Knowledge and Acceptability Towards Human Milk Bank Use Among Women Attending Haydom Lutheran Hospital,Tanzania

Abstract

Background:

Breast milk is the gold standard of infant nutrition, providing powerful nutritional and immunological protection and decreased mortality due to infection. The World Health Organization recommends using human breast milk from a milk bank if the mother is unable to provide for her own child.

Aim:

To determine the knowledge and acceptance of donor human milk use among women attending the Haydom Lutheran Hospital in Tanzania.

Methods:

An analytical cross-sectional study collected data at the Reproductive and Child Health Care, Neonatal Care units and postnatal ward at Haydom Lutheran Hospital. A total of 260 mothers aged ≥ 18 were included in the study.

Results:

In all, 86% of participants were unaware of human milk banks, 75% had limited knowledge of them, and 67% were willing to donate milk. Fear of having insufficient milk for their infants was the main reason for not donating. A total of 61% would use donated milk. Infectious diseases were the main reason for not using donated milk. In all, 89% who agreed to use donated milk were willing to donate and 67% of those who opposed using donated milk were unwilling to donate. Level of education was associated with willingness to donate (AOR 4.79, 95% CI [1.3, 17.6], p = 0.018) and receive donated breast milk (AOR 6.01. 95% CI [1.6, 23.2], p < 0.01).

Conclusion:

We found high potential acceptability for donating and using human donor milk for infants, with the only association being the level of education. However, further engagement is needed to foster awareness of its importance for communities while addressing cultural, religious, and health concerns.

Graphical Abstract

Keywords

acceptability breastfeeding donor human milk human milk bank knowledge

Key Messages

Before this study, there was no data on whether women attending Haydom Lutheran Hospital knew about human milk banks and their acceptability.

Although the majority had no previous knowledge of human milk banks, more than half were open to the idea of donating their own human milk.

Infectious disease and lack of human milk for their own children were significant concerns for opposing using or donating donated human milk.

A potentially high acceptability was found in the community, with targets for further community engagement to foster awareness.

Introduction

Breast milk is the gold standard for infant nutrition, offering essential nutrients and strong immune protection against gastrointestinal infections, while significantly lowering infant mortality (World Health Organization [WHO], 2023). Exclusive breastfeeding is recommended for the first 6 months of life, and when a mother’s own milk is unavailable, donor human milk (DHM) serves as the preferred substitute (Goodfellow et al., 2016; WHO, 2011, 2023). Previous studies have shown that improving breastfeeding behavior would save 823,000 infants annually, with 87% of those being infants under 6 months old (Victora et al., 2016; Walters et al., 2019).

DHM is donated by mothers and processed by the milk bank to be used by the recipient baby who cannot get it from their own mother (Hoodbhoy, 2013). Human milk banks (HMB) systematically collect, pasteurize, store, and distribute donated human breastmilk (Hoodbhoy, 2013). There are 750 HMBs in 66 countries, and more than 800,000 infants receive donor human milk annually, suggesting that over 1 million liters of milk are donated annually in support of optimal infant nutrition and breastfeeding. In South Africa alone, there are 70 hospitals with HMB services (Bhoola & Biggs, 2021; European Milk Bank Association, 2021).

However, due to a lack of knowledge on the importance of DHM, most mothers prefer infant formula over it (Alemu et al., 2021; Yang et al., 2020). Neonates, especially those who are premature and low birth weight, are more susceptible to morbidity and mortality, especially those who do not receive breast milk in the early days (Iloh et al., 2018; United Nations Children’s Fund [UNICEF], 2006). In low-income countries such as Tanzania, neonatal mortality contributes to 40% of under-five deaths (WHO, 2022b).

As an example, neonates who received DHM were at the lowest risk of prolonged hospital stay and neonatal complications, such as necrotizing enterocolitis, compared to those who received infant formula (Yang et al., 2020). This illustrates the benefits of DHM for neonates.

Several studies across Africa have shown that most mothers possess limited knowledge of HMB, resulting in low willingness to use or donate donor breast milk (Bhoola & Biggs, 2021; Iloh et al., 2018; Kimani-Murage et al., 2019; Mantji et al., 2019; Ogundele et al., 2022). However, a study conducted in South Africa demonstrated a significant increase in mothers’ willingness to donate and use donor breast milk following targeted education (Goodfellow et al., 2016).

