Thesis (M. Tech. (Biomedical technology)) - Central University of technology, Free State, 2013 / Thirty-one years after the discovery and isolation of the human immunodeficiency virus (HIV) by French and American scientists, much progress has been made in basic research, clinical treatment, and public heath prevention. Although, much evidence of mother-to-child-transmission (MTCT) of HIV has been amassed since then, not much of it describes the effects of HIV on the nutrient composition of breast milk. The aim of this study was to determine the effects of HIV on the nutrient composition of breast milk, by studying two groups of adult lactating respondents from the same socio-economic background, who were chosen randomly and participated voluntarily. The study population consisted of 60 breastfeeding mothers, divided into two groups of 30 mothers each. Group one represented the control group of HIV non-infected mothers whereas group two consisted of HIV-infected mothers who did not receive any treatment. After a registered medical nurse took blood and breast milk samples, analysis was done on ethylenediamine tetra-acetic acid (EDTA) whole blood to determine the haematological and immunological parameters and breast milk was analyzed for nutrient composition. Standard laboratory operating procedures (SOP) were followed, throughout, to determine the parameters of the blood and breast milk samples. Results showed that associations between the socio-economic statuses (SES) of the two respondent groups could be established. Albeit differences were not significant, some were, however, detected in the number of people contributing to the household income of the respondents (p = 0.0051), their employment status (p < 0.0001) and the availability of water sources (p = 0.1124). It is believed that factors, such as the prevalence of HIV, if related to the different levels of SES may play an important role in the outcome of the health statuses of individuals at different levels of society. By implication, it is not the different levels of SES, but rather factors related to the different levels of SES that have an impact. Significant differences could be seen in the haematological variables between the two respondent groups: Red blood cell count (RBC) (p < 0.0001), hemoglobin (Hb) levels (p = 0.0119), hematocrit (Hct) (p = 0.0031), mean corpuscular volume (MCV) (p = 0.0005), mean corpuscular hemoglobin (MCH) (p = 0.0043) and monocyte count (p = 0.0275). These differences, however, were not significant to this study. Other differences that were significant were immunological parameters between the two respondent groups: CD4 cell count (p < 0.0001) and viral load, done only on the blood of the HIV-infected respondent group. The CD4 cell count is used as a guideline for the initiation of treatment for HIV-infected persons and is required to accurately assess the immune status of any patient at any given time. The viral load has long been established as a strong predictor of the rate of disease progression. The only significant difference in the breast milk composition was reflected in the following variables between the two groups: percentage (%) proteins (p < 0.0001) and calcium levels (p = 0.0081). The median and mean values of the percentage proteins were elevated in the subject group of mothers living with HIV, while calcium levels in the same group showed a decrease in both median and mean values. The lack of significant differences between the groups might be due to the small study population. If nothing else, this study highlights the need for further trials to evaluate the true effects of HIV on the nutrient composition of breast milk.

