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      Perceptions on donated human milk and human milk banking in Nairobi, Kenya

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          Abstract

          Donor human milk (DHM) is recomended as the best alternative when use of mothers' own milk is not a feasible option. Kenya has not yet established human milk banks (HMBs) for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants or pathogens. This study aimed to establish the perceptions on donating and using DHM, and establishing HMBs in Kenya. Qualitative data were collected through 17 focus group discussions, 29 key informant interviews, and 25 in‐depth interviews, with women of childbearing age, community members, health workers, and policy makers. Quantitative interviews were conducted with 868 mothers of children younger than 3 years. Descriptive analysis of quantitative data was performed in STATA software, whereas qualitative interviews were coded using NVIVO and analysed thematically. Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%). The main concerns on donation and use of DHM were personal dislikes, fear of transmission of diseases including HIV, and hygiene concerns. Ensuring safety of DHM was considered important in enhancing acceptability of DHM and successful establishment of the HMBs. When establishing HMBs, Kenya must take into consideration communication strategies to address the main concerns raised regarding the quality and safety of the DHM. The findings will contribute to the development of HMB guidelines in Kenya and other African contexts.

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          Delayed breastfeeding initiation increases risk of neonatal mortality.

          Breastfeeding promotion is a key child survival strategy. Although there is an extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact on neonatal mortality. We sought to assess the contribution of the timing of initiation of breastfeeding to any impact. This study took advantage of the 4-weekly surveillance system from a large ongoing maternal vitamin A supplementation trial in rural Ghana involving all women of childbearing age and their infants. It was designed to evaluate whether timing of initiation of breastfeeding and type (exclusive, predominant, or partial) are associated with risk of neonatal mortality. The analysis is based on 10,947 breastfed singleton infants born between July 2003 and June 2004 who survived to day 2 and whose mothers were visited in the neonatal period. Breastfeeding was initiated within the first day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk. There was a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital abnormalities, premature, unwell at the time of interview) or when deaths during the first week (days 2-7) were excluded. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but most women already exclusively or predominantly breastfeed their infants.
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            Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis.

            To compare the effect of donor breast milk with infant formula in preterm infants. Separate comparisons with formula were made for donor breast milk that was: (1) given as a sole diet; (2) given as a supplement to mother's own breast milk; and (3) fortified with macronutrients and micronutrients. The main outcomes were death, necrotising enterocolitis (NEC), infection, growth and development. Electronic databases-Cochrane, CENTRAL, MEDLINE, EMBASE, CINAHL, and HMIC: DH. Systematic review and meta-analysis of trials and observational studies of preterm or low birthweight infants. Seven studies (including five randomised controlled trials), all from the 1970s and 1980s, fulfilled the inclusion criteria. All studies compared the effect of sole donor breast milk with formula (combined n = 471). One of these also compared the effect of donor breast milk with formula given as a supplement to mother's own milk (n = 343). No studies examined fortified donor breast milk. A meta-analysis based on three studies found a lower risk of NEC in infants receiving donor breast milk compared with formula (combined RR 0.21, 95% CI 0.06 to 0.76). Donor breast milk was associated with slower growth in the early postnatal period, but its long-term effect is unclear. Donor breast milk is associated with a lower risk of NEC and slower growth in the early postnatal period, but the quality of the evidence is limited. Further research is needed to confirm these findings and measure the effect of fortified or supplemented donor breast milk.
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              Human Milk Banking

              Human milk banks play an essential role by providing human milk to infants who would otherwise not be able to receive human milk. The largest group of recipients are premature infants who derive very substantial benefits from it. Human milk protects premature infants from necrotizing enterocolitis and from sepsis, two devastating medical conditions. Milk banks collect, screen, store, process, and distribute human milk. Donating women usually nurse their own infants and have a milk supply that exceeds their own infants' needs. Donor women are carefully selected and are screened for HIV-1, HIV-2, human T-cell leukemia virus 1 and 2, hepatitis B, hepatitis C, and syphilis. In the milk bank, handling, storing, processing, pooling, and bacterial screening follow standardized algorithms. Heat treatment of human milk diminishes anti-infective properties, cellular components, growth factors, and nutrients. However, the beneficial effects of donor milk remain significant and donor milk is still highly preferable in comparison to formula.
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                Author and article information

                Contributors
                mwanjohi@aphrc.org
                Journal
                Matern Child Nutr
                Matern Child Nutr
                10.1111/(ISSN)1740-8709
                MCN
                Maternal & Child Nutrition
                John Wiley and Sons Inc. (Hoboken )
                1740-8695
                1740-8709
                26 July 2019
                October 2019
                : 15
                : 4 ( doiID: 10.1111/mcn.v15.4 )
                : e12842
                Affiliations
                [ 1 ] Maternal and Child Well Being Unit African Population and Health Research Center Nairobi Kenya
                [ 2 ] Health and Systems for Health Unit African Population and Health Research Center Nairobi Kenya
                [ 3 ] Maternal and Child Health and Nutrition Program PATH Nairobi Kenya
                [ 4 ] Nutrition and Dietetics Unit Ministry of Health Nairobi Kenya
                [ 5 ] Neonatal, Child and Adolescent Health Unit Ministry of Health Nairobi Kenya
                [ 6 ] Nutrition Section, UNICEF ‐ Kenya Country Office Nairobi Kenya
                [ 7 ] Clinical Services, Gertrude's Children's Hospital Nairobi Kenya
                [ 8 ] School of Nursing University of Nairobi Nairobi Kenya
                [ 9 ] Departments of Paediatric University of Nairobi Nairobi Kenya
                Author notes
                [*] [* ] Correspondence

                Milka Njeri Wanjohi , African Population and Health Research Center, P.O. Box, 10787‐00100, APHRC Campus, Manga Close, Nairobi, Kenya.

                Email: mwanjohi@ 123456aphrc.org

                Author information
                https://orcid.org/0000-0003-4289-4762
                Article
                MCN12842 MCN-08-18-OA-3428.R1
                10.1111/mcn.12842
                6859964
                31099159
                da35e814-a388-4a01-b01c-43825c8d25ef
                © 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 10 September 2018
                : 13 March 2019
                : 10 May 2019
                Page count
                Figures: 0, Tables: 5, Pages: 11, Words: 6723
                Funding
                Funded by: A Sub‐ Grant from PATH's Research Grant from County Innovations Challenge Fund (CICF) , open-funder-registry 10.13039/100005624;
                Award ID: OCS. 2077‐01046760‐SUB
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                October 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:19.11.2019

                breastfeeding,donated human milk,donating,human milk banking,neonate

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