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Impact of Expressed Breast Milk Storage Education on Safe Breast Milk Storage Practices among Nursing Mothers in Nigeria

Abstract

Expressed breast milk storage is an important component of safe infant feeding, particularly for nursing mothers who express breast milk because of work, school, travel, maternal-infant separation, or other circumstances. Appropriate handling and storage of expressed breast milk can help preserve its quality and reduce the risk of contamination before it is given to an infant. However, nursing mothers in Nigeria may experience difficulties with safe breast milk storage because of limited knowledge, inconsistent access to refrigeration, unreliable electricity supply, inadequate storage containers, uncertainty about storage duration, inappropriate temperature control, and conflicting information from informal sources. Expressed breast milk storage education provides an opportunity to improve mothers' knowledge and practical skills concerning collection, labelling, storage, transport, thawing, warming, and use of expressed breast milk. Against this background, this study investigates the impact of expressed breast milk storage education on safe breast milk storage practices among nursing mothers in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Social Ecological Model. The Health Belief Model explains how mothers' perceptions of the benefits of safe breast milk storage, perceived risks of contamination, perceived barriers, self-efficacy, and cues to action may influence storage practices. Social Cognitive Theory emphasizes observational learning, practical demonstration, behavioural modelling, self-efficacy, reinforcement, and environmental influences in developing safe breast milk handling behaviours. The Social Ecological Model highlights the influence of individual knowledge, family support, workplace conditions, healthcare providers, household resources, electricity and refrigeration access, community factors, and broader health systems on expressed breast milk storage practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how expressed breast milk storage education may influence safe breast milk storage practices among nursing mothers in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise nursing mothers who express breast milk and have infants aged 0–24 months residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, workplaces where appropriate, and eligible nursing mothers. Expressed breast milk storage education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, appropriate hand hygiene before expression and handling, selection and cleaning of storage containers, labelling and dating of expressed milk, recommended storage conditions, appropriate storage duration, refrigeration and freezing practices, safe transport of expressed milk, separation of newly expressed milk from previously stored milk where appropriate, thawing methods, warming methods, avoidance of unsafe heating practices, handling of partially consumed milk, recognition of spoiled or improperly stored milk, and safe cleaning of breast milk storage equipment. Safe breast milk storage practices will be assessed using indicators such as hand hygiene, appropriate expression and collection methods, use of suitable clean storage containers, proper labelling, correct storage temperature, appropriate storage duration, safe refrigeration or freezing, proper transport, safe thawing, appropriate warming, avoidance of direct heating or unsafe temperature-control methods, appropriate handling of leftover milk, and safe disposal of milk that has been improperly stored or contaminated. Data will be collected using structured questionnaires, breast milk storage knowledge assessment tools, practice checklists, storage-container observation where appropriate, maternal feeding records, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize mothers' demographic and socioeconomic characteristics, breastfeeding experiences, reasons for expressing breast milk, access to refrigeration and electricity, sources of information, and storage practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of expressed breast milk storage education on safe breast milk storage practices. Where a quasi-experimental design is adopted, storage-practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that expressed breast milk storage education has a significant positive impact on safe breast milk storage practices among nursing mothers in Nigeria. Mothers exposed to structured, practical, evidence-based, and culturally appropriate education are expected to demonstrate improved breast milk handling and storage practices compared with mothers without comparable exposure. Education may improve mothers' understanding of appropriate collection, labelling, refrigeration, freezing, transportation, thawing, warming, and storage-duration practices. Practical demonstrations may increase mothers' confidence in handling expressed breast milk safely and reduce inappropriate practices that may increase the risk of contamination or deterioration. Education may also help mothers make safer decisions when refrigeration or electricity is limited and encourage them to seek professional breastfeeding support when storage difficulties arise. However, unreliable electricity supply, inadequate refrigeration, financial constraints, limited access to suitable storage containers, workplace limitations, maternal workload, insufficient family support, and inadequate breastfeeding support services may reduce the effectiveness of education alone. The study therefore expects accessible, practical, culturally appropriate, and sustained expressed breast milk storage education, supported by appropriate breastfeeding counselling and enabling household and workplace conditions, to contribute significantly to improved safe breast milk storage practices among nursing mothers in Nigeria. The study is expected to contribute to the literature on expressed breast milk, breastfeeding, infant nutrition, breast milk storage, maternal and child health, breastfeeding support, food safety, health education, 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, primary healthcare centres, maternity facilities, breastfeeding-support programmes, nurses, midwives, lactation-support personnel, community health workers, employers, development partners, and policymakers regarding strategies for improving safe expressed breast milk handling. The study will also provide evidence-based recommendations for integrating expressed breast milk storage education into maternal and child health services, strengthening practical breastfeeding counselling, improving access to suitable breast milk storage facilities, supporting breastfeeding mothers in workplaces and communities, addressing electricity and refrigeration challenges, training healthcare workers in expressed milk-storage counselling, and developing sustainable breastfeeding-support programmes that promote safe breast milk storage practices among nursing mothers across Nigeria.

Keywords: Expressed breast milk storage education, safe breast milk storage practices, nursing mothers, expressed breast milk, breastfeeding, infant nutrition, maternal and child health, breastfeeding support, food safety, health education, Nigeria, public health.