Had Alice Onyango given birth at another time, things would have been different. She would have had to express milk from her aching engorged breasts – the milk that her preterm baby had no energy to suckle – and pour it down the drain.
But the mother of three gave birth last week at Pumwani Maternity Hospital in Nairobi, just when the hospital was putting finishing touches on Kenya’s first human milk bank.
Her daughter, Genevieve, was born six weeks early – at 34 weeks – and wasn’t able to suckle until four days after birth. Even when she started suckling on the fourth day, she didn’t suckle much, leaving her mother’s aching breasts with more milk than she knew what to do with.
Luckily, she didn’t have to grapple much with thoughts of what to do with it, as she was recruited to donate milk to the bank at the neonatal intensive care unit at Pumwani that has been in the works since 2016.
The bank, which was officially launched last Friday, is meant to help make a dent in Nairobi’s neonatal deaths (deaths during the first 28 days of life), which stand at 38 deaths per every 1,000 live births – the highest in the country – by providing lifesaving breast milk to babies who are born premature, those born underweight or severely malnourished, those who are orphaned, and those who otherwise have no access to their mother’s milk.
The World Health Organisation (WHO) recommends that a preterm baby should receive milk from a human milk bank should its mother not be able to breastfeed.
It is in this context that the WHO issued a global call to scale up the establishment of human milk banks for the provision of safe donated human milk and to ensure timely access for at-risk infants. Without a milk bank, such babies (preterm babies make up 12 per cent of babies born in Kenya) previously had to be fed on formula, which is associated with increased risk of diarrhoea, feeding intolerance, necrosis of the bowel, sepsis and other infections.
But now they can drink from the generosity of the breasts of Alice and nine other mothers who have been recruited as breast milk donors. The donors, recruited from the Kangaroo Mother Care Unit that promotes skin-to-skin contact for babies born prematurely or with low birth weight, only supply the milk bank after feeding their babies.
Alice, for instance, breastfeeds her daughter for 20 minutes on each breast, then expresses the rest – 40 to 45 millilitres – for the milk bank, expressing in the morning and at midday using a breast pump provided by the hospital. She has been at it for three days. Nineteen-year-old Elizabeth Stephanie, another donor, gave birth prematurely at 29 weeks, and her son takes in only 10 millilitres of breast milk through a pipe. Given that her son only consumes a quarter of the milk she produces, she is happy to donate the rest to the milk bank.
But being a donor is not just a matter of having excess breast milk. Back in 2017, just after the process of setting up the milk bank began, researchers from the Africa Population Health Research Centre and the Program for Appropriate Technology in Health (PATH) interviewed 900 mothers of children aged less than three years, in Nairobi, for a feasibility study.
While eight out of 10 said that they would donate their breast milk, only six out of 10 would be comfortable having their babies feed on donated breast milk. However, 85 per cent endorsed the idea of feeding children in need with donated breast milk. Most said that the preferred donors should be healthy women. Among the concerns raised about donated breast milk were risks of disease transmission and poor hygiene of donor.
However, Dr Mary Waiyego, a neonatologist at the Pumwani Maternity Hospital, who also heads the human milk bank technical committee, says that the safety of the milk is guaranteed by numerous checks. Before the milk moves from the mother’s breast to the child who needs it, the prospective donors and their milk will undergo screening to ensure they are free from conditions that are transmissible through breast milk.
The milk will also be tested for contamination and pasteurised to kill microorganisms without altering its nutritional composition, before being frozen and stored in 50-millilitre bottles in freezers to preserve it. From there, it can be retrieved and given free of charge to the babies who need it. Priority is given to sick preterm babies, preterm babies, sick term babies, and lastly a term baby without access to its mother’s milk.
The milk bank will come in handy in efforts to reduce neonatal deaths in Kenya, 13,300 of which are blamed on preterm complications every year, if its tentacles spread out to other hospitals. For now, the team is focusing on making the milk bank at Pumwani work.
Thereafter, they will extend to three other hospitals in Nairobi – Mama Lucy Hospital, Kenyatta National Referral Hospital and Gertrude’s Children’s Hospital – using the infrastructure at Pumwani, but recruiting more donors from the selected hospitals. Later, the Nairobi County project could extend to other referral hospitals such as Moi Teaching and Referral Hospital in Eldoret, and the Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, but there are no plans for a national rollout for now.
“For now, we are restricting the process to Pumwani Maternity Hospital as we try the structure when the systems are set on how to distribute and get milk outside, then we will get to hospitals like Mama Lucy Hospital, Kenyatta National Hospital, and Gertrude’s Children’s Hospital,” says Dr Waiyego.
The odds are often stacked against babies born prematurely (before 37 weeks) and in Kenya, there are 193,000 such babies every year. While survival depends on a myriad factors, breast milk could be one factor that makes a big difference.
“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,” says Betty Samburu, a senior nutrition officer at the Ministry of Health.
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 the survival of preterm babies, is worth it.
“It will replace infant formula, which is expensive. It will also reduce the overall cost of treating a premature baby, including the costs of treating other complications such as sepsis,” adds Ms Samburu.
The machine handles 9.4 litres per cycle, a cycle takes two hours to run. It is fitted with 36 bottles of 120ml, which is equivalent to four litres at a go. A cycle can help about 50 children depending on their feeding pattern. The machines can run as many cycles as possible so long as there is running water.
This may solve one of the biggest headaches in Kenya’s healthcare system; that of reducing child mortality in the neonatal period, when nearly 45 per cent of all child deaths occur.
The Ministry of Health has included donated human milk in newborn care guidelines as the next best alternative to mother’s own milk, while the Breast Milk and Substitutes Regulation and Control Act champions exclusive breastfeeding. The setting up of the milk bank paves the way for implementing these guidelines for all babies, and helping them get a fighting chance at life from the benefits of breast milk. Breast milk works as the baby’s first vaccine to boost immunity, and serves as a baby’s best source of nutrition during the first six months of life, laying the foundation for good health and survival beyond the five-year mark.
Kenya becomes the only other African country, after South Africa (which has more than 20 banks) to have human breast milk banks. There are more than 500 human milk banks in 37 countries in the world, with most (220) in Brazil, which has recorded savings of Sh54 billion in healthcare costs by avoiding the costs of having to treat newborns for illnesses or conditions that they may develop in the absence of their mother’s milk.
Savings are also realised from shorter hospital stays and reduced use of expensive formula. This makes human milk banks a safe and cost-effective measure that gives more children access to the benefits of breast milk.