Also, we are not into the culture of forming support groups, unlike in the Western world, where you can go online and find bereavement support groups for parents and families who have experienced such; but for us, we really are not so huge on support groups because perhaps our family is majorly our support group, so we don’t see the need to share with others, because we are somewhat shielding ourselves.
“Under-reporting is a major factor that has made data inadequate. People don’t report to hospitals and when they do, a death certificate is just issued and the baby is buried quite summarily.
“But elsewhere, what happens is that because the child has died quite suddenly and there is no known cause, to make sure that it is truly unexplained, things like an autopsy need to be done, a thorough investigation of the home environment, including the cot and the sleeping environment, will be carried out, to make sure that nothing fishy happened and to find out if there were other reasons that could have led to the death of the child; like an abnormal heart condition or some other type of abnormality that could have made the child die suddenly that can be explained.
“But since we don’t have a register for SIDS and due process is not followed after an infant dies suddenly, we are not keeping track of the numbers. The medical community really needs to do more in explaining to mothers everything they need to know about SIDS and the risk factors so they can avoid them as much as possible,” he added.
Salako also noted that most Nigerians would choose to rather move on than go through the rigour of an autopsy to find out what went wrong.
She said, “If we have been carrying out autopsies and the necessary tests, I believe we would have had a headway by now and we would be able to better manage and maybe even prevent other cases that may arise.”
SIDS protocol in Western nations
In a conversation with Sunday PUNCH, a United-Kingdom-based Nigerian doctor, Dr Pamela Williams, said authorities in the Western world, specifically in the UK, would carry out an investigation even if it was a child that died.
She said, “I’ve managed just one case and that was in 2020. I was part of the team that handled the case and it all happened suddenly. I am not a paediatrician but I was doing a paediatric rotation at the time.
“In that case, all we knew was that the patient, that’s the child, was brought in as an emergency case and we had to start acting immediately. But within a few minutes, it was clear that sadly, the patient was dead. The child was about six or nine months and it was a Caucasian family.
“Within a few minutes after the child was pronounced dead, the police were there, social services also; there was a SIDS coroner involved, a pathology lab representative, laboratory services had to be contacted as well to let them know that there was a SIDS death so they could expect the samples, because only specific people can work on it.
“Everything was happening at the same time and it was incredible that they could pull this whole team over the weekend. So, there is what they call a SIDS protocol that happens right there in the ward, which is different from an autopsy, which will be carried out later.
“Since the death was still very fresh, we carried out several tests immediately. We took blood from the femoral vein of about two or three 20mls bottles, took some urine from the bladder, took some skin from the underarm for some biopsy, then we also did bone marrow tests.
“So, just imagine how traumatised the parents would be; this was within minutes of the death of their child and the doctors had to explain to them that there were investigations that had to go on and a nurse was specifically assigned for support and compassion purposes.”
Williams said the parents became suspects and their home became a crime scene until they were cleared of any form of involvement in the death of the child.
“Aside from wanting to find out if the child was murdered, they also wanted to know the circumstances that led to the death so they could prevent the next one.
“Here in the UK by rule, babies are not supposed to co-sleep; they must sleep in cots and must sleep on their backs, not on their tummies.
“Also, smoking in the home is not allowed, so they will check every detail to the littlest thing. Social services will also check for any possible case of domestic abuse, then collect history from the gynaecologist and paediatrician that handled both mother and child,” she added.
It’s June 2019 and Rebecca, who was now 25 years old, was pregnant with another child.
“I didn’t know until about eight weeks. I hadn’t seen my period since I gave birth in December 2018, till a month after the incident in May, then I didn’t see it again, so I wasn’t even bothered. I just thought my hormones were abnormal and would normalise when they were ready.
“Well, I was pregnant and that pregnancy was easier; no vomiting, swelling, spitting, back pain, nausea or dizziness. If not that my tummy grew bigger, I wouldn’t have believed I was pregnant; I worked till I was nine months!
“Then in March 2020, I went to a hospital for antenatal and they found out that I was already dilating. I didn’t even know, and I gave birth to a baby boy in 10mins,” Rebecca said.
She said after the birth of her second child, she sometime wouldn’t sleep at night because she thought she always had to be on guard to avoid a recurrence, but soon realised it wasn’t sustainable.
“My son is three years now, and I have a baby girl also, who is over one year already. We can only play our part as mothers and parents but God is the one who truly watches over our little ones. Since the incident, I have learned to hold on to him as my life depends on it, because to me, there’s a thin line between science and spirituality,” she added.