Introduction
Because human milk is still the only milk that is specifically crafted and perfectly matched for a baby, breastfeeding is still the greatest way to feed a baby. It should be emphasised to all women that they should nurse their children.1 One joint declaration from WHO and UNICEF reads, “Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human milk from other sources.”2 The first six months of a baby’s life should be spent solely on breastfeeding.3 As the best unique first source of nutrition, it is acknowledged on a global scale. Due to the physical and psychological benefits of nursing, mothers may not be able to produce a whole volume of milk
When a mother, for some reason, is unable to feed her infant directly, her breastmilk should be expressed and fed to the infant. If mother’s own milk is unavailable or insufficient, the next best option is to use pasteurized donor human milk (PDHM). India faces its own unique challenges, having the highest number of low birth weight babies, and significant mortality and morbidity in very low birth weight (VLBW) population. In our country, the burden of low birth -weight babies in various hospitals is about 20% with significant mortality and morbidities.4
Demand for human donor milk
There are various factors that make a mother’s own milk for her kid scarce or unavailable. Included in this are baby illnesses, difficulty latching, maternal illness or death, and abandonment. Due to physical obstacles and psychological strain, a mother may not make enough milk if a baby is preterm or admitted to a neonatal intensive care unit. The World Health Organization and other policy organisations advise donor human milk as a suitable replacement in such circumstances. By selecting and recruiting breast milk donors, collecting, processing, screening, pooling, and giving to newborns in need, a human milk bank serves a key role. 5
In 1909, the first human milk bank opened in Vienna, Austria and the first in North America opened in 1919 in Boston, USA. 6, 7 Worldwide, there are about 517 breast milk banks. However, the Sion Hospital in Mumbai, India, became home to the first breast milk bank in Asia in 1989. 8 In 2013, first public sector breast milk bank was established in Kolkata.9
Breast milk banks aim to provide mother’s milk to all newborns and hospital patients, avoiding bottle, animal, and formula milk, raising breastfeeding awareness, supporting breastfeeding habits, and promoting Baby Friendly Hospital care. 10
The best strategy to reduce infant mortality in India is to increase the number of breast milk banks. In order to improve outcomes and promote their health, nutrition optimisation is crucial. Because they are affordable and simple to manage, breast milk banks are highly important. Government and community involvement are crucial in motivating hospitals and non-profit organisations to work towards the development of more breast milk banks. 5
Materials and Methods
This quantitative, non-experimental, descriptive study was conducted at Paediatric department of tertiary care hospital of India. Total sample size was 206 nursing officers working in paediatric, obstetric and gynae departments. Tools used for the study consists of two parts.
Part A: Socio-demographic data
This part of consists of demographic information of the study participants such as age, gender, professional qualification, working area, working department and working experience.
Part B: Structured questionnaire to assess the knowledge of nursing officers regarding importance of human milk banking working in obstetric, gynae and pediatric wards
This part of tool consists of 25 structured multiple-choice questions having one correct answer among four options to assess the knowledge of nursing officers regarding human milk banking. Each item had a score of one (1) mark for correct answer and zero (0) for incorrect answer with overall score range from (0-25). Reliability of the tool was established by split-half method which is 0.83 (highly reliable).
Ethical considerations
Ethical approval was taken from Institutional Ethical Committee. A written informed consent was taken from each participant.
Statistical methods
The data was analyzed by using the descriptive statistics by calculating mean, median and standard deviation and inferential statistics by applying chi-square to assess the association of level of knowledge with selected demographic variables under study and karl pearson correlation is used to calculate the reliability of the tool.
Results
Part A: Socio-demographic characteristics of study participants
The frequency and percentage distribution of study participants as per their socio demographic characteristics is shown in Table 1.
More than half of the nursing officers (63.6%) were from the age group of 31-40 years and least number (5.8%) were from the age group 51-60 years. Majority of nursing officers (79.1%) were females whereas (20.9%) were males with M:F ratio of 0.26:1. Majority of nursing officers (93.2%) had professional qualification GNM course followed by (6.3%) BSc. Nursing. Only one (0.5%) had professional qualification of MSc. Nursing.
As per their working department (40.8%) nursing officers were working in neonatal ICU /paediatric ICU. Almost equal number of nursing officers were working in paediatric (30.1%) and gynae (29.1%) ward. Almost half of the nursing officers (52.4%) had working experience of 5-10 years followed by less than 5 years (25.2%) of experience. 14.1% and 5.8% of nursing officers had working experience of 10 -15 years and more than 20 years respectively. Hence, concluded that majority of nursing officers were females of age group of 31-40 years having professional qualification GNM Course. Maximum of nursing officers were working in neonatal ICU/Paediatric ICU having working experience of 5-10 years.
Part B: To assess the knowledge of nursing officers regarding importance of human milk banking.
Table 2 shows the frequency and percentage distribution of level of knowledge ofnursing officers. More than half of the nurses (57.8%) had adequate knowledge whereas, (42.2%) nursing officers had inadequate knowledge. Thus, more than half of nurses had adequate level of knowledge.
The skewness was calculated by using formula [3(mean - median)/SD] and found to be -0.45 suggesting the distribution is slightly –ve skewed. This implies that number of nurses having adequate knowledge is more towards the right side of the curve than to left, signifying more number of nursing officers have adequate knowledge that is (57.8%). Thus, it can be concluded that the more than half of the nursing officers have adequate knowledge regarding human milk banking.
