Knowledge, Attitudes, and Perceptions of Medical and Paramedical Students Toward Human Milk Banks and Breast Milk Donation

Background and objectives Human milk benefits for both mothers and babies are widely acknowledged. Human milk banks (HMBs) are essential in providing newborns who would not otherwise have access to pasteurized and stored human milk. The objective of this research was to investigate the understanding, opinions, and outlooks of medical and paramedical students regarding breast milk donation and the concept of an HMB. Material and methods A total of 398 professional female students specializing in physiotherapy, nursing, and medicine were given an online self-administered questionnaire as part of a descriptive cross-sectional study. Data on the characteristics, HMB knowledge, awareness levels, and attitudes toward HMB and breast milk donation were to be gathered through the questionnaire. Every student's answer to the survey was kept private and confidential. Result According to the survey, 188 students (47.24%) belong to the medical college, 126 students (31.66%) belong to the physiotherapy college, and the remaining 84 students (21.11%) are from the nursing college. A total of 294 students (74.12%) had heard about human milk banking before and received information from health professionals (195 students, 48.99%), the news (67 students, 16.83%), and family and friends (61 students, 15.33%). However, only 224 students (56.28%) are willing to feed their babies with HMB milk in the future. On the other hand, 216 students (54.27%) are ready to donate breast milk to HMB. The majority of students have a favorable opinion of breast milk donation. A staggering 394 students (98.99%) think that donating human milk can save babies. Furthermore, 379 students (95.23%) think that all the nutrients needed for a baby's healthy development are found in human milk. Merely 350 students (87.93%) think that breastfeeding does not result in malnourishment for either the mother or the baby. When there is an excess of milk, the majority of students (378 or 94.97%) think that there is nothing wrong with donating it. Moreover, 312 (80.41%) students are happy to donate milk in the future. A total of 373 students (93.71%) are overjoyed that a sick baby will survive because of their donated milk. Only 100 students (25.12%) will give milk, though, and only to the infants of their friends and relatives, never to complete strangers. Conclusion A dearth of knowledge pertaining to human milk banking is rampant among medical and paramedical female students, yet the gravity of the circumstances remains concealed. Consequently, it is imperative to extensively educate all Indian communities about the concept of human milk banking to gain widespread acceptance. This research sheds light on the issue and promotes scientific knowledge of HMB, as many students are unaware of it.


Introduction
Continuing breastfeeding until the child reaches at least two years of age is vital for their development and growth, especially during the first six months of life.Breast milk's unique composition provides abundant nutrition, immunological protection, and sufficient hydration for babies [1].These factors significantly reduce the occurrence of illness and death among newborns.The advantages of breast milk are widely recognized, and no replacement can match them.Breast milk includes vital minerals, digestive enzymes, hormones, and vitamins in addition to the right proportions of proteins, lipids, and carbohydrates.A baby's defense against infections is further aided by the antibodies and the mother's lymphocytes in breast milk.Breast milk provided by a woman other than the child's mother is referred to as donor human breast milk.This milk is given to needy babies after being processed at a milk bank [2][3].When a mother is not able to produce a sufficient amount of milk or if breastfeeding is contraindicated, the recommended alternative is to use donated breast milk for her infant.
Nevertheless, preserved milk can be a suitable substitute when obtaining a mother's milk is impractical.
Regrettably, there is opposition to breastfeeding among certain lactating mothers.Breast milk from donors is an invaluable asset for premature and high-risk infants, protecting them from conditions such as necrotizing enterocolitis and sepsis.While the well-established benefits and importance of breastfeeding for both mothers and infants are widely recognized, the act of donating breast milk remains relatively uncommon in our society [4].In addition to addressing many issues, breast milk donation helps reduce hospital stays.The success of any new healthcare intervention depends significantly on its acceptability.The increasing number of premature babies worldwide, particularly in low-income countries, presents a challenge for neonatologists and breast milk banks to ensure adequate nutrition for infant development.
Because of safety apprehensions, numerous mothers exhibit reluctance to utilize donor milk.Before instituting a new milk bank, it is essential to gauge the demand and availability of milk donors [5].The primary aim of this research is to assess the understanding, attitudes, and perspectives of medical and paramedical students regarding human milk banks (HMBs) and breast milk donation.

