• A milk bank enables mothers producing surplus milk to provide for babies whose own mothers cannot breastfeed
• It spares women from relying on breast milk supplements that are costly and induce more intolerance.
Charity, 30, went to Kenyatta National Hospital in November last year to deliver her second child. She’d had her first daughter through a C-section on medical grounds, and a repeat was inevitable.
Having had a problem with the medication administered during her first delivery, the doctor recommended a change.
"The injection I was given while in theatre had a lot of side-effects, so when I went to deliver my second child, I told the doctor my past experience and he opted for a change," Charity said.
The injection, however, affected the production of breast milk. She could not produce milk to breastfeed her baby.
Charity had no option but to resort to using Nan, breast milk supplement products bought from shops.
"One tin goes for Sh960. If you are lucky, you get someone to buy for you from town; otherwise, some sell it for as much as Sh1,300, and it doesn't even serve us for a full month," she says.
That is expensive to her, as she has other needs to take care of.
Charity is not alone. Janet could not breastfeed her baby after birth because the baby had been born preterm.
It started as stomach pain when she was seven months pregnant, but when she went to Mama Lucy Hospital, she was told they were labour pains. She gave birth to a baby weighing just 1.4kg.
"The baby was so tiny that had the incident happened while I was alone, I would have thrown it away, thinking it was some sort of rubbish," Janet said.
The baby was taken to the incubator as he could not survive on his own. She had to stay in hospital for three months before the baby could attain stability.
Charity and Janet are optimistic that the newly launched breast milk bank will mitigate the challenges they have experienced and ensure no baby suffers.
VULNERABLE NEWBORNS TARGETED
A milk bank is a way of providing milk from mothers who are producing surplus to babies who do not have access to their own mothers' milk.
The region's first milk bank was launched at Pumwani Maternity Hospital last Friday but one by the county government in collaboration with PATH.
The Sh66 million project targets sick, vulnerable newborns, who for one reason or another cannot get breast milk, with first priority being given to preterm babies.
The hospital has a pasteuriser, which has a capacity to hold 9.4 litres of milk at a go, two fridges and four freezers with a 240 litres capacity.
County nutrition coordinator Esther Kwamboka says the milk is going to be pasteurised at a very high temperature (60.5 per cent for 30 minutes) and then cooled suddenly to be sure that all microorganisms are killed.
Because of the high temperatures, the milk may lose a few micronutrient components, but then destruction of harmful viruses will be assured. So the milk will have all the other benefits.
“For instance, vitamin C, which may be found in the original milk, may be destroyed because it is heat-sensitive, but then we are sure we have safe milk and can supplement other nutrients we are not able to get in this milk,” Kwamboka said.
Freezers will have thermometers and well-coordinated temperature monitoring both in the room and within the freezers. The milk will be safe for use in the next six months and will be labelled accordingly to show the expiry date.
A technical team will always be on standby. They will be required to run the machines once in a while and check if there is any issue to ensure high safety standards.
The World Health Organisation has set guidelines on infant feeding. It recommends that the best alternative for infants is human milk, and when the mother is not available to feed her own baby, then donor human milk should be used until the mother is able to feed it.
“We have been having breast milk substitutes in the market, such as formulas and breast milk fortifiers. With the human milk, we are going to have less intolerances,” Kwamboka said.
She said since formulas are from the liquid part of the milk, the liquid is normally at about 20 per cent and the curd 80 per cent. But for human milk, the liquid is at 65 per cent and the curding at 35 per cent.
“That is why when a baby belches, you see a smooth vomit, but when a baby has taken infant formula or cow milk, when they belch you will see very solid particles coming out of their mouth. That tells you human milk is definitely more tolerated within the baby's system,” Kwamboka said.
And because of the nature of human milk, it promises better outcomes in terms of health and nutrition as a result of its immune properties.
It is expected that there will be fewer infant infections, normally commonly referred to as neonatal sepsis, which is the largest killer in babies within the first 28 days of birth, thus cutting down on infant mortality.
The milk bank will reduce length of stay in the hospital. So it will be economical for the hospital, parents, county and national governments, and save a lot in terms of taking care of the babies.
“They will leave space for more needy cases in the newborn unit,” Kwamboka said.
The nutritionist said Nairobi is the leading county in neonatal mortality.
“While the country is talking about 22 per 1,000 live births in Nairobi, we have an infant mortality rate of 59 per 1,000 live births. That is pretty high, and Pumwani being the maternity with the highest number of births, then we are actually going to realise a positive outcome in terms of mortality and morbidity,” she said.
To assess suitability, donor mothers will be passed through a vigorous screening process, including screening for hepatitis B and C, syphilis and HIV. Also checked will be their medical history, behavioural history (such as sexual behaviour), sexual partners, any use of drugs or substance abuse and blood transfusion history.
The hospital has also invested in good machines in the laboratory, set up a microbiology department, and will use an analyser machine that will do a lot of analysis to isolate viruses and avoid making a mistake during the screening process.
All these measures are aimed at ensuring the milk is safe for infant use.
DOZENS FED PER DAY
The hospital has a steering committee that has gone through training on critical care, hazard analysis and supporting breastfeeding (a process of complementing breastfeeding).
Nairobi Health executive Mohammed Dagane says the milk bank is expected to reduce infant mortality by 10 per cent. It will feed 10-12 babies a day.
For now, Pumwani is acting as a pilot and is focusing on making sure the milk bank works over time. Thereafter, the idea will extend to 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.
Kwamboka says Gertrude’s Hospital has already expressed interest, as they are the largest facility that handles children.
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.
The Health ministry has revised newborn care guidelines to include donated human milk 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, 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.