Assessment of Implementation Strategies for an Innovative Facility-Specific Human Milk Pasteurizer in an Ethiopian NICU

About This Grant

Project Abstract One of the most comprehensive and beneficial interventions for newborn-child health is early and exclusive human milk feeding. Exclusive human milk diet, compared to formula or mixed feeding, improves breastfeeding rates, reduces mortality, and improves long-term outcomes, including neurodevelopment, especially among premature infants. Thus, it is standard practice for premature infants to receive parent’s own milk (POM) and/or donor human milk (DHM) if POM is insufficient or unavailable. Access to DHM is limited in low-resource settings (LRS) despite these regions experiencing >60% of the global burden of preterm birth and high rates of infant mortality. Only 7 of 54 (13%) African countries have human milk banks (HMBs), which are facilities that screen human milk donors, collect donated milk, store and process DHM, and re-distribute DHM to be used among infants without POM access. The contributors to these HMB deserts are multifaceted and linked to well-known challenges in infrastructure, resources and cultural beliefs. Parent perspectives from countries such as Ghana, Kenya, Uganda, and Ethiopia demonstrate feasibility of DHM with many parents willing to donate milk and accepting of DHM in the absence of their own milk. Nonetheless, infrastructure and resources required for the screening, collection, storage, pasteurization and redistribution of milk to support “typical”, stand-alone HMB are limited. Novel strategies are needed to achieve sustainable, culturally and contextually appropriate HMBs in LRS. Through systematic evaluation of best implementation strategies for a facility-specific HMB in a single neonatal intensive care unit (NICU) in Saint Paul’s Hospital Millenium Medical College (SPHMMC), our proposal aims to build and evaluate a sustainable and contextually adaptable approach to HMB in Ethiopia. The newly developed platform will create a proof-of-concept HMB that can be adapted for other LRS context(s). The specific aims of the current proposal are to (1) determine key factors that influence the integration of a facility- specific HMB into existing routine NICU facility operations through the identification of multi-level facilitators and barriers of HMB integration, and (2) co-develop and pilot standard implementation and operational procedures for launching a facility-specific HMB program through simulation. The proposed research will provide the evidence-base for implementation of strategies to improve access to human milk and thereby improve outcomes of premature newborns cared for at SPHMMC NICU. Ultimately, our proposal provides the proof-of-concept for the successful implementation of a facility-specific HMB, which can promote newborn-child health in Ethiopia and beyond. Subsequent studies beyond this proposal include: 1) adaptation and integration of facility-specific HMBs in other LRS, 2) randomization to DHM or standard care and impact on neonatal outcomes and mortality in LRS, and 2) DHM nutritional profile and effect on growth in LRS.