Background
Human milk is the optimal nutrition source for every newborn. It
contains bioactive compounds that are fundamental for their developing
immune system. This single characteristic of human
milk makes it crucial especially for premature and underweight newborns,
whose weak immune systems are essential to their survival (Sánchez et
al., 2021). Other health advantages associated with human milk include
the promotion of gastrointestinal health, decreased mortality rates from
severe respiratory infections and constipation, enhanced
neurodevelopmental outcomes, and lowered risk of infectious illnesses in
early childhood (Couto et al., 2020).
Human milk provision has been considered a foundation for child survival
and a viable means of reducing the more than 2.5 million infant
mortalities that occur annually across the globe (Rosa-Mangeret et al.,
2022). Considering the death risk for a non-breastfed child is significantly greater compared to that of a breastfed infant especially in low- and middle-income countries, it is evident that human milk has the greatest effect on child health (North et al., 2022).
Therefore, to survive and flourish, newborn babies require the greatest
care possible, including human milk, one of the most sophisticated forms
of tailored medicines available. Following World Health Organization
(WHO) recommendations, all infants need to be fed human milk exclusively
at least six months after birth (WHO, 2003). The most popular method of
giving human milk to infants is through breastfeeding or using expressed
mother’s milk.
However, not all mothers can breastfeed their babies for a variety of
reasons, including being too ill to breastfeed, using medications that
are not advised during breastfeeding, delayed lactation, and separation
from their babies. Furthermore, infants who are at risk—such as those
who are orphaned, abandoned, underweight, preterm, or suffering from
serious health conditions—might lack access to mother’s milk (Victora
et al., 2016). These neonates are susceptible to adverse health outcomes
due to complications that are preventable or treatable with simple and
affordable interventions such as the provision of human milk.
In instances where mother’s milk is insufficient or inaccessible, WHO
advocates Donor Human Milk (DHM) as a life-saving substitute
particularly for vulnerable, preterm, and low birth weight (LBW)
neonates who are considered high-risk populations with high mortality
and morbidity rates (World Health Organization, 2011). Evidence strongly
suggests that DHM from Human Milk Banks (HMBs) is preferable to infant
formula. Systematic analyses comparing DHM to infant formula show that
the latter is substantially less likely to cause necrotizing
enterocolitis in neonates, it is better tolerated by preterm newborns
and significantly reduces the risk of late-onset sepsis (Altobelli et
al., 2020).
In recognition of the advantages of DHM in place of infant formula where
utilization of mother’s milk is not a viable option, WHO issued a call
for the scale-up of HMBs to provide babies who lack access to mother’s
milk safe DHM (Darmstadt et al., 2023). HMBs are designed to collect
human milk from recruited donors after which, the donated milk is
pasteurized, screened, and safely stored to ensure it’s free from any
form of contamination. Upon prescription, the DHM is distributed to
cater to the unique nutritional and health requirements of infants in
need (Demarchis et al., 2017).
It has been established that the use of DHM over formula feeding in
countries around the world, particularly developed countries where donor
human milk is commonly utilized in caring for preterm and LBW neonates,
considerably lowers Neonatal Mortality Rates (NMRs). For instance, since
milk banks were incorporated into Brazil’s newborn health strategy,
there has been a dramatic 73% decrease in neonatal mortality between
1990 and 2013 (You et al., 2015).
The global trend in establishing and maintaining HMBs to meet clinical
demand for donor human milk has increased as the advantages of DHM are
becoming more widely understood. Over 60 countries throughout the world
have now established human milk banks, with a modest but growing number
of HMBs operating in resource-constrained regions (Shenker et al.,
2020). The slow uptake of human milk banking in some countries can be
attributed to knowledge gap on the practice among the public. According
to research conducted in countries including South Africa and Nigeria,
participants who demonstrated awareness of human milk banking were more
conversant with the procedures and hence more likely to donate or
utilize DHM (Abhulimhen-Iyoha et al., 2015; Goodfellow et al., 2016)
Lack of knowledge led to inaccurate information on HMBs which affected
the donor pool in that only a few mothers wanted to donate according to
studies carried out in Italy and the USA (Arianna Virano et al., 2017;
Pal et al., 2019). The fear of spreading diseases is considerably high
in most developing countries considering they bear the heaviest burden
of HIV/AIDS, a factor that drastically constricts the pool of potential
donors. Other obstacles include fragmented institutions, lack of policy
support from the government, unfavorable community and maternal attitude
towards human milk banking, and detrimental traditions that frequently
hinder the success of HMBs (McCloskey & Karandikar, 2018).
The Sustainable Development Goals (SDGs) aim to eliminate all
preventable infant mortalities by 2030 and lower NMR to at least twelve
deaths per one thousand live births. In this regard, additional
resources and efforts are required during this crucial neonatal stage.
Out of all the known strategies, human milk has the biggest possible
effect on child survival (Wu & Clark, 2016).The improvement of
lactation practices thus, mother’s milk availability, depend on the
support, promotion and protection of breastfeeding (Demarchis et al.,
2017). Increased lactation assistance and better lactation counseling
would help build a strong breastfeeding culture which would boost the
pool of potential donors (Gelano et al., 2018).
Kenya launched a hospital-based model HMB, the first one in Eastern
Africa recently at Pumwani Maternity Hospital. The human milk bank
enhances the safe delivery of DHM to newborns unable to obtain mother’s
milk as well as improving breastfeeding support for lactating mothers.
The ministry of health also incorporated DHM in its policy framework as
the superior alternative to mother’s milk.
Promoting awareness of the significant contribution of DHM as well as
addressing cultural beliefs and misconceptions among community members
through the provision of adequate information is considered a key
approach to boosting communities’ acceptance of human milk banking.
Public sensitization is also an important factor which contributes to
the successful establishment and sustainability of HMBs (Gürol et al.,
2014).
In Kenya currently, limited literature is available citing the awareness
and acceptance of the practice of human milk banking. This study seeks
to address this significant evidence gap by determining the awareness
and acceptance level of the practice. Furthermore, it will evaluate
determinants of human milk donation and use of the donated milk among
postpartum mothers. The evidence generated from this research is crucial
for guiding the establishment of additional HMBs in the country,
including the formulation of operational standard procedures for human
milk banking, integration HMBs into the healthcare system, and the
creation of effective and focused advocacy and communication campaigns
regarding human milk banking (Amundson et al., 2017).