Coming soon, a human milk bank run on charity


INFANT MORTALITY: Banking on breast milk

Inside Kenya’s ambitious plan to build human milk banks.

You have heard of commercial banks, and mobile banks, or even blood banks; now brace yourself for one of the most innovative banks on these shores,  should a government project go according to plan.

The Ministry of Health, in conjunction with various partners, is on course to set up Human Milk Banks (HMBs) to address shortage of the “white gold” in Kenyan hospitals. Once this dream is actualised, Kenya will become the only other African country, after South Africa, to have human breast milk banks, designed to cater to babies who are born underweight, are severely malnourished, or have been orphaned.

Under the programme, specialised institutions will be established for the purpose of collecting, screening, processing and distributing donated human milk to meet the specific medical needs of the individuals for whom it is prescribed.

Do not rush to the nearby hospital yet, though, as the milk will only be available through prescription, and at no cost.

Human breast milk, it has long been agreed, is a matter of life and death for babies. One drop of this highly valuable natural resource contains around one million white blood cells, which strengthen babies’ immune systems and hence protect them from infection.

It particularly goes a long way for those born too soon — before 37 weeks instead of a full term of 40 weeks, or nine months. And, for Kenya, they are many, topping 193,000 annually. Data from the Ministry of Health shows that 13,300 children under five years die annually due to pre-term complications.

These babies’ survival is dependent on a myriad of factors, and one of them is breast milk.

However, their mothers may not have started producing milk as the babies were born too soon. The hospitalisation stress is also known to make breasts dry up.

The World Health Organisation recommends that a pre-term baby should receive milk from a human milk bank should its mother not be able to breastfeed.

The programme will be embedded within the breastfeeding promotion, Kangaroo Care (where infants are carried, usually by the mother, with skin-to-skin contact, allowing for warmth, and for exclusive breastfeeding as there is direct suckling from the breasts), and newborn care package already offered by the Ministry of Health.

WASTE NOT

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The Ministry of Health is on course to set up Human Milk Banks in Kenyan hospitals. Once this dream is actualised, Kenya will become the only other African country, after South Africa, to have human breast milk banks, designed to cater to babies who are born underweight, are severely malnourished, or have been orphaned. PHOTO | FILE

The idea is simple: Many nursing Kenyan mothers have surplus milk, which they throw away after expressing yet there are many babies who desperately need that milk. The mothers will be encouraged to collect this milk and donate it to collection centres, where it will be stored and delivered to those in need, in key hospitals.

The milk project, known as the Mother-Baby Friendly Initiative Plus model, is expected to be first piloted next year at the Pumwani Maternity Hospital before it is tried out in other hospitals, such as Mama Lucy Hospital, Kenyatta National Hospital, and Gertrude’s Children’s Hospital.

Kenya, however, is joining the fray a bit late, as globally there are nearly 600 human milk banks. Nearly 220 such centers are in Brazil, the forerunner of the idea, while the rest are spread out across more than 37 countries worldwide.

Kenya will borrow lessons from South Africa and Brazil as the two lead the pack in promoting donor milk for babies.

Brazil’s efforts to increase breastfeeding and milk donation are already bearing fruit as they have slashed child mortality rates by two thirds in the last 25 years, according to the Brazilian Human Milk Banks Network and the country’s ministry of health.

Brazil launched its bank network in 1998, and in the last decade nearly two million babies have benefitted from it. In 2011, the country collected 165,000 litres from 166,000 mothers and provided service to 170,000 babies.

Supported by Brazil, the human milk bank network is growing in Latin and South America.

While some mothers might cringe at the prospect of their babies being nourished by the milk of other women, this is not an entirely new idea. For instance, the Journal of Perinatal Education reports that wet nursing, where sisters or friends with similar-aged babies share breastfeeding sessions, has been common throughout the world.

During the late years of the Roman Empire, wet nurses, who were often slaves, were contracted to feed babies that had been abandoned; and in some European countries during the Renaissance, wet nursing was a strictly regulated, paying job.

Ms Betty Samburu, a senior nutrition officer at the Ministry of Health, says this practice was quite common in Kenya until the early 2000s, when the HIV/Aids epidemic sparked concerns about viral transmission through milk.

