Human Milk Bank Processes: YOUR FACILITY AND LOCATION

Dr Peter McCormick Beryl Thyer Trust UK Establishing breast milk banks in Cameroonian Hospitals

Background info

How did your human milk bank (HMB) began? When?

Brief description On recognising the need at 4 hospitals, in 2001 - 2004

Who provided initial funding? How are ongoing operations funded? Integrated into government services?

My Charity. Thereafter the banks are largely self – sustaining with minimal external input. Our BMBs are accepted by the Cameroonian MoH, but not integrated into their services Senior midwives / Paediatric physicians / CMOs at the 4 hospitals

Who regulates /oversees HMB in your country/region (if any)?

How many HMBs are part of your system? Where are they?

One at a Government Hospital; three at Mission Hospitals; three in the NW Province, one in the SW Province, Cameroon. All anglophone

Is there a central HMB that processes milk and distributes or many HMBs that process milk and distribute? (Centralized vs de centralized) How many NICU/Neonatal wards/community homes does each bank serve? Are they collocated? How many babies does your facility/system serve annually?

How many liters/year does your facility/system process annually?

Each of our 4 hospitals pasteurises its own donated milk, using the same protocol and apparatus, for the benefit of its own hospital’s vulnerable newborns.

Each bank, in each hospital, serves its own community of fragile neonates in its own Mat. Unit, or the babies of sick mothers elsewhere in the hospital Approximately 500 babies per year. Range 3/mth to 20/mth Approximately 1,800 Litres / year. 100ml x 3, from 6,000 mothers

How many donor mothers initiate donation to your facility/system annually?

Approximately 6,000 donor mothers per year

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Process

Staffing •

Brief description of processes 2 midwives trained in the procedure, at each of our 4 hospitals

Donor recruitment • • •

Mainly from Infant Immunisation Clinics Some donors from Postnatal wards Some donors from the local community

•

Overnight agar plating of all donated milk

Donor screening Recipient eligibility and selection Handling and storage of donor milk (from donation to feeding) • • • • • • • • •

Questionnaire and counselling for all potential donors: Not from HIV Positive mothers / VDRL Positive mothers Not from smokers / excessive alcohol consumers Not from illegal drug users Not from chronic condition women; e.g. TB Screened milk kept in freezer compartment for max. 3 months.

Milk for use allowed to warm up on bench Warmed-up milk to be used same day, or disposed of.

Donor milk by cup/spoon, or OG tube

Process

Transport of milk •

Brief description of process N/A. Donated milk remains in the hospitals only

Pasteurization • •

Identical Protocol supplied to each hospital Apparatus is Single Bottle Pasteuriser; ACE Intermed, Andover, UK

Tracking and record keeping • •

Tracking N/A.

Record of baby feeds in the infants’ case records

Assessing milk quality and safety (ie. microbiology assays) • • •

All hospitals insist that there has never been a worrying episode of ill health or distress which might be attributable to donated milk All hospitals have >90% clear/no growth results from overnight plating The remaining few are re-tested with greater precaution.

Quality assurance •

Under review at present.

Equipment/Location

What is used/how many?

• • • • •

Brief description of process Single Bottle Pasteuriser (SBP) ACE Intermed, UK Small Fridge/Freezers; dedicated for BMB; unlocked Plastic, 60 ml pots for donated milk Glass, 30 ml jars for storage of cleared milk Plastic 5 ml sample tubes for bacteriology

Additional HMB equipment requirements?

• • •

Pens and markers ‘Clingfilm’ for glass bottles Electric kettles

Referral/feeder/depot facilities?

•

N/A in our setting

Neonatal ward equipment requirements?

•

N/A in our setting

Other?

• •

Infrequent supply of new Petri dishes to laboratories One cake, and one cup of fruit juice for each donor

Organizational Successes

Policy

Brief description of top 3-5 successes

•

Programme as described above is hugely welcomed by Hospital Administrations, Maternity Units, Laboratories, CMOs, junior medical staff. Promoted in a Cameroonian newspaper, and on Cameroonian radio.

Operational • •

It is an insurmountable challenge to assess the outcome of the growth / developmental/ morbidity and mortality rates / cognitive status / educational achievement, of breast fed v formula fed; let alone breastmilk bank fed v other forms of infant feeding in our rural sub-Saharan setting.

The ideal of any intervention would be to measure such outcomes. We cannot do it. We only know that we are giving the best food possible, for fragile, vulnerable neonates, for whom – according to the Governing Document of our Registered Charity – we have assumed responsibility whilst they are still in our care, in our hospitals.

Policy

Operational

Organizational Challenges

Brief description of top 3-5 challenges

•

As described above, we have no opposition or serious challenges, with our Breastmilk Bank programmes.

•

Repeated attempts to establish similar banks to our own, failed in The Gambia; cultural / tribal reasons.

•

Our BMB units all have two workers skilled in the pasteurisation procedure. They all work reliably and efficiently

•

Relationship with the bacteriologists is cordial.

Technology

I welcome suggestions from this Conference, as to any desirable, affordable, appropriate modifications, that may be feasible in our low cost setting, to the ongoing and successful work upon which we have been engaged in the past 10 years

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