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Contexte : Pour favoriser l’allaitement, la Condition 3 de l’Initiative des amis des bébés (IAB) (OMS / UNICEF) vise à offrir une information complète aux femmes enceintes. Or, cette condition est implantée de façon variable dans les CLSC de Montréal car les intervenants de la santé ne semblent pas confortables à faire la promotion de l’allaitement en prénatal, surtout dans les milieux « québécois » et défavorisés. Objectif : Explorer les expériences personnelles et professionnelles des infirmières en santé communautaire qui sont reliées à la promotion de l’allaitement en prénatal en milieu défavorisé. Dans la présente étude, les informations moins souvent transmises, soit les risques du non-allaitement ainsi que la recommandation de poursuite de l’allaitement jusqu’à deux ans ou au-delà, ont été examinées. Méthodologie : La collecte des données de cette recherche qualitative s’est effectuée auprès d’infirmières de huit CLSC montréalais offrant des services à une population importante de femmes défavorisées, francophones, nées au Canada et ce, sous forme d’entrevues individuelles (n=12 infirmières) et d’entrevues de groupe (n=36 infirmières). Résultats : Les principaux facteurs favorables au niveau de confort des infirmières à faire la promotion de l’allaitement sont d’avoir suivi 20 heures ou plus de formation en allaitement dans les cinq dernières années, et d’avoir des croyances profondes positives quant à la valeur de l’allaitement comparativement aux préparations commerciales pour nourrissons (PCN). Craindre de susciter la culpabilité nuit à la promotion de l’allaitement. De plus, les infirmières exposées à la culture d’allaitement pendant l’enfance, ayant eu une expérience personnelle d’allaitement positive, qui perçoivent que leur rôle est d’encourager les mères à allaiter, ou qui recommandent rarement de donner des PCN en postnatal en cas de problèmes d’allaitement, sont plus confortables à informer les femmes enceintes des risques du non-allaitement. Conclusion : Plusieurs infirmières semblent manquer de connaissances sur la qualité supérieure de l’allaitement par rapport à l’alimentation artificielle et sur les risques du non-allaitement. De plus, il semble que plusieurs infirmières n’aient pas les habiletés cliniques optimales pour soutenir les mères dans leur allaitement. Des formations appropriées aideraient les infirmières à avoir davantage confiance dans leur capacité à soutenir les mères en postnatal, ainsi qu’à promouvoir l’allaitement en prénatal. Finalement, les infirmières devraient prendre conscience de leurs biais personnels, afin d’en réduire les impacts négatifs sur leur pratique professionnelle. / Background: In order to increase breastfeeding rates, the third Step of the Baby Friendly Initiative (BFI) (WHO / UNICEF) aims to offer complete information on breastfeeding to pregnant women. However, this step’s implementation varies among the Montreal’s CLSCs as healthcare professionals seem uncomfortable to promote breastfeeding prenatally, especially in French speaking and underprivileged areas. Objective: To explore the personal and professional experiences of community health nurses which are linked to the promotion of breastfeeding during the prenatal period in underprivileged areas. Information less often offered were examined in this study: the risks of not breastfeeding and the recommendation to continue breastfeeding up to 2 years or beyond. Methodology: The data of this qualitative study were collected in 8 CLSCs of Montreal, offering services to an important population of underprivileged women, French speaking and born in Canada, through nurses’ individual interviews (n=12 nurses) and group interviews (n=36 nurses). Results: The most important factors for the level of comfort of nurses to promote breastfeeding are: to have followed 20 hours or more of training on breastfeeding within the 5 past years, and to have positive profound beliefs about the value of breastfeeding compared to artificial infant formula (AIF). Fear of causing guilt by promoting breastfeeding hinders breastfeeding promotion. Furthermore, nurses exposed to breastfeeding culture during their childhood, with a positive personal breastfeeding experience, who perceived that their role is to support women to breastfeed, or those who rarely recommended mothers to give AIF postnatally in case of breastfeeding problems, are more comfortable to inform pregnant women about the risks of not breastfeeding. Conclusion: Many nurses seem to have a lack of knowledge about the superior quality of breastfeeding in comparison with artificial feeding and about the risks of not breastfeeding. Moreover, it seems that many nurses do not have the optimal clinical abilities to support mothers in their breastfeeding experience. Appropriate training could greatly help nurses to have greater confidence in their abilities to support mothers during the postnatal period, as well as to promote breastfeeding in the prenatal period. Finally, nurses should become aware of their personal bias, in order to reduce as much as possible negative impacts on their professional practices.

