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).