Achieving the Sustainable Development Goal (SDG) target of fewer than 12 deaths per 1,000 live births by 2030 requires efforts, including promoting the use of breast milk as a key intervention (Alkema et al., 2014;WHO, 2022a, 2022b).

Tanzania has not yet established any HMB. In the absence of such infrastructure, only a small number of neonates whose mothers are unable to breastfeed due to illness or death receive breast milk through informal wet nursing by close relatives. This limited access underscores the urgent need for structured, safe alternatives to support infant nutrition and survival. Several studies have documented the practice of informal milk sharing, whereby breast milk is directly donated from one mother to another. This enables mothers with surplus milk to provide nourishment to newborns whose mothers have insufficient milk supply, or who are severely ill, or deceased (Kimani-Murage et al., 2019). This practice is discouraged due to the fear of contact infections, mainly human immunodeficiency virus (HIV). As a result, infant formula is mostly preferred over DHM (Mantji et al., 2019).

In rural communities, cultural diversity often contributes to limited knowledge about HMBs. Therefore, establishing HMBs requires raising awareness to address and mitigate the fears associated with traditional milk-sharing practices. This study aims to assess the knowledge and acceptability of DHM among women attending Haydom Lutheran Hospital in Tanzania.

Methods

This was an analytical cross-sectional study, conducted between October 2022 and October 2023. The study was conducted at Haydom Lutheran Hospital, a remote faith-based referral hospital in the Manyara region, approximately 300 km off-road southwest of Arusha. The area is inhabited by diverse ethnic groups, with the majority being the Iraqw and Datooga. The hospital serves seven districts across four regions, providing care for over 1 million people in its catchment area. It provides Level III neonatal care under the pediatrics department, caring for about 1,500 neonates annually, most of whom are premature with birth weights ≤ 1,500 g. The unit is equipped with radiant warmers, oxygen concentrators, suction devices, resuscitation equipment, and CPAP for advanced respiratory support, with care delivered by trained nurses and medical doctors under pediatrician oversight (Haydom Lutheran Hospital, 2015). Although no full-time neonatologist is available, ongoing staff training in neonatal resuscitation and infection prevention supports the feasibility of introducing a HMB in this resource-limited setting.

Women attending reproductive and child health services (RCHS), the neonatal care unit (NICU), and or receiving postnatal care (PNC) during the time of the study were enrolled. The inclusion criteria were women aged ≥ 18 years with children under 2 years. Exclusion criteria were women who did not consent to participate and those with mental health problems.

The calculated sample size was 236 participants, based on an assumed baseline knowledge rate of 18.9% regarding human milk banks (Bhoola & Biggs, 2021a), as no baseline data for HLH existed. A 95% confidence interval and a marginal error of 0.05 was used. A further 10% was added to compensate for non-responders.

Data Collection and Analysis

A structured questionnaire was administered by trained research assistants to participants. The questionnaire had four parts, totaling 30 questions in Swahili, the lingua franca in Tanzania. The first part collected sociodemographic and obstetric information, such as age, sex, and tribe. The second part assessed knowledge of human milk donation, and the third part assessed the acceptability of human milk donation and HMBs. The fourth part identified myths about human milk donation. Knowledge questions were adapted from the existing literature, with each question on DHM and HMBs marked with 1 point, for a total of 12 marks; 9–12 equals good knowledge, 6–8 equals satisfactory knowledge, and 0–5 equals poor knowledge (Tian et al., 2021). The study was conducted at three sites (RCHS, NICU, and postnatal). Data collectors introduced themselves to potential participants and explained the study’s aim. After obtaining consent, participants completed the questionnaires anonymously. In case of any misunderstanding, the data collectors clarified the question. Every participant had to sign a consent form, be > 18 and be allowed to exit the study at any point.

