Assessing the Need for Donated Breast Milk Use and Human Milk Banking in Kenyatta National Hospital

Abstract

Background: In the rare instances when mothers are unable to establish breastfeeding or supply mothers’ own milk (MOM), breastmilk substitutes are recommended and currently the preferred option should be donor breast milk (DHM). In practice the most commonly used alternative has been formula milk. Broad Objective: This study sought to determine proportion of newborns exposed to non-human milk as an initial feed as a proxy to determining the potential need for a human milk bank and also determine health care workers knowledge on donor human milk. Methodology: This was a cross-sectional study at Kenyatta National Hospital newborn unit. Consecutive mother-infant pairs were recruited after giving informed consent and data was collected using a standard tool, by interview and review of the medical records. Health workers in the unit were interviewed using a structured standard tool after obtaining informed consent. Data Analysis: SPSS version 23 was used to carry out the data analysis after being cleaned for errors and inconsistencies Results: A total of 376 mother infant dyads and 82 health workers recruited into the study. The mean birth weight was 2182 grams and median gestational age was 34 weeks (IQR 6weeks). Overall 14% of the newborns were fed formula on day 1 with a non-significant decline in this proportion by half by the 3rd day of life and an increase of breast milk use from 85% to 92%. The percentage of LBW newborns who used formula was 59 %( n = 26). Compared to the babies with birthweight > 2500grams, babies weighing < 1000 grams had significantly increased odds of being formula fed OR = 5.5 [(95% CI 1.4, 21.1) p=0.003]. Babies from mothers with a multiple pregnancy (n=24, 7.9%) had significantly increased odds of being formula fed OR = 5.2[(95% CI 2.1, 12.5) p = 0.001)].

There were 82 HCW in the study, 80% female with an average of 11yrs (SD+/- 8.69) year of service Only 17(20%) of the respondents achieved a score of 75% and above signifying good knowledge. Conclusion: There are a significant number of newborns who are exposed to non-human milk as an initial feed despite recommended practices. There is poor knowledge on DHM amongst healthcare workers. Amongst the HCWs there is a perceived need for human milk banking Recommendations A further study is needed to delve into the reasons for prescribing and administering non-human milk initial feeds. Train HCWs on donor human milk with an emphasis on use, advantages and disadvantages. Set up a HMB as there is a need.