Materials And Methods
After obtaining approval from the Datta Meghe Institute of Higher Education and Research (DMIHER) Institutional Review Board (IRB) under approval number 107-2021, a cross-sectional study was conducted at Jawaharlal Nehru Medical College, DMIHER, Sawangi (Meghe), Wardha.The study was carried out over two months, starting in September 2023.The inclusion criteria necessitated a minimum age of 18 years and enrollment in the medical, nursing, or physiotherapy college for female students only.The exclusion criterion was non-consent to participate in the study.For the medical, nursing, and physiotherapy students, a questionnaire was distributed in the form of Google Docs.
The participants were then asked to fill out a carefully crafted questionnaire designed to align with the study's goals.This survey sought to collect information on participants' characteristics, their understanding of HMBs, and their attitudes and perceptions regarding both donor breast milk and HMBs.The response of each student to the questionnaire was kept completely confidential.The English-based questionnaire used was formulated following an extensive review of the literature.The questionnaire was administered in English language only.Given that the study participants were students attending English-medium educational institutions, there was no need for translation.To assess the questionnaire's validity, clarity, and length, a pilot study was conducted involving 50 student participants.The knowledge and attitude of HMB were assessed using seven questions.Finally, perceptions toward HMB and DBM were evaluated using a 13-item questionnaire, where the "agree" answers were coded as 1 and "disagree" answers as 0.
The sample size required for the study was determined through the utilization of the Epidemiological Information Package (EPI) Info Version 7.2, developed by the Centers for Disease Control and Prevention (CDC) in Georgia, USA.The software indicated that a minimum of 384 participants were needed based on a margin of error of ±5%, a confidence level of 95%, and an expected frequency of 50%.After the completion of the survey, all the student participants were given knowledge of the HMB, and the process of functioning of the HMB and its benefits for the babies were explained in detail.

Statistical analysis
Descriptive statistics were employed to summarize the characteristics of the entire student group.The demographic characteristics of the participating students were expressed using frequency and percentage distribution.Continuous variables were represented using the mean.The differences in knowledge and attitudes among participants with varying characteristics were not assessed.All data analyses were carried out using STATA Version 10.0 (StataCorp LLC, College Station, Texas, USA).

Results
The characteristics of female students participating in the study are shown in Table

Knowledge and attitudes of students about HMB and breast milk donation
According to the findings, 74.12% of students had heard of human milk banking before and received information from health professionals (195, 48.99%), the news (67, 16.83%), family and friends (61, 15.33%), etc., while 25.88% of students did not know about it.When considering the future feeding practices of the students, it was observed that only 43.72% were inclined to nourish infants with human milk banking milk.
On the other hand, the remaining 56.28% expressed reluctance toward this approach.Among those who were unwilling, 27.39% cited concerns about disease transmission, while 17.84% held the belief that breast milk from other women is nutritionally inferior to that of one's lactating mother.Regarding the willingness to donate breast milk to HMB, a majority of 54.27% of the students expressed their openness to contributing.However, a significant proportion of 45.73% did not share this sentiment.Among the reasons for not wanting to donate, 20.35% believed it could lead to substantial health issues, 11.31% felt their baby required more breast milk, 29.65% simply disliked the idea, and 2.51% were restricted by religious or cultural reasons.Furthermore, the findings revealed that a considerable number of students, specifically 43.97%, expressed interest in joining the HMB association and providing financial support.Additionally, 36.18% of students displayed interest in advancing their professional development toward leadership roles.These findings are summarized in (Table 2).A total of 394 students (98.99%) think that babies can be saved by human milk donation.Three hundred and seventy-nine students (95.23%) think that human milk has all the nutrients needed for a baby to grow and thrive.According to 380 students (95.47%), breast milk donation diminishes breast engorgement, which proves beneficial for the well-being of mothers.Merely 350 students (87.93%) are inclined toward the idea that the act of donating breast milk does not lead to malnourishment of the mother or her baby.The majority of students, accounting for 378 students (94.97%), are of the view that there is no harm in donating milk if there is an excess production of it.On the other hand, 193 students (48.49%) believe that their baby should solely consume their milk and not any other, while 205 students (51.51%) do not concur with this statement.Similarly, 155 students (38.94%) are in favor of restricting the consumption of their milk to their baby and not others, but 243 students (61.06%) disagree with this notion.In the context of this study, a majority of 312 students (78.39%) express their willingness to donate milk in the future, whereas 86 students (21.61%) are not inclined to do so.Moreover, 353 students (88.69%) think that religion, caste, or culture have little bearing on milk donation.In addition, 380 students (95.47%) feel a sense of joy and contentment knowing that their donated milk will be instrumental in the survival of a sick baby.However, a mere 100 students (25.12%) would confine their milk donation only to the babies of their family members and friends, excluding any strangers.Finally, 140 students (35.17%) express concern that their milk might not be enough for their own child if they gave it to other newborns (Table 3).