Data was collected, entered, and analyzed using SPSS (Version 20). Descriptive statistics were performed, with frequencies and percentages used for categorical data. Frequency distribution and percentages were used to assess mothers’ knowledge. A multivariate logistic regression was done, including age, tribe, residency, religion, occupation, education level, marital status, and parity, to investigate factors associated with acceptance of donating and using DHM to calculate the crude and adjusted odds ratios to determine the strength of association. A p value < 0.05 was considered statistically significant.

Due to low numbers, the tribal associations of Nyaturu, Hehe, Chagga, Haya, and Ngoni were grouped into a variable labelled “others.” Likewise, for residency, people from Kilimanjaro and Tabora regions were grouped under “others.”

Ethical clearance was granted by NIMR (Ethical number: NIMR/HQ/R.8a/Vol.IX/4109), and local permission was obtained from the executive director of HLH.

Results

A total of 260 women aged 18 and above were recruited, with one person later dropping out. The most common tribal affiliation was Iraqw (58%), and the most common parity was between one and three children (63%). The majority of participants were from the Manyara region (78%), were Christian (83%), and were married (83%). Close to half (47%) had primary education, and 36% were housewives. Additional sociodemographic characteristics of the participants are shown in Table 1.

Table 1.

Sociodemographic Characteristics Distribution of the Participants (n = 260).

Variable	Category	No. of Participants	Percentage
Age (years)	18–30	160	61.5
	31–40	86	33.1
	> 40	14	5.4
Tribe	Iraqw	151	58.1
	Datooga	37	14.2
	Sukuma	17	6.5
	Nyiramba	45	17.3
	Other^a	10	3.9
Residency	Manyara	204	78.4
	Singida	47	18.1
	Arusha	7	2.7
	Other^b	2	0.8
Religion	Christian	215	82.7
	Muslim	33	12.7
	Pagan	12	4.6
Education Level	Never been in school	38	14.6
	Primary school	151	58.1
	Secondary school and higher	71	27.3
Occupation	Formal/private	72	27.7
Occupation	Housewife/peasant/student	188	72.3
Marital Status	Single/divorced/widowed	46	17.7
Marital Status	Married	214	82.3

Nyaturu, Hehe, Chagga, Haya, Ngoni. ^bKilimanjaro, Tabora.

Table 2 shows the obstetrics and breastfeeding history. The majority (82%) had spontaneous vertex delivery; for 82% the baby was born at term; and 89% exclusively breastfed for 6 months.

Table 2.

Obstetrics and Breastfeeding History of the Participants (n = 260).

Variable	Category	No. of Participants	Percentage
Parity*	1–3	164	63.3
	4–6	68	26.3
	> 6	27	10.4
Mode of delivery*	SVD	212	82.2
Mode of delivery*	Cesarean section	46	17.8
The current baby is born at term*	Yes	237	91.9
The current baby is born at term*	No	21	8.1
Mode of feeding in less than six months of age*	EBM	228	88.7
	Cow’s milk/formula	26	10.1
	Mixed feeding	3	1.2

Note. SVD = spontaneous vertex delivery; EBM = exclusive breast milk, percentage calculated according to the number of respondents.

Missing value.

Knowledge of HMB

A total of 86% of participants were unaware of DHM, whereas 33.3% had heard of it from health facilities. Regarding the 12 knowledge questions, 29.7%, 51.8%, and 26% knew the benefits, use, and expiration of donor human milk, respectively. However, 51.6%, 13.9%, and 11.5% recognized that donors require examinations, that pasteurization does not destroy nutrients, and that there is currently no HMB in Tanzania, respectively. The details are summarized in Table 3. Figure 1 shows the knowledge scores.

Table 3.

Responses About Knowledge Towards HMB Among Women Attending Haydom Lutheran Hospital (n = 259).

