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Effect of Human Milk Banking on Exclusive Human Milk Feeding among Preterm Infants in Nigeria

Abstract

Preterm infants are particularly vulnerable to feeding difficulties, infections, poor growth, and other complications because of their immature physiological systems and increased nutritional requirements. Adequate human milk feeding provides important nutritional, immunological, and developmental benefits for preterm infants and may reduce the risk of infections and other neonatal complications. Human milk banking provides an opportunity to make screened and appropriately processed donor human milk available to preterm infants when their mothers' own milk is unavailable, insufficient, or temporarily contraindicated. In Nigeria, however, limited availability of human milk banks, inadequate donor recruitment, insufficient awareness, concerns about donor milk, weak collection and storage systems, limited trained personnel, and financial and infrastructural constraints may affect the implementation and utilization of human milk banking services. Against this background, this study investigates the effect of human milk banking on exclusive human milk feeding among preterm infants in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how mothers' perceptions of the benefits and safety of human milk feeding, perceived barriers to breastfeeding and donor human milk, and cues to action may influence acceptance and utilization of human milk banking services. The Social Ecological Model emphasizes the influence of mothers, families, healthcare workers, neonatal units, communities, cultural practices, and broader socioeconomic factors on infant feeding decisions. The Health Systems Framework emphasizes service delivery, health workforce, medical products and technologies, health information, financing, governance, and accessibility as essential components of effective human milk banking and neonatal nutrition services. Collectively, these theoretical perspectives provide a suitable framework for explaining how human milk banking may influence exclusive human milk feeding among preterm infants in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise preterm infants and their mothers receiving care in selected Nigerian hospitals with or without human milk banking services. A multistage sampling technique will be used to select states, local government areas, hospitals, neonatal units, preterm infants, and eligible mothers. Human milk banking exposure will be assessed using indicators such as availability of human milk banking services, access to donor human milk, timing of donor milk initiation, frequency and duration of donor milk use, donor screening procedures, milk collection and storage practices, availability of trained personnel, counselling provided to mothers, and documentation of donor human milk administration. Exclusive human milk feeding will be assessed using indicators such as receipt of only human milk, including mother's own milk and appropriately screened donor human milk, during the defined observation period, absence of formula feeding, frequency and duration of human milk feeding, feeding method, and transition to mother's own milk where applicable. Data will be collected using structured questionnaires, neonatal feeding records, human milk bank registers, maternal and newborn medical records, feeding charts, and hospital programme documents. Descriptive statistics will be used to summarize maternal and infant characteristics, human milk banking exposure, feeding patterns, and feeding outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of human milk banking on exclusive human milk feeding. Where a quasi-experimental design is adopted, exclusive human milk feeding rates among preterm infants before and after implementation of human milk banking services may be compared, while relevant maternal, infant, and facility-level factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that human milk banking has a significant positive effect on exclusive human milk feeding among preterm infants in Nigeria. Preterm infants who have access to screened donor human milk when mother's own milk is insufficient or unavailable are expected to have a greater likelihood of receiving exclusive human milk feeding compared with infants without access to donor milk services. Human milk banking may provide a nutritional bridge that supports continued human milk feeding while mothers establish or increase their own milk supply. It may also reduce the need for formula supplementation in situations where mother's own milk is temporarily inadequate. However, limited milk-bank availability, inadequate donor recruitment, concerns about donor milk, maternal knowledge, cultural beliefs, staff capacity, storage and processing requirements, and financial or infrastructural constraints may limit the effectiveness of human milk banking. The study therefore expects accessible, safe, well-regulated, and adequately supported human milk banking services, combined with breastfeeding support for mothers, to contribute significantly to improving exclusive human milk feeding among preterm infants in Nigeria. The study is expected to contribute to the literature on human milk banking, donor human milk, exclusive human milk feeding, preterm infant nutrition, neonatal health, breastfeeding support, neonatal intensive care, maternal and child health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, neonatal intensive care units, paediatricians, neonatologists, midwives, nurses, lactation specialists, nutritionists, development partners, and policymakers regarding strategies for strengthening human milk feeding for vulnerable newborns. The study will also provide evidence-based recommendations for expanding human milk banking services, improving donor recruitment and screening, strengthening milk collection and storage systems, training healthcare workers, improving maternal breastfeeding and lactation support, increasing awareness of donor human milk, strengthening regulatory and quality-assurance systems, and integrating human milk banking into comprehensive neonatal and maternal health programmes across Nigeria.

Keywords: Human milk banking, donor human milk, exclusive human milk feeding, preterm infants, neonatal nutrition, breastfeeding, human milk, neonatal intensive care, maternal and child health, Nigeria, public health.