Assessment of the Human Milk Bank Program at the Pumwani Maternity Hospital, Nairobi, Kenya

Abstract

Background: The World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF) have recommended using Donor Human Milk (DHM) from a Human Milk Bank (HMB) to feed low birthweight (LBW) and preterm infants as the ‘first alternative’ when mothers are unable to provide their own milk. Despite the spread of Human Milk Banks globally, there is limited data on the establishment, processes, and patient characteristics including outcomes, especially in the Lower – Middle-Income Countries. Objective: To determine the level of conformity in staffing, infrastructural sufficiency and step processes in the operation of Human Milk Banking at Pumwani Maternity Hospital against Global standards (PATH template). Methodology: This was a descriptive cross-sectional study evaluating the Human Milk Bank process and a retrospective aspect that looked at the characteristics of the infants receiving DHM. The study was conducted at Pumwani Maternity Hospital Milk Bank. An Evaluation tool adapted from the PATH Resource Toolkit for Establishing and Integrating Human Milk Bank Programs was used to describe the Human Milk Bank Process. The study population included all neonates who received DHM at the Pumwani Maternity Hospital since its launch in 2019. A case record form was used to pick the characteristics of interest of the recipients from the HMB Data register. Results: The hospital conformed fully with milk collection from donors as well as milk handling. The areas that need to be addressed are; staffing, milk processing and allocation, and some aspects of the facility conformity. The majority 374/562 (66.6%) of the children were on DHM due to delayed lactation, and 111/562 (19.7%) were due to mothers’ sickness. Other causes were abandoned babies 15/562 (2.7%), orphaned 14/562 (2.5%), and insufficient milk production 11/562 (2.0%). Conclusion: This study established that the HMB program at PMH conformed to staffing with staffing requirements. The hospital did not conform fully with milk processing and allocation i.e., did not have the date of birth of the recipient indicated and there was no record of storage environments for the milk, including the condition of the sealed container and storage temperature. The majority of the infants who were on DHM were born at term, followed by those who were born at moderate or late preterm. In terms of recipients’ birth weights, the majority were 11 of low birth weight. The main reason for DHM administration for the majority of the babies was delayed lactation by the mothers. Recommendations: We recommend that a qualitative study involving staff members be conducted to determine the reasons for non-conformity in the highlighted areas. We also recommend that the hospital re-evaluates its program to try and address nonconformity, especially in screening for the Human T-lymphotropic virus considering its possible transmission via breastmilk as well as conforming to the set hygiene standards