Question	Response	No. of Correct Responses	Percentage
Have you ever heard about human milk donation	Yes	34	13.1
Where have you heard about human milk banks?		16
From the health facility		6	33.3
From school		1	5.6
From neighbors		9	50.0
Media		2	11.1
There are more advantages to feeding premature or low-birth-weight infants with donor milk than with formulas	Yes	76	29.7
When mothers are unable to breastfeed due to illness or insufficient milk supply, donor milk may be used instead	Yes	132	51.8
Donor milk has an expiry date	Yes	64	26.0
Mothers do not need a medical examination before they donate their milk	No	128	51.6
Sterilized donor milk is stored frozen and is valid for 12 months	Yes	38	14.8
Milk donors require regular medical examinations to continue donating	Yes	161	63.9
Donor milk can be given to infants without disinfection	No	126	50.8
Donor milk is stored in milk banks	Yes	48	19.6
After pasteurization, the nutrients in milk are destroyed	No	35	13.9
Using donor milk reduces the incidence of heart disease in preterm infants	Yes	12	4.8
Everyone can donate their excess milk	No	99	39.3
There are several milk banks in Tanzania	No	29	11.5

Figure1.

Knowledge scores on HMBs among women attending Haydom Lutheran Hospital.

Acceptability and Myths Towards HMB Among Women Attending Haydom Lutheran Hospital

A total of 97% of participants had never donated or breastfed another baby. About 67.1% of participants were ready to donate their own milk to HMB if asked. Among those who were not ready to donate their own milk, the main reason was fear that their milk would not be enough for their baby (32.4%). Among women who participated, 61% were ready to accept donated milk for their babies if needed. Among those who opposed using human-donated milk, the main reasons were the risk of disease transmission (33.3%) and personal dislike (25.8%). Other reasons are clarified in Tables 4 and 5.

Table 4.

Acceptability, Willingness, and Myths Towards Human Milk Bank Among Women Attending Haydom Lutheran Hospital.

Variable	Category	No. of Responses^a	Percentage
Donated milk or breastfed another child (n = 255)	No	249	97.6
Donated milk or breastfed another child (n = 255)	Yes	6	2.4
Accept to donate breast milk (n = 249)	No	82	32.9
Accept to donate breast milk (n = 249)	Yes	167	67.1
Accept to use donated milk for your own child (n = 247)	No	95	38.3
Accept to use donated milk for your own child (n = 247)	Yes	152	61.3
Culture allows for donating breast milk or breastfeeding another child (n = 173)	No	43	17.1
	Yes	130	51.6
Cultural reasons against breast milk donation or breastfeeding another child	Fear of acquiring an inherited disease	4	44.4
	Not possible to breastfeed someone’s child	3	33.3
	Cow milk can be used	1	11.1
	Culturally not allowed	1	11.1
Culture allows the use of another mother’s breast milk (n = 164)	No	37	15.0
	Yes	127	51.6
Reasons for the culture not to allow the use of another mother’s breast milk	Cow milk can be used	3	21.4
	Not possible in our culture	4	28.6
	Fear of acquiring an infection	7	50.0

Missing variables are non-responders, therefore % values are based on the total number of responses.

Table 5.

Reasons for Not Accepting to Donate/Use Breast Milk From a HMB.

Reasons	No. of Responses	Percentage
Reasons for not accepting to donate milk (n = 36)
It will not be enough for my baby	12	33.3
Personal dislike	11	30.6
Fear of acquiring infections	5	13.9
Cow’s formula milk can be used to breastfeed a child	3	8.3
Not good /possible to breastfeed someone’s baby	2	5.5
Fear of acquiring genetics from another family	1	2.8
I do not see anywhere that people donate breast milk	1	2.8
Culturally not allowed	1	2.8
Reason for not accepting donated milk (n = 66)
Risk of disease transmission	22	33.3
Personal dislike	17	25.8
Fear of the transfer of genetic and personal traits	10	15.2
Donated breast milk loses its strength	9	13.6
Cultural or religious unacceptable practice	5	7.6
Hygiene concerns	2	3.0
Fear of familial diseases	1	1.5

Factors Associated With Acceptability Toward DHM Among Women Attending Haydom Lutheran Hospital

Evidence indicated that the acceptability of donating human milk among women was associated with secondary school or higher education, with an AOR of 4.79 (95% CI [1.3, 17.57], p = 0.018).

However, for DHM use, there was evidence of associations in both groups: primary school education had an AOR of 3.2 (95% CI [1.09, 9.85], p = 0.03), and secondary school or higher education had an AOR of 6.01 (95% CI [1.55, 23.21], p = 0.009). No other variables showed evidence of association (see Tables 6 and 7).

