Knowledge and perceptions of donor human milk among university health sciences students in southern Ecuador: a...

Donor human milk (DHM) is the safest nutritional alternative when breastfeeding is not possible, particularly for preterm newborns. Health sciences undergraduate students will play a key role in DHM counseling, promotion, and appropriate clinical use; however, evidence on their knowledge and perceptions in Latin America remains limited.

To assess and compare the knowledge and perceptions regarding donor human milk (DHM) among undergraduate students of Medicine, Nursing, and Nutrition and Dietetics in southern Ecuador, and to examine the association between both variables according to academic program.

An analytical cross-sectional study was conducted between October 2022 and April 2023 at a university in southern Ecuador. A total of 387 valid questionnaires were analyzed using convenience sampling. Data were collected using three structured instruments: a sociodemographic/academic questionnaire, an ad hoc 12-item dichotomous knowledge questionnaire, and an ad hoc 15-item dichotomous perception questionnaire. Associations were explored by academic program. The association between knowledge and perception scores was assessed using Spearman's rank correlation coefficient (rs). Adjusted odds ratios (OR) were estimated for knowledge categories by academic program.

Overall, 59% of participants showed low DHM knowledge and 41% high knowledge, with significant differences across academic programs (p = 0.007). Perceptions were predominantly favorable (75.2%) and did not differ significantly across sociodemographic or academic groups (p > 0.05). A weak but statistically significant positive correlation between knowledge and perception scores was observed in the overall sample (rs = 0.12; p = 0.02) and among Nursing (rs = 0.165; p = 0.02) and Nutrition and Dietetics students (rs = 0.29; p = 0.02), whereas no significant correlation was found among Medicine students (rs = -0.02; p = 0.80). Nutrition and Dietetics students showed higher odds of adequate knowledge in categories related to DHM storage (OR = 2.39; 95% CI: 1.36-4.15) and DHM availability, access, and clinical use (OR = 2.03; 95% CI: 1.16-3.55).

Although perceptions toward DHM were favorable, knowledge gaps persist. The association between knowledge and perception was weak and not uniform across programs, highlighting the need to strengthen and standardize undergraduate training to support evidence-based counseling and improve DHM implementation.