Breastmilk meets all nutritional needs of a baby in first six months of life. Breast milk promotes neurodevelopment, prevents NEC, provides optimum growth of the infant, prevents sepsis, prevents asthma, atopy, eczema, hypertension and malnutrition.(1) As per WHO ranking of feeding options for newborns the sequence from best to worst is: MOM, fresh pre-term milk, fresh term mature milk, pasteurized donated breast milk, pre-term formula and other ordinary formula. (2) Due to reasons concerning the mother or the baby such as severe infections, use of medications, Hepatitis-B/C, substance use, pre-mature birth and low birth-weight, breastfeeding is sometimes not possible (3,4). A human milk bank is a service which collects, screens, processes and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant. Need of the Study: WHO and UNICEF has stated that if the baby doesn’t get his/her own mother’s milk, the best food for that baby is human breast milk from another lactating mother. Breastmilk is not recommended for mothers who have certain health problems. In the absence of the infant’s own mother milk, donor milk offers the benefits of human milk for the infant including optimal nutrition, easy digestibility and immunological protection against many organisms. Human milk also contains growth factors that can protect immature tissue, promote maturation particularly in the gastrointestinal tract, and protect healing of tissue damaged by infection. (5) The objective of breast milk banks are to ensure that every baby born or admitted to the hospital receives mother’s milk, to avoid bottle, animal and formula milk, to heighten breastfeeding awareness, to give ancillary support to breastfeeding practices and to promote baby friendly hospital care. Breast milk donation is endorsed and recommended as first alternative when it is not possible for the mother to breastfeed their hospitalized babies or if their mothers do not have sufficient milk production and any other condition where mothers may not be able to feed their babies. India’s first human milk bank was establishes in 1989 at Sion Hospital. The first Comprehensive Lactation Management Centre: CLMC ( Human Milk Bank) of Odisha was established in PGIMER and Capital Hospital, Bhubaneswar in March 2022. Nearly, more than 500 babies benefit from the services of this milk bank every year. Nearly 250 liters of human milk each year is received and feed to sick and vulnerable babies in the SNCU and NICU. In the CLMC, new mothers are provided support to breastfeed their babies, to express milk and donate excess milk for other sick babies in the hospital. However, there are certain gaps in the knowledge, attitude and practices among the mothers of babies admitted in SNCU regarding milk bank which also creates demand-supply mismatch. To bridge this gap, this study was warranted to carry out in the CLMC of PGIMER and Capital Hospital, Bhubaneswar, Odisha. Aim of the study: To assess knowledge, attitude and practices associated with milk bank among the mothers in the SNCU of a tertiary care center of Odisha

Place of Study: Department of pediatrics, PGIMER and Capital Hospital, Bhubaneswar Period of study: December 2023 to November 2024 (One year) Study Design: Cross-sectional Study Study Population: Inclusion Criteria: 1. Mothers of all babies admitted to SNCU who are donating milk in CLMC of the tertiary care center 2. More than 18 years of age 3. Able to read, write and communicate Exclusion Criteria: 1. Mothers who didn’t give consent 2. Mothers disgnosed positive for Hep-B, Hep-C and HIV 3. Mothers with Psychological illness 4. Intravenous drug users 5. Sick mothers 6. Under Chronic treatment Sampling technique: Purposive sampling Sample Size: Study outcomes collected from 147 mothers Study tool: Structured, pre-designed, pre-tested questionnaire with one to one interview method IEC Approval: IEC approval was taken from IEC, PGIMER and CH, Bhubaneswar Statistical Analysis: IBM SPSS V21

