1. Human Milk Banking Rachel N Musoke Professor Paediatrics/Neonatology
Department of Paediatrics & CH
University of Nairobi, Kenya
Human milk banking - KPA April 2019

2. Human milk banking - KPA April 2019
History: Milk banking
HMB is more than 100 yrs old
Has been refined and made more safe
Receiving donor human milk is 100 times safer than receiving blood!
Should not be confused with ‘human milk sharing’
1st HMB 1909 Vienna, Austria
Human milk banking - KPA April 2019

3. “Human Milk is Essential to Newborn Care”
WHO/UNICEF recommendations:
Exclusive human milk feeding
Mother’s own milk (MOM)
When MOM is not (yet) available – donor human milk (DHM)next best option (where safe HMB facilities are available)
2008 WHA Resolution called on countries to make DHM available
Promoting HMB is part of the strategy for protecting, promoting, and supporting breastfeeding
Human milk banking - KPA April 2019

4. What makes donor human milk safe?
Rigorous Donor Screening
Lifestyle
Maternal diseases and Medications
Serology
Strict contraindications (permanent or temporary)
Education on breastmilk expression & storage (if done at home) specified containers
Donor screening based on blood &/or tissue donation. Preferably with national laws and regulations.
Human milk banking - KPA April 2019

5. What makes donor human milk safe?
Operative procedures in the milk bank
Good Manufacturing Practice and Hazard Analysis Critical Control Point (HACCP)
From donor to recipient
Bacteriology pre & post processing
Storage before & after pasteurization
Record keeping and documentation
Processing is based on diary industry with more stringent steps. HACCP is a systematic preventive approach to identify, evaluate, and control significant hazards to food safety. HACCP has 4 steps that must be followed
Human milk banking - KPA April 2019

6. What makes donor human milk safe?
Pasteurization methods
Low temp, long time: Holder pasteurization– 62.5oC for 30minutes
High pressure processing
High temp short time 72oC for 15 seconds (Flush-heat)
Effect on compositions
Balance between killing microorganisms and preserving anti-infective properties as well nutrients in the milk
Human milk banking - KPA April 2019

7. Human milk banking - KPA April 2019
Milk bank processing
Work top
Laboratory
Human milk banking - KPA April 2019

8. Human milk banking - KPA April 2019
Milk bank processing
PiAstra equipment
Flush heat treatment
Human milk banking - KPA April 2019

9. Human milk banking - KPA April 2019
Types of HMB & donors
Working within MBFHI
HMB
Stand alone
Within the hospital complex
Donors
Mothers within the hospital – esp NBU & KMC
Mothers of term infants – from home
Pooled or not
Human milk banking - KPA April 2019

10. Human milk banking - KPA April 2019
Recipients
Recipient baby – informed parental consent
Usually VLBW but can be any in need
Mother’s milk not available or partially so
Limited period while working with mother
Traceable donor through records or not
Human milk banking - KPA April 2019

11. Kenyan studies: Nairobi
1. Joyce Munge 2011
102 mothers in Pumwani Maternity Hospital – 87.4% support HMB
2. Kelvin Kiplimo 2018
51 mothers in Kenyatta National Hospital – 80.% no knowledge; 90% would donate but 47% would accept use
Human milk banking - KPA April 2019

12. Kenyan studies: Nairobi
The road to establishing HMB ( )
3.Research: APHRC, PATH, MOH, UON, UNICEF
Quantitative – 981 mothers
Qualitative – 17 FDGs, 21 KI, 25 ID
The visit to South Africa
Training & development of guidelines
Human milk banking - KPA April 2019

13. Human milk banking - KPA April 2019
Study 3 findings
Health Facility
Interviews Conducted
Gertrude's Lavington
226
Gertrude’s Muthaiga
286
Kenyatta National Hospital
217
Mama Lucy hospital
252
TOTAL
981
Human milk banking - KPA April 2019

14. Study 3: Views on donating to HMB
78% of the mothers would donate.
80% not particular on the recipient.
Preferred recipients (for those who were particular) – any child in need of BM(64%), Orphans (59%) relatives (22%),very sick child (21%).
80% would not donate to irresponsible mothers
Human milk banking - KPA April 2019

15. Views on feeding children on DHM from HMB
Study 3
Views on feeding children on DHM from HMB
59 % would allow their children to be fed on donated human milk from HMB Mothers (70%) whose children had complications at birth more like to allow (P=0.05) Majority would accept DHM from any healthy mother (55%) and relatives (24%)
Human milk banking - KPA April 2019

16. Concerns on donating HM to a HMB
HUMAN MILK BANKING
Concerns on donating HM to a HMB
“In a case where a family member needs, like let's say my sisters kid, my cousin's kid and the owner of the baby actually approaches me and asks me to do that, of course I'll try my best to do, but my problem is, donating my milk it is in a bank somewhere, I don't know, okay, I don't know… IDI mother”
“Like being unsure, what are you going to do with my milk? You know, and there are those bad stories of they took my hair, they took my nails and I don’t know went where” KII- health worker)
Human milk banking - KPA April 2019

17. Ethics, Acceptability & Concerns
Muslims – milk kinship
HIV
African culture?
Cost & sustainability
Donor: Compensation/ renumeration / commecialisation
Human milk banking - KPA April 2019

18. Human milk banking - KPA April 2019
Our first HMB 2019!
Human milk banking - KPA April 2019

19. Human milk banking - KPA April 2019
Thank you
Human milk banking - KPA April 2019

20. Human milk banking - KPA April 2019

21. Hazard Analysis Critical Control Point (HACCP) 4 steps
Step 1: From donor to recipient
Assemble multidisciplinary HACCP team
Describe product/process
Identify the intended use/consumer
Construct a flow diagram of process
On-site verification of flow diagram
Human milk banking - KPA April 2019

22. Hazard Analysis Critical Control Point (HACCP) 4 steps
Step 2: Identify potential hazard to each process
List potential hazards, conduct hazard analysis and determine control measures
Determine Critical Control Points (CCP's)
Establish critical limits for each CCP
Establish a monitoring system for each CCP
Establish corrective actions for deviations from critical limits
Establish verification procedures
Human milk banking - KPA April 2019

23. Hazard Analysis Critical Control Point (HACCP) 4 steps
Step 4: Establish monitoring system for each CCP:
Record keeping and documentation to include:
Written plans
Corrective actions
Adjustments for deviations
Human milk banking - KPA April 2019