Table 6.

Factors Associated With Acceptability of Donating DHM Among Women Attending Haydom Lutheran Hospital (N = 249).

Variable	No. of Responses	Acceptability to donate n (%)	COR (95% CI)	P Value	AOR (95% CI)	P Value
Age (years)
18–30	155	109 (70.3)	1		1
30–40	80	51 (63.8)	0.74 [0.42, 1.31]	0.3	0.88 [0.37, 2.07]	0.769
> 40	14	7 (50)	0.42 [0.14, 1.27]	0.12	1.34 [0.23, 7.72]	0.747
Tribe
Iraqw	145	97 (66.9)	1		1
Datooga	34	19 (55.9)	0.63 [0.29, 1.34]	0.23	1.39 [0.56, 3.49]	0.476
Sukuma	17	11 (64.7)	0.91 [0.32, 2.60]	0.86	0.78 [0.19, 3.08]	0.722
Nyiramba	43	32 (74.4)	1.44 [0.67, 3.10]	0.35	1.37 [0.36, 5.25]	0.650
Other^a	10	8 (80)	1.98 [0.41, 9.68]	0.39	1.86 [0.29, 11.70]	0.509
Residency
Manyara	194	125 (64.4)	1		1
Singida	46	35 (76.1)	1.76 [0.84, 3.68]	0.14	2.46 [0.69, 8.79]	0.167
Arusha	7	6 (85.7)	3.31 [0.39, 28.1]	0.27	3.64 [0.29, 45.21]	0.314
Other^b	2	1 (50)	0.55 [0.03, 8.96]	0.68	0.88 [0.04, 18.69]	0.936
Religion
Christian	206	143 (69.4)	1		1
Muslim	31	20 (64.5)	0.80 [0.36, 1.77]	0.58	0.30 [0.09, 1.01]	0.052
Pagan	12	4 (33.3)	0.22 [0.06, 0.76]	0.016	0.29 [0.76, 1.12]	0.072
Education Level
Never been in school	35	16 (45.7)	1		1
Primary school	144	92 (63.9)	2.10 [0.99, 4.43]	0.051	2.26 [0.82, 6.27]	0.117
Secondary and higher	70	59 (84.3)	6.37 [2.52, 16.1]	< 0.001	4.79 [1.30, 17.57]	0.018
Occupation
Formal/private	72	59 (81.9)	1		1
Housewife/farmer/student	177	108 (61.0)	0.35 [0.18, 0.68]	0.002	0.59 [0.26, 1.37]	0.223
Marital Status
Single/divorced/widowed	45	28 (62.2)	1		1
Married	204	139 (68.1)	0.77 [0.39, 1.51]	0.45	1.19 [0.56, 2.52]	0.660
Parity
1–3	159	113 (71.1)	1		1
4–6	65	40 (61.5)	0.65 [0.36, 1.19]	0.17	1.01 [0.41, 2.53]	0.976
> 6	25	14 (56.0)	0.52 [0.22, 1.23]	0.13	0.86 [0.22, 3.39]	0.835

Note. Differences in denominators are caused by missing responses.

Nyaturu, Hehe, Chagga, Haya, Ngoni. ^bKilimanjaro, Tabora.

Table 7.

Factors Associated With Acceptability to Use DHM Among Women Attending Haydom Lutheran Hospital (N = 248).

