By Sola Abe
The World Health Organisation (WHO) states that prematurity is the leading cause of death in children under the age of 5, globally. In low-income settings, WHO notes that half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care such as warmth, breastfeeding support, and basic care for infections and breathing difficulties.
Most preterm births occur in Africa, with Nigeria having the third greatest number of premature births in the world. WHO states that 773, 600 babies are born too soon in Nigeria, unfortunately, more than 90% of extremely premature babies (less than 28 weeks) born in low-income countries die within the first few days of life.
The Power of Breastmilk
In 2022, WHO published a list of simple interventions that can substantially reduce mortality in preterm and low birthweight babies, one of which is early initiation of breastmilk.
Mother’s own milk and Human donor milk come second and third respectively on the list of the survival interventions for preterm babies. Strongly recommending mother’s own milk over artificial formulas, WHO noted that the latter confers important immune and nutritional advantages for preterm babies while the former lacks the antibodies, immune modulators, and primers present in human milk that protect the immature gastrointestinal tract of preterm.
However, where a mother’s own milk is not available, WHO endorses donor human milk rather than infant formula for preterm babies.
The Miracle of Milk Booster’s Breast Milk Bank
The Milk Bank Nigeria is the first human donor milk bank in Lagos, Nigeria. The Milk Bank Nigeria is on a mission to provide donor breast milk for sick, low birth weight, and premature babies in the country. The creation of the Milk Bank Nigeria was inspired by its counterparts abroad and their impact on the survival rates of premature babies.
“Our breastfeeding rates are not at optimal level and premature babies are still not going to get breastmilk to help them gain weight and leave the Intensive Care Unit (ICU). We are in a country where the facilities are not there to sustain health. One thing that can make a big impact is breast milk,” Dr. Chinny Obinwanne, a medical doctor and lactation consultant explained.
The Milk Bank Nigeria launched in August 2022 and as of December, they had registered four active breastfeeding donors who supplied 33 litres of breastmilk ready for consumption.
Apply To Be A Donor
A visit to Milk Booster’s website shows a call for healthy breastfeeding mothers to get involved in saving preterm babies by donating their breast milk. However, an interested donor must pass the test of eligibility, first by filling an online interest form – one of the four steps of becoming a milk donor.
The other three steps include completing a 10 to 15 minutes phone screening about past and present medical history of mother and child, as well as completing and returning an informational packet. Where the medical information of a prospective donor is certified okay, she proceeds to the fourth level.
“In order to provide the safest milk possible for preterm and critically ill babies, The Milk Bank Nigeria requires all donor moms to complete a blood test to screen for harmful viruses like HIV I & II, syphilis, Human T-Lymphotrophic Virus I & II, Hepatitis B, Hepatitis C,” the lactation consultant stated, adding that once the tests come out negative, the prospective donor’s milk is collected for processing and she becomes a registered member.
Just like blood banks are run, The Milk Bank Nigeria does not pay donors, but it bears all the screening expenses.
“We pay for blood screening and storage bags. We pay for the transport to collect the milk and then run tests before we pasteurise the milk. We bear a lot of costs,” Dr. Obinwanne stated.
The Milk Booster’s Supply strategy
Although individual parents have applied for breastmilk for their babies, the Milk Bank Nigeria is yet to supply them because their primary aim is babies in the neonatal ICU.
“The Milk Bank Nigeria prioritises babies in the ICU because they are the ones who will die from complications if they don’t get breastmilk. They are fragile and the breastmilk will save them from dying,” Dr. Obinwanne revealed.
Hence, the reason for the organisation’s collaboration with the neonatal unit of the Lagos State Teaching Hospital. “We agreed that when they meet a mum that is expecting prematurely, they would educate her on the donated breastmilk and share our contact with her. Currently, we are reaching out to hospitals that have neonatal ICUs that are functional,” the Milk Bank Nigeria founder shared.
But There Are Challenges
The inability to leave pasteurised breastmilk at hospitals is one of the many challenges that the Milk Bank Nigeria faces. This is due to the lack of constant electricity supply in the country. According to Dr. Obinwanne, a hospital must have a capable freezer with the required cold temperature to maintain the given temperature of the breast milk.
Religious beliefs also pose a challenge to the operations of the Breast Milk Bank Nigeria.
“At inception, my plan was to mix up milk because they mix up everybody’s milk abroad. One of the issues that came up in my conversations with doctors in neonatal ICU was religion. In the Muslim community, there is a relationship that comes when babies share breastmilk. For us, this means that we must wait for a single donor mum milk before we can pasteurise rather than add up milk from different mums to make up the requested amount,” the lactation consultant explained.
An article titled, Human Milk Bank – The Benefits and Issues In An Islamic Setting stated that the donation of human milk is perfectly allowed and even praised as a virtue in Islam, however, a child lesser than 2 years old would be considered the sibling of the donor mother’s children if she fed him more than five times.
“This means that, being brothers or sisters, they cannot marry each other. Even though this belief would not create a problem in individual cases of milk sharing since both families involved are fully aware of what is happening, and marriage of the children thus connected could be prohibited, it makes establishment of a milk sharing program at hospital level complex,” it read in part.
Where milk sharing must take place, it was advised that only a donor to a child is allowed and there must be no mixing of milk, among others.
Illiteracy, another challenge that the Milk Bank Nigeria faces, affects the quality of donated milk. Even though they have been educated about it, unlearned people are often worried about the purpose of the milk, unlike their educated counterparts.
Also, there is a lot of contamination while they are trying to extract the milk. This is because they do not clearly understand the impact of their actions on the process of milk extraction.
“I’ve got some milk that has a lot of bacteria in it. Even when I tried to pasteurise it, it still did not kill it. And you can’t feed such milk to a baby. There is a level of contamination that comes with different classes of people. So far, the four donors we have are learned women.
The organisation also faces a behavioural challenge as regards the donation and acceptance of breastmilk. Dr. Obinwanne stated that while some women do not mind donating their breast milk, others stated that they would rather buy formula than feed their children with another woman’s milk.
According to Dr. Omolara Ibinola of St Gerald’s hospital, Kaduna, there are recorded cases of new mums who do not produce breast milk in the first few days after delivery, and resort to supplementary feeds or cow milk because the baby has to be fed. These have some side effects which include increased rates of constipation. “Having healthy breast milk available goes along way in supporting those mothers till they are able to produce some themselves”, Dr. Ibinola submits.
However, another challenge in Nigeria is the reluctance of mothers to have their babies feed on another woman’s breast milk. It is marred by a lot of skepticism and most women prepare to feed their babies with store-bought complementary/supplementary feeds. This skepticism is further fueled by the lack of faith in hospitals/labs to properly screen the breastmilk and ensure the donors do not have any communicable diseases and are not on any drugs that can be passed to the newborns, says Dr Ibinola.
“One way advanced societies have addressed this is to have known donors. These women are followed up routinely and are checked regularly to ensure they are healthy and not on drugs or alcohol. If the banks in Nigeria can prove that they regularly carry out these checks, faith will grow in them,” the doctor explained.
“Another approach to solving the challenge of storage is to use designated solar freezers at hubs for breast milk. The milk should not be stored at the hospital, but at the hubs which can be located at multiple locations within a state.
“When the milk is given out to mothers, it should be stored at a certain temperature and thermometers be given to them to ensure that temperature is maintained. A rapid test kit should also be given to the mothers to help test and verify that the milk is safe before administering to the babies.
“Above all, a massive awareness campaign and education of women is needed to drive this initiative. It is a good one and the hurdles to be crossed are fewer than most other health initiatives so it is doable,” she concluded.
This story was produced in partnership with Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.
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