Demographic Profile: Table: 1 Variable Frequency (n=147) Percentage 1. Age Group a. <20 years b. 20-30 years c. >30 years 68 76 3 46.1 51.7 2.0 2. Education a. <10th 63 42,9 b. >10th 84 57.1 3. Employment a. Employed 44 29.9 b. Unemployed 103 70.1 4. Parity a. Primigravida 64 43.5 b. Multigravida 83 56.5 5. Mode of delivery a. NVD 102 69.4 b. LSCS 45 30.6 6. Birthweight a. <2.5kg 96 65.3 b. >=2.5kg 51 34.7 7. Gestational Age a. Pre-term 87 59.1 b. Term 60 40.9 8. Gender of baby a. Male 110 74.8 b. Female 37 25.2 9. Place of delivery a. Inborn 101 68.7 b. Out-born 46 31.3 10. SES a. Low 94 63.9 b. High 53 36.1 11. Residence a. Rural 107 72.8 b. Urban 40 27.2 12. Previous Pre-term a. Yes 32 21.8 b. No 115 78.2 Knowledge: 141(95.4%) mothers didn’t know about milk bank prior to hospitalization of their babies. 107(72.1%) mothers didn’t know that DHM is the best alternative for pre-term when MOM is insufficient or unavailable. 97(65.5%) mothers believed that most nutrients of DHM are destroyed after pasteurization. 137 (93.1%) mothers knew that feeding pre-term with DHM facilitates growth recovery from disease. All mothers knew that mothers who donate milk have to undergo screening blood tests. All mothers believed that mothers having excess milk can donate it. All mothers knew that DHM is stored in milk bank and is frozen for storage. 120(81.6%) mothers didn’t have any idea regarding duration of safety of usage of frozen, stored DHM. All mothers were aware about the location of milk bank in the hospital. All mothers knew the methods to express DHM. 117 (79.6%) mothers believed that after milk donation, milk will be sufficient for mother’s own baby. All mothers were aware that it’s not compulsory to donate milk. 91(61.90%) believed that personality of donor is important for milk donation. Attitude: 108(73.5%) mothers were willing to donate. All mothers were willing to undergo pre- donation screening. 77 (52.4%) mothers were not willing to accept DHM for their baby. All mothers believed that HM donation shouldn’t be rewarded by money. 83(56.5%) mothers’ family were supportive for milk donation. Practices: All mothers were being informed by the hospital staff regarding milk donation, informed consent taken, and pre-donation screening being practiced. 74 (50.3%) mothers were donating >4 times a day. 96 (65.3%) mothers were donating after Day 1 of delivery. All mothers were counselled regarding milk expression techniques, proper hygiene being maintained, and they were provided privacy during milk expression. All mothers used breast-pump for milk expression. All mothers were simultaneously breastfeeding their babies and are practicing KMC. No mother was taking any supplements/ medication for milk production. There were no safety concerns in the entire procedure. No mother was provided with any monetary benefit for donating milk. All mothers were provided with lactation counselling. Table: 2 Relationship between selected demographic variables with knowledge of the mothers towards milk bank Variable Chi-sqaure P value Significance Employment Employed Unemployed 10.905 0.0009 Significant Area od Residence Rural Urban 0.6199 0.431 Not Significant Parity Primi Multi 13.9219 0.0001 Significant Age <20 20-30 >30 8.0119 0.018 Significant Table-3 Relationship between selected demographic variables with attitude of the mothers towards milk bank Variable Willingness to donate Willingness to accept Significance Education P-0.03 P-0.004 Significant Socio-economic Status P-0.78 P-0.48 Not Significant Parity P-0.13 P-0.23 Not Significant

K- Majority of the mothers (95.9%) did not know about milk bank, but all of them were aware of the proper methods of expressing breast milk A-72.3% Willing to donate; but only 52.4% willing to accept DHM for their own babies P- Hand hygiene, pre-donation screening, KMC practices were upto mark (100%) There is a significant association between education and attitude of post natal mothers on human milk banking. There is a significant association between employment and age of the mother on level of knowledge on milk banking.

There is a need for a written policy. Deficits in knowledge may be attributed to relatively poor population attending government health facilities who have not been made aware of facilities called ‘milk bank’. There is a need of awareness campaigns and use of social media for the same. Facilities of milk donation should be opened at every level of health care.

1. Bertino E, Giuliani F, Occhi L, et al. Benefits of donor human milk for preterm infants: Current evidence. Early Hum Dev. 2009;85(10):S9-S10. Doi:10.1016/J.EARLHUMDEV.2009.08.010 2. Breastfeeding.” World Health Organization, World Health Organization, www.who.int/health- topics/breastfeeding#tab=tab_3. Accessed 7 Dec. 2023 3. PATH. Policy brief: Ensuring equitable access to human milk for all infants: a comprehensive approach to essential newborn care. Seattle: PATH; 2017. Global Breastfeeding Collective; 2017. 4. Lee ACC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP, et al. National and regional estimates of term and preterm babies born small for gestational. age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1(1):26–36. https://doi.org/10.1016/S2214- 109X(13)70006-8. 5. LTMGH | Human Milk Bank. Accessed January 13, 2022. http://www.ltmgh.com/frontview/inner.aspx?Mkey=M TA5NQ==&lKey=NA==