Exploring the barriers and facilitators to the acceptability of donor human milk in eastern Uganda – a qualitative study

Abstract

Background: Human milk is the best nutrition for all infants. When the mother's own milk is not available, the World Health Organization recommends the use of donated human milk and milk banking for neonates born prematurely or with medical problems. Donor human milk is rarely available in low-resource settings where both the rates of preterm birth and neonatal mortality are highest. The potential to reduce neonatal mortality through use of donated human milk is one that is yet to be fully explored in the African setting. For the introduction of any new health intervention to be successful, determining the barriers and facilitators to its acceptability is a vital first step. There are limited studies on this in sub-Saharan Africa. Methods: This qualitative study used focus group discussions and in-depth interviews to explore the potential barriers and facilitators to utilizing donated human milk for neonates in a hospital setting in eastern Uganda from the perspectives of caregivers (parents, grandparents) and healthcare workers. Results: Six focus group discussions involving 28 caregivers were conducted in a hospital setting in eastern Uganda. Four in-depth interviews were then also held with healthcare staff. Lack of knowledge of donated human milk emerged with discussants, and the barriers relating to transmission of infection (HIV) and poor hygiene. Common reasons which facilitated its acceptability were; a general knowledge and recognition that human milk is better than formula milk and a strong belief by caregivers in healthcare workers providing knowledgeable and safe care. Healthcare workers were supportive of introducing donor human milk but perceived a need for community and hospital education programs to enable this to be facilitated and scaled up. Conclusions: This study shows that donor human milk can be acceptable to the caregivers of vulnerable babies in hospital settings in Uganda. Lack of awareness of donor human milk, its benefits and the methods of screening, acquisition and storage of donor milk are all barriers that could be addressed through improved education. This study advocates for national policies and programs that build capacity for effective and sustainable donor milk banking.

Rural Nurses’ Views on Breastmilk Banking in Limpopo Province, South Africa: A Qualitative Study

“…Furthermore, healthcare workers are the most likely people to encourage mothers to use donated milk [ 19 ]. It was also reported that in this area, caregivers mostly rely on healthcare workers, who advise them on accurate information that is most beneficial for their infants [ 34 ]. Hospital-based education and increased awareness in the community are definitely imperative, and must occur during antenatal visits [ 23 , 34 ].…”

“…It was also reported that in this area, caregivers mostly rely on healthcare workers, who advise them on accurate information that is most beneficial for their infants [ 34 ]. Hospital-based education and increased awareness in the community are definitely imperative, and must occur during antenatal visits [ 23 , 34 ]. In order to reach the maximum donor population, awareness of breastmilk donation should be emphasised in society using numerous means such as mass communication, Non-Governmental Organizations (NGOs), and social clubs, which can play a role in motivating donors [ 35 ].…”

The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo

“…Previous studies conducted in African countries 28 have identified similar ‘complex’ 29 or ‘gendered’ 30 decision-making processes that can delay pregnant women’s search for care and determine the acceptance of maternal health interventions. 31 …”

“…Previous studies conducted in African countries 28 have identified similar 'complex' 29 or 'gendered' 30 decision-making processes that can delay pregnant women's search for care and determine the acceptance of maternal health interventions. 31 Beyond husband's and relatives' perspectives, pregnant women's perceptions of SP for use in IPTp also shape their acceptance of the C-IPTp strategy. The perception that SP can induce adverse effects was a recurrent finding throughout the study that is mirrored in other qualitative studies on MiP prevention strategies.…”

“…In this light, the acceptability of C-IPTp from the perspective of husbands and relatives is key to its success. Previous studies conducted in African countries28 have identified similar ‘complex’29 or ‘gendered’30 decision-making processes that can delay pregnant women’s search for care and determine the acceptance of maternal health interventions 31…”