Discussion
Breastfeeding is regarded as the esteemed standard that encompasses all essential requirements for newborns, even those who are unwell.Human breast milk offers unique advantages for newborns, evident in both short-term and long-term health outcomes for both the mother and child [6][7][8].The first HMB was established in Vienna, Austria, in 1909.This pioneering concept gained swift acceptance in numerous locations worldwide, leading to the establishment of HMBs across the globe.India's inaugural HMB was founded at Sion Hospital in 1989, serving approximately 3,000 to 5,000 infants annually with essential services.As human milk is specific to the species, it possesses a comparative superiority over alternative formulas for newborn feeding.The collection, screening, pasteurization, and distribution of donated milk to recipients are all carried out in accordance with well-defined guidelines [9][10].The utilization of donor milk varies across different regions of the world.The global community's dedication to reducing newborn mortality and promoting child survival has resulted in a swift expansion of HMB facilities.Integrating the HMB system with existing hospitals can enhance donor convenience and reduce barriers to donation.
Collaborating with community leaders to raise awareness about healthcare is instrumental in supporting donor recruitment.Regrettably, due to a lack of awareness within the community, breast milk is often discarded without consideration for donation when an infant passes away.In hospital settings, when a mother's milk is unavailable, it is recommended to provide pasteurized human donor breast milk to sick newborns instead of commercial formula.Despite advancements in baby formulas, human breast milk remains the most effective source of nutrition.HMBs play a crucial role in ensuring that infants receive this essential nutrition.Offering human milk is particularly beneficial in reducing the risk of necrotizing enterocolitis and sepsis in premature infants.
HMBs serve as carriers for various elements such as drugs, genes, immunoglobulins, and vaccines, contributing to the optimal growth and maturation of infants [7][8][9].Breast milk donations can serve as a temporary solution to meet the nutritional needs of newborns when their mothers' milk supply is insufficient or when the baby is too young to nurse.It is essential for medical and paramedical students to expand their knowledge and foster a positive attitude toward breastfeeding, supporting breastfeeding mothers and advocating for the importance of HMBs in the future.Nursing students play a significant role in raising public awareness about the establishment of breast milk banks.Additionally, medical students should receive more instruction or training on breastfeeding, breast milk donation, and the establishment of breast milk banks.While awareness and acceptance of HMBs may be low, a considerable number of students have shown a positive attitude toward human donor milk.Educational campaigns are necessary to promote HMBs.Table 4 presents the results of various studies conducted on HMBs and donor human milk.

Limitations of the study
The use of an online self-administered questionnaire may introduce sampling bias, as only students with internet access and willingness to participate in an online survey would be included.This may exclude individuals who have different perspectives or limited access to technology.Respondents may provide answers that they believe are socially acceptable rather than reflecting their true attitudes or behaviors.The study's findings may be specific to the geographical location where it was conducted.Cultural, regional, or institutional factors could influence attitudes and knowledge, and the results may not be applicable to other settings.