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Made available in DSpace on 2016-03-22T17:26:43Z (GMT). No. of bitstreams: 1 m.pdf: 562847 bytes, checksum: e678b218ac0d3ffc4a3361f6837de09a (MD5) Previous issue date: 2005-05-25 / Objectives: To measure exclusive breastfeeding indexes in the first month of life and compare the feeding practices of children born in hospital which adopts the Baby Friendly Hospital Initiative, with the other hospitals of the city. Methods: Quasi-experimental study, nested in a cohort. 973 mother-baby pairs were randomly chosen for home follow-up from an initial sample of 2741 mothers (hospital screening). Results: Being born in hospitals which did not adopt the Baby Friendly Hospital Initiative has increased the risk of having mothers who were not stimulated to breastfeed, of babies not suckling in the first hour and received pacifier and tea at the hospital.The prevalence of one-month exclusive breastfeeding was of 60%. Children born in hospital which adopts Baby Friendly Hospital Initiative had a larger rate of one-month exclusive breastfeeding and the use of pacifier has shown a negative association with the outcome. Conclusions: The intervention was positive and, probably, the impact would be bigger if the implementation of ten steps were total during the data collection phase. The breastfeeding promotion efforts should continue after the patient is released through the formation of counseling groups to the mothers. / Objetivos: Medir os índices de aleitamento materno exclusivo no primeiro mês de vida e comparar o padrão alimentar das crianças nascidas no hospital que adota a Iniciativa Hospital Amigo da Criança, com os demais hospitais da cidade. Métodos: Estudo quase-experimental, aninhado a uma coorte. Foram selecionados, aleatoriamente, 973 pares mãe-bebê para o acompanhamento domiciliar a partir de uma amostra inicial de 2741 mães ( triagem hospitalar). Resultados: Nascer em hospitais que não adotam a Iniciativa Hospital Amigo da criança, aumentou o risco das mães não terem sido incentivadas para o aleitamento materno, dos bebês não mamarem na primeira hora e receberem chupeta e chá, no hospital. A prevalência de aleitamento exclusivo com um mês foi de 60%. As crianças nascidas no hospital que adota a Iniciativa Hospital Amigo da Criança tiveram maior índice de aleitamento exclusivo com um mês e o uso de chupeta mostrou uma associação negativa com o desfecho. Conclusões: A intervenção foi positiva e, provavelmente, o impacto seria maior, se a implantação dos dez passos já fosse total, na fase da coleta de dados. O incentivo ao aleitamento materno deve continuar, após a alta, através da formação de grupos de aconselhamento às mães.

Wong Hing-yan, Esther. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 264-278 (2nd gp.)). / Abstracts in English and Chinese. / Acknowledgements --- p.I / Contents --- p.III / List of Tables --- p.VIII / List of Figures --- p.X / List of abbreviations --- p.XI / Abstract --- p.XII / Chapter 1 --- Introduction and Study Hypothesis --- p.1 / Chapter 1.1 --- Introduction and Overview --- p.1 / Chapter 1.2 --- Study Aim and Hypothesis --- p.2 / Chapter 2 --- Literature Review --- p.4 / Chapter 2.1 --- Definition of Breastfeeding --- p.4 / Chapter 2.2 --- Definition of the Exclusive Breastfeeding --- p.5 / Chapter 2.3 --- Benefits of Breastfeeding --- p.6 / Chapter 2.4 --- Current Status of Breastfeeding Globally and in Hong Kong --- p.10 / Chapter 2.4.1 --- Breastfeeding Globally --- p.10 / Chapter 2.4.2 --- Statistics on Global BF Practice --- p.11 / Chapter 2.4.3 --- Breastfeeding in Hong