Human milk stimulates the development of the infant immune system while providing protection from germs. Transmission of antibodies, however, opens up the potential for infection with HIV, syphilis, hepatitis and herpes, among other viruses, which can pass along with these cells.

Kenya has adopted the Option B+ programme by the United Nations Children’s Fund and the Joint United Nations Programme on HIV and AIDS, where mothers and their newborns receive antiretroviral drugs to keep the baby HIV-negative while still enjoying all the benefits of breast milk.

SCREENING PROCESS

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A new mom is shown how to position the baby while breastfeeding at the Kenyatta national hospital. PHOTO | FILE

The safety of the donated milk, which Dr Catherine Mutinda of Pumwani Maternity Hospital refers to as “white gold”, will be guaranteed by numerous checks and balances. It will, however, be an uphill task to convince many women to allow their children to feed on the milk, as a survey shows mothers are particularly concerned about safety.

About 900 mothers of children aged less than three years who were surveyed on the feasibility of the project between August and December last year identified safety as their biggest concern. While there was overwhelming support for the project, at 80 per cent, participants were more willing to donate their milk than use the donations on their own children.

Some of their concerns were personal dislike, fear of transmission of diseases, hygiene concerns, quality of the breast milk after storage, and cultural beliefs. To address these concerns, the government plans to test donated milk for contamination, sterilise it and the handling and processing equipment, and educate donating women on personal hygiene.

The milk, therefore, will not move from one woman’s breast to a waiting child, as many of the respondents believed.

The first stage in the donation process would be screening of the potential donor to find out if they are on any kinds of drugs, which may pass along to the recipient baby.

Here, the donor’s medical history — including, particularly, that of HIV, Hepatisis B and C, and syphilis — will be examined. The health worker will also ensure that the woman seeking to donate can produce enough milk for her child, lest she starves her baby.

If she passes this stage, the donating mother will then be given a consent form to sign, allowing the hospital to collect her milk.

She will then be taught how to hygienically express milk, label it, and deposit it at the milk bank.

The collected milk will then labelled using a bar code that will be computed into a system for ease of follow up, if necessary.

It will also be tested for pathogens before being heated to about 65 degrees Celsius for 30 minutes  — to kill pathogens such as HIV and Hepatitis (B and C) — cooled, retested for any bacteria, frozen, and stored.

At that heat, nutritional components in the milk are not altered, and carbohydrates, fats and salts remain unchanged.

For mothers, breastfeeding has been linked to a reduced incidence of breast and ovarian cancers, diabetes and cardiovascular diseases. It also helps women return to their pre-pregnancy weight faster

The human milk banks programme is a partnership between the Ministry of Health and the Africa Population Health Research Centre, alongside PATH, an international health organisation.

REDUCED COSTS

Kiersten Israel-Ballard, the PATH project manager, says the initial phase of this project involved the feasibility study, building capacity of key stakeholders, and coming up with guidelines which are Kenya-specific.

“Moving forward, we are seeking to improve technologies for quality control systems. PATH is developing affordable, easy-to-use devices to help (the banks) operate safely and effectively.”

Such technologies include the cellphone–based FoneAstra pasteurisation monitoring system, developed in partnership with the University of Washington and the Human Milk Banking Association of South Africa, which guides workers step by step on how to pasteurise milk.

A human milk bank may cost anything from less than Sh100,000 to nearly Sh5 million to set up, but the return on investment, especially in ensuring survival of pre-term babies, is worth it.

“It will displace infant formula, which is expensive,” says Ms Betty Samburu of the Ministry of Health.

“It will reduce the overall cost of treating a sick child as well as costs of treating other complications such as sepsis through the use of donor human milk.”

This may solve one of the biggest headaches in Kenya’s health care system; that of reducing child mortality in the neonatal period — the first 28 days of life when nearly 45 per cent of all child deaths occur.

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What the law says 

The Breast Milk and Substitutes (Regulation and Control) Act of 2012 regulates the marketing and distribution of breast milk substitutes and champions for exclusive breastfeeding. Article 53 (c) of the Constitution stipulates that every child has the right to basic nutrition, shelter and health care.

The Ministry of Health has included donated human milk in newborn care guidelines as the next best alternative to mother’s own milk.