There is strong evidence for the role of donor human milk (DHM) from human milk banks as a secure alternative to MOM especially among preterm infants in the neonatal intensive care unit [9, 10]. Also, studies have shown that DHM ultimately improves breastfeeding rates/consumption of mother’s own milk [5, 6]. These are the main reasons for establishing human milk banks. However, the implementation of this practice varies globally. In this observational study, our objective was to assess the knowledge and perceptions of healthcare workers regarding HMB and DHM, aiming to gain insights into the prevailing attitudes and understanding within the healthcare community in Ekiti State, Southwest Nigeria.

This study revealed that HCWs are knowledgeable about HMB. These findings can also be cautiously interpreted as follows: HCWs are likely to support HMB in our environment, as most of them are willing to donate their breast milk and encourage other mothers to donate. A notable majority of healthcare workers (52.8%) in this study exhibited reluctance to allow their infants to receive DHM, a finding consistent with the observations of Chagwena et al. in Zimbabwe [25], who reported a similar trend with a greater proportion (69%). Interestingly, when examining the acceptance of DHM across various professions, doctors and pharmacists emerged as the groups demonstrating the highest levels of acceptance for their own children. This finding aligns with Chagwena et al. [25] in Zimbabwe, suggesting a pattern of greater acceptance among medical professionals. Regarding the inclination to donate, the substantial number of respondents expressing a willingness to donate breastmilk has a positive trend, contrasting with the findings of Chagwena et al. [25], where less than half of the respondents demonstrated a similar willingness. Possible explanations for these differences may stem from increased access to information on the subject matter, as the Zimbabwe study was conducted approximately four years before our study.

Notably, HAs exhibited a less favourable attitude toward HMB in this study. The majority of the HA were not willing to donate their breastmilk or accept donated breast milk to feed their babies. Additionally, approximately half of the mothers in this group were not inclined to donate their breast milk. It is essential to highlight that health assistants play a crucial role in primary healthcare delivery in Nigeria, often being the first point of contact for mothers and clients at primary health centres within the community.

This study underscores the importance of disseminating information about HMB to all categories of health workers in Nigeria. By addressing the knowledge gaps and attitudes among health assistants and other healthcare professionals, there may be an opportunity to consider and propose the establishment of HMB services. Furthermore, improving the quality of information provided to mothers is essential, as it empowers them to make informed and appropriate choices for the well-being of their children [23, 25, 26]. It is important to state that though DHM is the clinically preferred supplement when maternal milk is insufficient all efforts should first be made by HCWs to increase the mother’s own milk production.

Breastfeeding is integral to achieving the Sustainable Development Goal (SDG), Goal 3, Target 3.2, aiming to reduce neonatal mortality to 12 per 1000 live births and under-5 mortality to 25 per 1000 live births by 2030 [27]. Emphasizing the significance of DHM over breast milk substitutes (BMSs) is crucial in this context. The hesitancy of healthcare workers (HCWs) to accept DHM, despite expressing a preference for DHM over BMS in this study, suggests a bias that might have cultural or religious roots. For example, the Islamic religion adherents believe in milk kinship which means that human milk creates a relationship between a breastfeeding woman, her biological child who is being breastfed, and her nonbiological children whom she is also breastfeeding and this relationship prohibits future marriages between these “milk brothers and sister” [28]. Although this study did not delve into detailed sociocultural influences, addressing and understanding these factors are essential for providing effective HMB services.

Moreover, this study highlights the diverse sources of information influencing negative perceptions of HMB, with many respondents citing the internet, formal education, personal knowledge, and workplace experiences, sources that may lack evidential backing. This underscores the need to disseminate accurate information about HMB throughout the community, correcting misconceptions that contribute to biases against HMB services.

Some HCWs in this study reported a significant hurdle to the success of HMB, particularly related to concerns about its safety. Some HCWs believed that HMB could transmit genetic diseases, indicating a knowledge gap that could be addressed through appropriate health education. In regions with strong negative cultural perceptions and a high prevalence of infections, it is crucial to convince HCWs about the safety of DHM for HMB to gain acceptance in the community. Despite infrastructural challenges in Nigeria that might make this infant feeding option seem unattainable, successful models in other countries highlight that strong political will and effective information dissemination can overcome such obstacles.

Some scholars have raised concerns about the potentially greater cost associated with setting up DHMB and DHM compared to the cost of BMS [29, 30]. Hence, providing adequate support, information, and education to breastfeeding mothers with insufficient milk to help improve their milk production should be the priority in low-resource settings such as Nigeria. However, it is crucial to emphasize that the advantages of DHM surpass this challenge, particularly when contrasted with the expenses linked to managing morbidities such as necrotizing enterocolitis, sepsis, and feeding intolerance, which are conditions effectively reduced by DHM [8, 31,32,33,34]. The practice of HMB has also been associated with increased breastfeeding rates [5, 6] and this hopefully should help in improving the exclusive breastfeeding rate in Nigeria which currently stands at 34% which is still far from the 50% target for 2025 set by the WHO in 2014 [35].

Healthcare workers play pivotal roles in the success of HMB, as evidenced by prior studies indicating that sufficient knowledge and a positive attitude among healthcare professionals toward breastfeeding can motivate mothers to breastfeed their infants and contribute milk to feed other babies [18, 36]. It is imperative to integrate HMB-related information and education into the training of healthcare workers in Nigeria, as well as establish human milk banks. Furthermore, policymakers in Nigeria need to make substantial investments in educating healthcare professionals about feeding practices for infants and young children, emphasizing the utilization of DHM for medical purposes. This finding aligns with the recommendations of Chagwena et al. [25] in the Zimbabwe study. Enhanced education for HCWs will not only increase the quality of the information provided to mothers but also empower them to make well-informed and appropriate choices for their children.

It is noteworthy to mention that a human milk bank was established in Lagos in August 2022, however, there are challenges confronting the practice such as, the inability to leave the pasteurized milk in the hospitals because of the lack of steady power supply, and behavioural challenges with regards to the availability of donors and the acceptability of the donated milk.