Variable	No. of Responses	Acceptability of Use n (%)	COR (95% CI)	P Value	AOR (95% CI)	P Value
Age (years)
18–30	154	100 (64.9)	1		1
30–40	81	45 (55.6)	1.48 [0.86, 2.57]	0.16	1.21 [0.52, 2.81]	0.65
> 40	13	7 (53.8)	1.59 [0.51, 4.96]	0.42	0.36 [0.06, 2.22]	0.27
Tribe
Iraqw	143	92 (64.3)	1		1
Datooga	35	14 (40)	2.71 [1.27, 5.77]	0.01	1.28 [0.53, 3.09]	0.59
Sukuma	17	12 (70.6)	0.75 [0.25, 2.25]	0.61	0.43 [0.11, 1.67]	0.22
Nyiramba	43	27 (62.8)	1.07 [0.53, 2.17]	0.85	0.64 [0.19, 2.19]	0.47
Others^a	10	7 (70)	0.77 [0.19, 3.12]	0.71	0.66 [0.13, 3.39]	0.61
Residency
Manyara/Arusha	202	124 (61.4)	1		1
Singida	46	28 (60.9)	1.02 [0.53, 1.97]	0.94	1.31 [0.43, 3.95]	0.63
Religion
Christian	205	129 (62.9)	1		1
Muslim	31	18 (58.1)	1.23 [0.57, 2.64]	0.6	1.95 [0.66, 5.76]	0.22
Pagan	12	5 (41.7)	2.38 [0.73, 7.75]	0.15	1.37 [0.37, 4.98]	0.63
Education Level
Never been in school	34	11 (32.4)	1		1
Primary school	144	84 (58.3)	2.80 [1.26, 6.21]	0.01	3.2 [1.09, 9.85]	0.03
Secondary and higher	70	57 (81.4)	8.77 [3.42, 22.49]	< 0.001	6.01 [1.55, 23.21]	0.009
Occupation
Formal/private	70	57 (81.4)	1		1
Housewife/farmer/student	178	95 (53.4)	3.83 [1.96, 7.49]	< 0.001	2.19 [0.96, 5.01]	0.06
Marital Status
Single/divorced/widowed	43	26 (60.5)	1		1
Married	205	126 (61.5)	0.96 [0.49, 1.88]	0.90	0.89 [0.42, 1.88]	0.75
Parity
1–3	157	104 (66.2)	1		1
4–6	66	35 (53)	1.74 [0.97, 3.12]	0.06	1.00 [0.41, 2.46]	0.98
> 6	25	13 (52)	1.81 [0.77, 4.24]	0.17	1.02 [0.28, 3.77]	0.97

Note. Differences in denominators are caused by missing responses.

Nyaturu, Hehe, Chagga, Haya, Ngoni.

Discussion

This study aimed to assess knowledge, acceptability, and myths among women attending HLH regarding HMB. Our study found that 14% of participants had heard of HMB and obtained information from the health facility. Studies conducted in Kenya and Nigeria showed that more than one quarter of all participants and up to a half, respectively, had ever heard of HMB. However, only 12% in a different study from Tanzania had ever heard about HMB, which is comparable to our results (Kimani-Murage et al., 2019; Kimaryo et al., 2024; Ogundele et al., 2022). Based on our study’s results, the idea of HMB in Tanzania appears to be unfamiliar and shows a need to raise awareness.

Most participants had low HMB knowledge scores, with 75% scoring below 6 points. This result is comparable with the findings from Limpopo in South Africa, which showed that women did not know about DHM (Bhoola & Biggs, 2021; Mantji et al., 2019). Likewise, a multi-center study from Nigeria revealed a significant lack of awareness, too, with one-quarter of the participants unfamiliar with the concept of DHM (Iloh et al., 2018). Similarly, low levels of familiarity with HMB were found among populations in China and Nepal, where awareness was confined to a small fraction of people (Sapkota et al., 2024; Tian et al., 2021). Conversely, an online survey in Malaysia demonstrated that over half of the respondents possessed a good understanding of both milk sharing and HMB (Ramachandran et al., 2024). Compared to other countries, our study shows that women attending HLH have low overall knowledge of donor milk and need to improve it. This may relate to the socioeconomic and educational characteristics of the area in which our study was conducted. The participating regions had lower general levels of formal education and limited access to technology and modern communication channels. We hypothesize that in this context this directly limited prior exposure to and awareness of DHM. This is supported by our finding that participants unfamiliar with DHM at baseline had significantly lower knowledge about it. Thus, lower baseline knowledge in our cohort may not reflect a general lack of interest, but, rather, a lack of opportunity to access relevant information, suggesting that educational background is a key factor shaping awareness due accessibility of said information.