Kong --- p.15 / Chapter 2.4.4 --- Summary and Conclusions --- p.21 / Chapter 2.5 --- Factors Infuencing Breastfeeding --- p.22 / Chapter 2.5.1 --- Social Demographic Factors --- p.22 / Chapter 2.5.2 --- Psychosocial Factors --- p.31 / Chapter 2.5.3 --- Health Services Related Factors --- p.45 / Chapter 2.5.4 --- Cultural Practices --- p.51 / Chapter 2.5.5 --- Summary and Conclusions --- p.62 / Chapter 2.6 --- Strategies to Promote Breastfeeding --- p.62 / Chapter 2.6.1 --- Breastfeeding Policy Recommendations --- p.63 / Chapter 2.6.2 --- Baby Friendly Hospital Initiative --- p.66 / Chapter 2.6.3 --- International Code of Marketing of Breast Milk Substitutes --- p.69 / Chapter 2.6.4 --- Breastfeeding Consultant Programmes --- p.72 / Chapter 2.6.5 --- Breastfeeding Peer Counsellor Programmes --- p.73 / Chapter 2.7 --- Peer Counsellor Programmes --- p.75 / Chapter 2.7.1 --- Adult Learning Model --- p.76 / Chapter 2.7.2 --- Learning Breastfeeding --- p.77 / Chapter 2.7.3 --- Peer Counselling on Learning Breastfeeding --- p.79 / Chapter 2.7.4 --- Historical Review of Peer Counselling Programmes --- p.81 / Chapter 2.7.5 --- Peer Counselling Programmes in Other Countries --- p.82 / Chapter 2.7.6 --- Peer Counselling Programme in Hong Kong --- p.91 / Chapter 3 --- Methodology --- p.95 / Chapter 3.1 --- Sampling --- p.95 / Chapter 3.1.1 --- Study Population --- p.95 / Chapter 3.1.2 --- Sample Sources --- p.95 / Chapter 3.1.3 --- Inclusion / Exclusion Criteria --- p.95 / Chapter 3.1.4 --- Sample Size Determination --- p.96 / Chapter 3.2 --- Study Design --- p.97 / Chapter 3.2.1 --- Ward Allocation --- p.97 / Chapter 3.2.2 --- Peer Counsellor --- p.97 / Chapter 3.2.3 --- Sampling Method --- p.100 / Chapter 3.3 --- Subject Recruitment --- p.101 / Chapter 3.3.1 --- Pilot Study --- p.101 / Chapter 3.3.2 --- Recruitment --- p.103 / Chapter 3.3.3 --- Recruitment Interview --- p.107 / Chapter 3.3.4 --- Follow-up Interviews --- p.107 / Chapter 3.4 --- Data Collection --- p.108 / Chapter 3.4.1 --- Recruitment Data Collection --- p.109 / Chapter 3.4.2 --- Follow-up Data Collection --- p.109 / Chapter 3.4.3 --- Final Evaluation --- p.112 / Chapter 3.4.4 --- Data Collection on Termination of Breastfeeding --- p.112 / Chapter 3.4.5 --- Evaluation from Peer Counsellors --- p.114 / Chapter 3.4.6 --- Tools / Questionnaire Design and Its Validity --- p.115 / Chapter 3.4.7 --- Content of the Study Booklet --- p.116 / Chapter 3.4.8 --- Data Validity --- p.123 / Chapter 3.5 --- Data Entry & Analyses --- p.123 / Chapter 3.5.1 --- Data Entry --- p.123 / Chapter 3.5.2 --- Data Analyses --- p.123 / Chapter 4 --- Results --- p.127 / Chapter 4.1 --- Overview --- p.127 / Chapter 4.2 --- Sample Characteristics and Demographic Background --- p.127 / Chapter 4.2.1 --- Subject Profile --- p.127 / Chapter 4.2.2 --- Sample Characteristics --- p.131 / Chapter 4.2.3 --- Sample Characteristics Compared with HK Census Information --- p.137 / Chapter 4.3 --- Main study Findings --- p.138 / Chapter 4.3.1 --- Infant Feeding Categories at Follow-Ups --- p.138 / Chapter 4.3.2 --- BF duration --- p.140 / Chapter 4.3.3 --- BF exclusivity --- p.144 / Chapter 4.3.4 --- Relationship between BF Duration and BF Exclusivity --- p.155 / Chapter 4.3.5 --- Reasons for Giving Formula Supplement to BF Infants --- p.158 / Chapter 4.3.6 --- Termination of BF --- p.162 / Chapter 4.4 --- Subsidiary Results --- p.169 / Chapter 4.4.1 --- Overview --- p.169 / Chapter 4.4.2 --- Rationale for Regrouping Study Mothers --- p.169 / Chapter 4.4.3 --- "Characteristics Differences of Mothers from the ""Short-term Breastfeeders"" Group and