Table 3 shows that19 (9.2%) nursing officers in the group 20-30 years had adequate knowledge regarding importance of human milk banking while 19 (9.2%) had inadequate level of knowledge. On the other hand, only 7 (3.4%) nursing officers in age group 51-60 years age group had adequate knowledge. 78 (37.9%) and 15 (7.3%) nursing officers in age group 31-40 years and 41-50 years had adequate knowledge respectively while 53 (25.7%) and 10 (4.9%) nursing officers in age group 31-40 years and 41-50 years had inadequate knowledge respectively. To explore the association of level of knowledge with age, Chi-square ᵡ2, test was computed, the value of which was found to be 1.16 with p-value 0.762 which was statistically not significant. Hence, it was concluded that level of knowledge has no association with age.
Table 4 shows that 28 (13.6%) male nursing officers had adequate level of knowledge while 15 (7.3%) had inadequate level of knowledge. On the other hand, 91 (44.2%) female nursing officers had adequate level of knowledge while 72 (34.9%) had inadequate level of knowledge. To explore the association of level of knowledge with gender, Chi-square ᵡ2, test was computed, the value of which was found to be 1.2031with p-value 0.27 which was non-significant at p-value. Hence, it is concluded that level of knowledge has no association with gender.
Table 5 reveals that 111 (53.9%) nursing officers with professional qualification GNM course had adequate knowledge regarding importance of human milk banking while 81 (39.3%) of them had inadequate level of knowledge. 8 (3.9%) nursing officers with professional qualification BSc. Nursing had adequate knowledge while 5(2.4%) had inadequate knowledge. There was only one nursing officer with professional qualification MSc. Nursing and he had inadequate knowledge. To explore the association of level of knowledge with professional qualification, Chi-square ᵡ2, test was computed, the value of which was found to be 1.443 with p-value 0.48 which was statistically not significant. Hence, it is concluded that level of knowledge has no association with professional qualification.
Table 6 depicts that 55 (26.7%) nursing officers working in neonatal ICU/paediatric ICU had adequate knowledge while 29 (14.1%) had inadequate knowledge. Nursing officers working in paediatric ward had similar level of knowledge regarding importance of human milk banking. On the other hand, 33 (16%) of nursing officers working in gynae ward had adequate knowledge while 27 (13.1%) had inadequate knowledge. To explore the association of level of knowledge with working department, Chi-square ᵡ2, test was computed, the value of which was found to be 3.767 with p-value 0.015 which was significant at p-value < .05. Hence, data shows that nursing officers working in paediatric department had more knowledge regarding human milk banking as compare to nurses working in Gynae department.
Table 7 reveals that 27 (13.1%) nursing officers having working experience less than 5 years had adequate knowledge regarding importance of human milk banking while 25 (12.1%) had inadequate level of knowledge. 62 (30.1%) nursing officers having working experience 5-10 years had adequate knowledge while as 46 (22.3%) had inadequate knowledge. On the other hand, 4 (1.9%) and 7 (3.4%) nursing officers having working experience 15-20 years and more than 20 years respectively had adequate knowledge. To explore the association of level of knowledge with working experience, Chi-square ᵡ2, test was computed, the value of which was found to be 3.229 with p-value 0.520 which was non-significant at p-value. Hence, it is concluded that level of knowledge had no association with working experience.
Table 1
Frequency and percentage distribution of the nursing officers according to their demographic variables (n=206)
Table 2
Frequency and percentage distribution of level of knowledge of nursing officers
|
Level of knowledge |
Criteria/Range |
Number (%) |
|
Adequate knowledge |
≥ 20.68 |
119 (57.8) |
|
Inadequate knowledge |
Below mean ˂ 20.68 |
87 (42.2) |
Table 3
Association of level of knowledge with age
Table 4
Association of level of knowledge according to gender
|
Gender |
Adequate knowledge N (%) |
Inadequate knowledge N (%) |
Total |
Chi-square value |
P- Value |
|
Male |
28 (13.6) |
15 (7.3) |
43 |
1.2031 |
0.27 |
|
Female |
91 (44.2) |
72 (34.9) |
163 |
||
|
Total |
119 |
87 |
206 |
Table 5
Association of level of knowledge with professional qualification
Table 6
Association of level of knowledge with working department
Table 7
Association of level of knowledge with working experience
Discussion
The findings of the present study reveal that 57.8% of nursing officers had adequate knowledge while 42.2% had inadequate knowledge regarding human milk banking. Study by Kumari P et al 11 showed that 66% had adequate knowledge. Findings in study by Renuka 12 revealed that 15% staff nurses had poor knowledge, 66.66% had average knowledge and 18.37% had good knowledge. Bhat Asha Vinod did a study among B.Sc. Nursing students and found that only 3% had poor knowlegde, 33% had good knowledge and rest had average knowledge. 13 On contrast to these studies, Safeena Beevi et al 14 reported that only 6.82% of nursing officers had adequate knowledge about human milk banking.
In our study 37.9% nursing officers in the age group 31-40 years had adequate knowledge human milk banking. This observation was similar to other study. 11 Pankaj Ray et al 15 showed slightly higher (80%) incidence in this age group. Nursing officers with professional qualification GNM course had adequate knowledge regarding importance of human milk banking which is similar in other studies also.
Data from our study showed that nursing officers working in paediatric department had more knowledge regarding human milk banking as compare to nurses working in Gynae department. This was observed in other studies also. Nursing officers having working experience 5-10 years had more adequate knowledge than more than 10 years of experience this was in contrast to study by Poonam Kumari et al.
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