This study shows that despite having limited knowledge, more than half of the participants accept donor milk, either as donors or recipients. This is similar to several studies which reported high acceptability rates in Nepal, India, Turkey, Kenya, Uganda and Tanzania, while significantly lower rates were found in Ethiopia and Nigeria (Ekşioğlu et al., 2015; Gelano et al., 2018; Kimani-Murage et al., 2019; Kimaryo et al., 2024; Namuddu et al., 2023; Ogundare et al., 2023; Sapkota et al., 2024; Taksande et al., 2024) showing a variable picture over several countries.

One of the most frequently mentioned reasons for not accepting DHM in our study was fear of transmitting infections or of passing on genetic and personal traits. These reasons for not accepting donated milk have been shown in other studies from a variety of countries, such as Ethiopia, Turkey, Kenya, Tanzania, Uganda, Malaysia, and Nigeria (Ahmed et al., 2024; Alemu et al., 2021; Gelano et al., 2018; Ekşioğlu et al., 2015; Kimani-Murage et al., 2019; Kimaryo et al., 2024; Namuddu et al., 2023; Ogundele et al., 2022; Ramachandran et al., 2024).

A survey from South Africa showed a significant improvement in knowledge and acceptance after counseling and educating the women (Goodfellow et al., 2016). Similarly, in Nigeria, the majority of participants indicated that they would be more likely to accept donor human milk if provided with additional information (Ogundare et al., 2023), highlighting that perhaps lower or no education can be counteracted by actively improving awareness about breast milk donation and its use at HMBs. Likewise, in Nepal, 74% of study participants had heard of HMB through obtaining information from health facilities (Taksande et al., 2024).

In our study, we found evidence that women with primary or secondary education, or higher, were more likely to accept the use of DHM than those who never had formal education. Interestingly, this evidence was observed only among women with secondary education or higher when donating DHM. Why primary education had no impact is not clear yet. Our results are similar to a study conducted in Uganda which showed that graduates had higher odds of donating human milk. However, in the study from Uganda, this was only the case for the univariate analysis, whereas in our study the effect was still seen after conducting a multivariate analysis (Ahmed et al., 2024).

Limitations

The main limitation of this study was the restriction of the sample to women attending a single rural hospital rather than to women from the surrounding villages. Therefore, the results may not reflect the urban context or the country as a whole. Another limitation is the predominance of area-specific groups, which could be addressed by conducting larger-scale surveys across multiple areas. Additionally, the questionnaire was not designed to elaborate in depth on how education would impact the acceptability of donating or using DHM.

Conclusion

This study highlights the acceptability of donating and using DHM for infants. However, there is a need to engage with and further emphasize the importance of DHM in communities, while addressing cultural, religious, and health concerns, and building awareness of the value of breastfeeding and milk. Also, this study shows that overall acceptability among women and staff is a cornerstone for establishing a DHM at HLH and can be advanced to the next practical level. More information about human milk banks should be provided to mothers through the antenatal clinic, a vital setting where more mothers are seen daily. However, greater effort is needed from the government in policymaking, political support, and financial investment.

Footnotes

Acknowledgements

We extend our gratitude to our families for their support and to the mothers who participated in this study.

ORCID iDs

Dorcus Mduma

Christian Kositz

Author Contributions

Dorcus Mduma: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualization; Writing – original draft; Writing – review & editing.

Sifael Katengu: Conceptualization; Project administration; Supervision; Writing – original draft.

Raphael Mduma: Data curation; Formal analysis; Investigation; Resources; Validation; Writing – original draft.

Godfrey Guga: Data curation; Formal analysis; Methodology; Validation; Writing – original draft.

Editha Girgis: Investigation; Resources; Writing – original draft.

Bertha Eliya: Investigation; Resources; Writing – original draft.

Lanta Sulle: Formal analysis; Resources; Writing – original draft.

Christian Kositz: Conceptualization; Formal analysis; Methodology; Validation; Writing – review & editing.

Vickfarajaeli Z. Daudi: Conceptualization; Formal analysis; Methodology; Supervision; Validation; Writing – original draft; Writing – review & editing.

Theresa Harbauer: Conceptualization; Formal analysis; Methodology; Validation; Writing – review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data underlying this article are available at Haydom Lutheran Hospital. Access can be requested through the hospital administration.

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