Mothers from the ""Long-term Breastfeeders"" Group""" --- p.171 / Chapter 4.4.4 --- "Characteristics Differences between ""Short-term Breastfeeders"" and ""Prolonged Breastfeeders""" --- p.176 / Chapter 4.4.5 --- Cox Proportional Hazard Regression Analysis and BF Duration --- p.181 / Chapter 4.4.6 --- BF Duration and Working Mothers --- p.184 / Chapter 4.4.7 --- Formula Advertisement and BF --- p.187 / Chapter 4.4.8 --- Knowledge of BF --- p.189 / Chapter 4.5 --- Evaluation of Breastfeeding Experience --- p.193 / Chapter 4.5.1 --- Mothers' Evaluation of the Overall BF Experience --- p.194 / Chapter 4.5.2 --- Mothers' Evaluation of PC Support Intervention --- p.196 / Chapter 4.5.3 --- Peer Counsellors' Consultation Log Sheets --- p.198 / Chapter 4.5.4 --- Peer Counselors' Evaluation --- p.199 / Chapter 5 --- Discussion --- p.204 / Chapter 5. 1 --- Main Result Interpretation --- p.204 / Chapter 5.1.1 --- BF Duration --- p.204 / Chapter 5.1.2 --- BF Exclusivity --- p.205 / Chapter 5.1.3 --- BF Duration and BF Exclusivity --- p.210 / Chapter 5.1.4 --- Possible Explanations of the Study Results --- p.210 / Chapter 5.1.5 --- Similarities between Mclnnes' Peer Counseling Study and the Present Study --- p.213 / Chapter 5.2 --- Study Limitations --- p.216 / Chapter 5.2.1 --- Study Sample --- p.216 / Chapter 5.2.2 --- Data Validity and Recall Bias --- p.219 / Chapter 5.3 --- Common Reasons for Termination --- p.220 / Chapter 5.4 --- Implications of the Study Result and Future Direction --- p.221 / Chapter 5.5 --- Subsidiary Result Interpretation --- p.227 / Chapter 5.5.1 --- Factors that Have Positive Influences on BF --- p.228 / Chapter 5.5.2 --- Factors that Have No Particular Influences on BF --- p.243 / Chapter 5.5.3 --- Factors that Have Negative Influences on BF --- p.246 / Chapter 5.5.4 --- Future Directions --- p.261 / Conclusion --- p.262 / References --- p.264 / Appendices --- p.279

Antigua and Barbuda, in the eastern Caribbean, is one of several countries with exclusive low breastfeeding rates and premature weaning. Researchers have demonstrated that babies exclusively breastfed for the first 6 months of life are better protected from childhood diseases and experience a better quality of life into adulthood, while early weaning is associated with morbidity and mortality. However, at 6 weeks postpartum, only 30% of Antiguan and Barbudan mothers are exclusively breastfeeding. Researchers have explained why mothers in general cease exclusive breastfeeding prematurely: insufficiency of breast milk, returning to paid employment, lack of social support; but an explanation specific to Antigua and Barbuda has not been identified. This qualitative phenomenological study, therefore, initiates research concerning breastfeeding attitudes and practices specific to this country. It explores the experiences and perceptions of 13 Antiguan and Barbudan 1st-time mothers on exclusive breastfeeding and weaning. The theory of planned behavior provided the theoretical framework. Data collected from semistructured interviews were coded using key word as themes. Manual analysis of the research data was also conducted. The findings indicated inadequate lactation education and counselling for mothers, poor levels of lactation education among nurses, and minimal statutory maternity leave as the reasons for premature weaning among the research participants. The findings of this research can contribute to social change in Antigua and Barbuda by providing evidence-based information to strengthen breastfeeding policies and interventions and become part of regional scholarship on this issue.