Conclusions
The underlying principle behind this endeavor is to disseminate awareness among the fledgling cohort of medical and paramedical scholars regarding the act of donating human milk.A dearth of knowledge pertaining to human milk banking is rampant among medical and paramedical students, yet the gravity of the circumstances remains concealed.Consequently, it is imperative to extensively educate all Indian communities about the concept of human milk banking to gain widespread acceptance.Although the attitudes and practices toward HMB appear satisfactory, deficiencies in the student's comprehension and awareness of these conditions were detected.Despite the availability of institutions that facilitate the storage and distribution of human milk, there exists a considerable demand for such services in countries like India.To initiate consciousness concerning human milk banking and its registration process, it is indispensable to evaluate students' familiarity with this subject and devise novel educational strategies.
that it would be convenient (particularly if dropping off milk) and not Study participants would welcome having access to 2024 Taksande et al.Cureus 16(2): e55145.DOI 10.7759/cureus.participantswere previously aware of HMBs and milk donation.
of participants were aware of donor milk or milk banks, while 76.7% were willing to donate their milk.Various factors, such as parity, delivery mode, milk production, history of preterm delivery, education from health professionals, and infant age, influenced their attitude (P < 0.001).model showed that predictors of knowledge were having prior experience of breastfeeding another infant (P = 0.006) and encouraging others to breastfeed (P = 0.008).The predictor of attitude was aligned with encouraging others to breastfeed (P < 0.001).answer rate about the knowledge of breast milk donation was not high (29.23%).The average score of breast milk donation attitude was relatively low, with a score of 32.97 ± 4.30.
of women were open to donating breast milk, while only 27.7% were willing to use donor milk for their infants.The women expressed negative attitudes due to religious concerns, fear of diseases, and distrust of researchers, 98.3% of participants had never heard of HMBs.While the majority of participants (71.9%) would use human milk from milk banks if needed, 28% of moms said they would not use milk from a milk bank for their children.Of those surveyed, 99.2% were unaware that human milk banking methods are accepted in Bangladesh, and only 8.3% stated that HMBs were inappropriate in accordance with of respondents were nulliparous, and 54.2% were aware of milk banks.56.4% desired the establishment of milk banks in Turkey, and 50.8% considered donating milk.Reasons for rejecting milk banks included fear of disease transmission and potential incestuous relationships.participants knew about milk banking.Many participants were willing to donate milk and use donor milk.Employment and knowledge of milk banking were predictors of willingness to donate milk.Monthly income, awareness, and knowledge of milk banking were associated with willingness to use donor milk.A majority of postnatal mothers had poor knowledge of milk banking.There was a significant association between demographic variables and knowledge of milk banking.No association was found between education, occupation, family type, and previous information with knowledge of milk banking.participants had limited knowledge about human milk banking.A large percentage of postnatal mothers had average knowledge, while a smaller percentage had poor knowledge.Additionally, a majority of postnatal mothers displayed an unfavorable attitude.The study also found a significant association between demographic variables and the level of knowledge of human milk banking.However, no significant association was observed between education, occupation, type of family, or previous information and the level of knowledge on human milk banking.was discovered that 48% of mothers had average knowledge, 40% had bad knowledge, and only 12% had strong knowledge.Mothers' knowledge and sociodemographic characteristics revealed a statistically significant link with the mother's educational status.The relationship between mothers' knowledge level and age, religion, source of knowledge, and involvement was not statistically significant (P < 0.05), but there was a statistically significant relationship between mothers' knowledge level and family income, education, mothers were pleased to give milk.Recipient mothers agreed to use DHM but had worries about donor mothers' health and hygiene.Nurses shared their opinions on expansion, including enhancing awareness and infrastructure.Need to scale up the human milk banking practices in low-middleincome countries.2024 Taksande et al.Cureus 16(2): e55145.DOI 10.7759/cureus.55145

TABLE 2 : Students' knowledge and attitudes on human milk banking and donor human milk (n = 398)
HMB, human milk bankPerceptions of students about HMB and breast milk donation2024 Taksande et al.Cureus 16(2): e55145.DOI 10.7759/cureus.55145 human milk contains all the essential nutrients required for the healthy existence and complete development of the baby.
Q3I believe that donating breast milk is good for a mother's health, too, as it reduces breast engorgement.Q9I believe that culture/caste/religion does not have any role in milk donation.I believe that it is good to donate milk to babies who are struggling to survive.2024 Taksande et al.Cureus 16(2): e55145.DOI 10.7759/cureus.Q11 I feel very happy that my donated milk will be the reason for the survival of a sick baby.

TABLE 3 : Students' perceptions of HMB and DHM
DHM, donor human milk; HMB, human milk bank; MS, medical student; NS, nursing student; PS, physiotherapy student; Q. no., question number

TABLE 4 : Studies on human milk bank and donor human milk
DHM, donor human milk; HMB, human milk bank