Setting
deaths
This study took place at a community health center in a low-resource community in Santo Domingo de los Tsa’chilas, Ecuador from 2018 to 2020. In 2007 the University of Kentucky partnered with this health center to supplement primary care and promote community health. The center is privately supported by a non-governmental organization (NGO) and provides low cost or free primary health care, including care during pregnancy. This study originated in part due to concerns from the Ecuadorian health center clinic staff, who indicated unsafe infant sleep practices are common in the community, with several of their patients reporting infant deaths related to the sleep environment. The baby boxes were donated by a US company to the NGO and were not modified for use in this study, research funds were used to purchase the diaper bags and newborn gifts. This region has a similar climate year-round so the use of blankets or items in the sleep environment was not influenced seasonally. Additionally, this region is very humid so safety and integrity of the box in this context was a priority of the research team. Participants were told to discontinue use if the box was not fully intact, and the box was assessed by the study personnel at each time point.