<p>Promotion of exclusive breastfeeding (EBF), (giving breast milk only without any solids or liquids), has proved to be very challenging in the South African context, although this infant feeding practice has been found to protect babies against diarrhoea and respiratory tract infections and to carry a lower risk of HIV infection than mixed feeding (breastfeeding combined with formula or solids). Study design: The PROMISE-EBF study is a multi-country cluster randomised trial to examine peer support to promote exclusive breastfeeding in Africa. For the South African site in the PROMISE-EBF study, three sites, Paarl, Rietvlei and Umlazi, were selected because of their different geographic settings and each site operated as a separate stratum for cluster selection and randomisation purposes. The clusters were then randomised into intervention and control arms making a total of 17 clusters in each arm. HIV positive and negative women in the intervention arm received support on their choice of infant feeding from the peer supporters who visited them at their homes while the women in the control group only received the standard infant feeding counselling and support provided by health care&nbsp / workers at health facilities. Data collection: Mothers were interviewed at recruitment during the antepartum period to establish eligibility, obtain informed consent and data on socio-economic status. Home visits were scheduled for data collection by trained data collectors at 3, 6, 12 and 24 weeks after birth. Analysis of results: This mini-thesis was a secondary analysis of the PROMISE-EBF data focusing on the South African data only. The data was adjusted for clustering and analysed using SAS. Comparison of variables between the intervention and control groups within sites was done. Results: A significant difference, regarding counselling and infant feeding practices, was observed among all women who received peer support compared to those who received the standard antenatal counselling, with more women in the intervention group (20.5%) practising EBF than those in the control group (12.8%) by Week 3. When the women‟s HIV status was considered, more than 65% of HIV positive and 40% of HIV negative women practised MF and EFF (giving formula milk only with no breast milk) throughout the study, respectively, regardless of the group they were in. For women who hadintended to practise EBF at recruitment, 33% in the control group and 20% in the intervention group actually practised EBF by Week 3. Regarding disclosure and feeding choice, 77.4% of women who had disclosed their HIV status actually practised MF versus 8.6% who practised EBF by Week 3.Conclusion: Community peer counselling should be strengthened as the results from this study showed that a high percentage of women who practised EBF were those who had received counselling, irrespective of their HIV status. The high percentage of HIV positive women who practised high risk feeding, despite receiving infant counselling, is of concern. Disclosure of the women‟s HIV status did not translate to them practising low risk infant feeding methods, which may suggest that there are other issues that determine the women‟s choice of infant feeding.</p>

Cuatro estudios meta-analíticos evalúan la eficacia de los programas de apoyo a la lactancia materna, en mujeres con intención de lactar, sobre los resultados en duración de cualquier tipo de lactancia materna (clm) y lactancia materna exclusiva (lme), a los tres y seis meses. Con respecto a la lme, las mujeres que siguen un programa de apoyo (GE), abandonan la lactancia un 18% (dr3meses=0.182) menos a los tres meses y un 12% (dr6meses:0.120) menos a los seis meses, en comparación con las madres que no se adscriben a ningún programa de apoyo (GC). Referente a clm, las mujeres del GE, interrumpen la lactancia un 7% menos a los tres y seis meses (dr3meses=0.076 y dr6meses:0.072), en comparación con las madres del GC. Finalmente, en los estudios de mayor cobertura temporal, se analiza la influencia de variables moderadoras y su efecto sobre la duración de clm y lme.

Aim: To evaluate the primary health care professionals‘ practice of promoting and supporting breastfeeding in Kaunas city. Objectives: 1.) To evaluate knowledge and breastfeeding practice of mothers who have a baby of age less than 1 year; 2.) To evaluate knowledge and activity of primary health care professionals in promoting breastfeeding; 3.) To compare breastfeeding practice promoted by professionals of primary health care centers with breastfeeding practice of mothers; 4.) To compare the activity of primary health care professionals in informing mothers about breastfeeding with mothers’ evaluation of this activity. Method of assessment: Anonymous questionnaire. 407 questionnaires for mothers were distributed in 26 family clinics, GP’s offices (284 questionnaires returned – 69.8 %) and to all primary health care professionals (84 general practitioners and 52 general practice nurses). 51 questionnaire returned – 60.7 % of GP and 40 questionnaires – 76.9 % of general practice nurses. Data analysis was made with Statistical Package for Social Sciences SPSS (12.0 v.). Microsoft Excel was used for diagrams and tables. Results: Only 62.7 % of questioned mothers were breastfed their babies. Only 42.3 % of mothers were breastfed their babies till their age of 6 months. Only 6 % of mothers were trying to breastfeed their babies more often after reduction of milk in breasts; 8.5 % of mothers were breastfed according regimen; 31 % of mothers were giving pacifiers to their... [to full text]