Transcript Document

Human Milk Bank Processes:
iThemba Lethu Breastmilk Bank, Durban, South
Africa
Anna Coutsoudis
Professor,
Dept Paediatrics & Child Health.
University KwaZulu-Natal
Durban, South Africa
[email protected]
Background info
Brief description
How did your human milk bank (HMB) began?
When?
Began in response to a need for sick AIDS orphans to be provided with optimum nutrition
with immune benefits. Began in 2000
Who provided initial funding? How are
ongoing operations funded? Integrated into
government services?
Initial seed funding provided by UNICEF – all future funding from donors – all local SA
donors. Not integrated into government services.
Who regulates /oversees HMB in your
country/region (if any)?
Oversight (very limited) provided by Human Milk Banking Association of South Africa.
No government oversight yet, although is being planned.
How many HMBs are part of your system?
Where are they?
1 – plus a few satellite points at pharmacies where people can leave their milk for later
collection. Also collect milk from private hospital NICUs
Is there a central HMB that processes milk
and distributes or many HMBs that process
milk and distribute? (Centralized vs decentralized)
Decentralised
How many NICU/Neonatal wards/community
homes does each bank serve? Are they
collocated?
Serves 2 homes of 6 children each – the actual number of children at any one time who
receive milk varies – if we have insufficient milk, HIV infected children are prioritised and
then the youngest infants.
Milk from pre-term infants is donated to one of the local hospital NICus
How many babies does your facility/system
serve annually?
Variable – approx 20
How many liters/year does your
facility/system process annually?
Approximately 150 litres from local mothers and we also receive donations from US
mothers also approx 150 litres
How many donor mothers initiate donation to
your facility/system annually?
40 – 50 donors
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Process
Brief description of processes
Staffing
•
1 breastmilk bank manager – volunteers occasionally assist with pasteurising
Donor recruitment
•
•
Through antenatal clinics, women groups, word of mouth.
Newspaper and magazine publicity – have produced video clips but too expensive to
flight on TV
Donor screening
•
Screening form for lifestyle risks – similar to blood donor screening and HIV and
syphylis tests from pregnancy.
Recipient eligibility and
selection
•
No infections, healthy mother with hygienic home, fridge and freezer
Handling and storage of
donor milk (from donation
to feeding)
•
Mothers given sterile bottles and information and training on expressing and storing
of milk in a safe way. Each donor mother is given a donor number – she writes this
number together with the date of expression on each bottle before freezing. When
her freezer space is filled with donor milk she contacts the milk bank to collect the
milk – then collected and stored frozen at the milk bank until pasteurisation.
Pasteurisation done in large batches of about 72 bottles – defrosted and then
pasteurised and re-frozen until it is dispensed to the homes for use by the children.
Screening questionnaire
• Have you received a blood transfusion or blood products in the last
12 months?
• Do you regularly have more than 50ml of hard liquor or its equivalent
in a 24-hour period?
• Regular use of medications, or use of radio-active drugs or
cytotoxins?
• Are you a total vegetarian?
• If yes, do you supplement your diet with B12 vitamins?
• Do you use habit-forming drugs?
• Do you smoke?
• Have you ever had hepatitis B, HIV, or TB?
• Have you ever had a sexual partner who is at risk for HIV, takes habitforming drugs, or is a haemophiliac?
• Do you have a copy of the results of your anti-natal HIV and syphilis
tests?
• If not, would you be prepared to undergo a rapid test for HIV at your
expense and submit the results to the screening officer?
Process
Brief description of process
Transport of milk
•
Manager collects milk from mothers’ homes or collection depots in cooler box with
ice packs and transports it to milk bank
Pasteurization
•
Holder Pasteurisation – using automated Sterifeed Pasteuriser
Tracking and record
keeping
•
Each pasteurisation has batch number, temperature logging on computer
Assessing milk quality and
safety (ie. microbiology
assays)
•
Micro assays on post-past’n sample – one random sample per batch and each new
donor has first sample assayed.
Quality assurance
•
Screening of mothers, HIV and syphilis test results, issue of sterile collection bottles;
temperature control of freezers; temperature monitoring of pasteurising and cooling;
batch numbers and donor number on each bottle; expiry date on each bottle
Equipment/Location
Brief description of process
What is used/how many?
• 1 x Sterifeed Pasteuriser
• 1 x Freezer for unpasteurised milk and 1 for pasteurised
• 1 x Refrigerators
Additional HMB equipment • Lockable room with alarm
• Computer
requirements?
• Generator for freezers
• Dishwasher to wash bottles
Referral/feeder/depot
facilities?
• 6 depots
• Each depot has freezer – bottles supplied to them as well
as screening forms?
Neonatal ward equipment
requirements?
• n/a
Other?
• n/a
Organizational Successes
Brief description of top 3-5 successes
Policy
• Success with milk bank led to banks been set up in Gauteng and
Western Cape Provinces – these hubs then grew independently
• Advocacy work together with PATH led to National/regional policy and
support for breastfeeding as well as roll out of donor milk banks.
Operational
• Donors have felt they can make a difference in the life of orphans –
visiting infants that they donate milk for exposes them to the scourge of
HIV.
• Improvement in health of infants fed donor milk – when donor milk runs
out problems with infants not being able to tolerate formula milk –
switch over is often traumatic for care givers.
Technology
• Gradually progressed from equipment specifically developed for our
milk bank by a South African company, to an international pasteuriser –
Sterifeed.
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Case Studies-Baby S
• BW: 2.5 kg
• Arrived :2 mths old
• Weight: 3kg malnutrition,
scabies, TB, respiratory
distress and HIV pos.
• Mother and grandmother full
blown AIDS, mother died
when he was 3 mths old
• Put on breastmilk. Gained
weight despite respiratory
infections and diarrhoea.
• Skin improved almost
immediately
He continued to receive the breast
milk until he was 14 months old. He is
a real delight and has a very infectious
laugh. At 21 months, he started on
HAART treatment and continued to do
well.
When he was 2 yrs old, he was
adopted by a loving family who are
thrilled to have him in their care, he
has settled well with his family and he
is flourishing in their care.
Baby A was born
prematurely weighing 1500g
and was abandoned in
hospital. He was brought to
the home at 7 months of
age weighing 2700g. In 7
months of being fed on
formula he put on 1200g!
In 2 weeks of being
fed on donated
breastmilk he put on
550g
Donor Mom
• Despite the fact that this mom is
a busy GP, she donated milk for a
period of 6 months, a total of
17.7 litres.
• She stopped donating when her
baby was 10 months old, not
because she is no longer breast
feeding, but rather because she
has adopted an abandoned baby
herself whom she is now breast
feeding as well as continuing to
feed her baby.
• The baby’s mother had died
shortly after birth from AIDS.
Organizational Challenges
Brief description of top 3-5 challenges
Policy
• Uncertainty around importance of donor milk, health care workers more
comfortable working with formula milk, more experience.
• Lack of policy level support for breastfeeding promotion.
• Lack of guidance from Ministry of Health
Operational
• Funding for dedicated staff – staff normally wearing 2 or 3 hats
• Insufficient donor milk due to insufficient donors – poor breastfeeding
promotion – leads to many women discontinuing breastfeeding at 4
months
• High percentage of HIV in our province – 43% prevalence in antenatal
clinics – cuts eligible pool into half
Technology
• Time consuming – defrosting such a large number of bottles takes a long
time but automated pasteuriser compensates for this.
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