1
|
Israel-Ballard K, LaRose E, Mansen K. The global status of human milk banking. Matern Child Nutr 2024:e13592. [PMID: 38318679 DOI: 10.1111/mcn.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 02/07/2024]
Abstract
Human milk provides essential nutrition for infants and holds many health benefits for infants and mothers. When a mother's own milk is not available for her infant, the World Health Organization recommends feeding donor human milk (DHM) from a human milk banking facility. DHM is human milk produced, collected then donated to a human milk bank (HMB). HMBs serve many vital functions, including screening donor mothers, then collecting, processing, storing, and allocating DHM to recipients. The first HMB opened in 1909, and today there are more than 700 HMBs globally. Unfortunately, HMB facilities are not present in all locales, with notable gaps in South Asia and Africa. Additionally, there are no global standards to guide HMB operational procedures. Even though most HMBs attempt to employ quality control systems to provide safe DHM, differences in community needs, resource availability, and a range of methods and policies to execute processes result in significant variations in DHM quality and HMB operations. Robust and collaborative systems that ensure safe and equitable access to DHM are needed. In this paper, we present a global snapshot of current human milk banking practices; review an interdisciplinary framework to guide and support HMB activities as an integrated part of health and newborn care systems; discuss factors that contribute to HMB sustainability; outline barriers to scaling HMBs worldwide; and highlight knowledge, policy, and research gaps. Developing global HMB guidance and rigorous, adaptable standards would strengthen efforts to improve newborn health.
Collapse
Affiliation(s)
| | - Emily LaRose
- Harvard School of Public Health, Boston, Massachusetts, USA
| | | |
Collapse
|
2
|
Wilunda C, Israel‐Ballard K, Wanjohi M, Lang'at N, Mansen K, Waiyego M, Kibore M, Kamande E, Zerfu T, Kithua A, Muganda R, Muiruri J, Maina B, Njuguna E, Njeru F, Kiige LW, Codjia P, Samburu B, Mogusu E, Ngwiri T, Mirie W, Kimani‐Murage EW. Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya. Matern Child Nutr 2024; 20:e13594. [PMID: 38051296 PMCID: PMC10750015 DOI: 10.1111/mcn.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.
Collapse
Affiliation(s)
- Calistus Wilunda
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | - Milka Wanjohi
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Nelson Lang'at
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Kimberly Mansen
- Maternal, Newborn, Child Health and Nutrition ProgramPATHSeattleWashingtonUSA
| | | | | | - Eva Kamande
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Taddese Zerfu
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | | | | | | | | | | | - Laura W. Kiige
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Patrick Codjia
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Betty Samburu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Esther Mogusu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Thomas Ngwiri
- Clinical ServicesGertrude's Children's HospitalNairobiKenya
| | - Waithera Mirie
- School of Nursing SciencesUniversity of NairobiNairobiKenya
| | | |
Collapse
|
3
|
Coffey PS, Israel-Ballard K, Meyer L, Mansen K, Agonafir N, Bekere M, Dube Q, Kaberuka G, Kasar J, Kharade A, Maknikar S, Namgyal KC, Nyondo-Mipando AL, Rulisa S, Worku B, Engmann C. The Journey Toward Establishing Inpatient Care for Small and Sick Newborns in Ethiopia, India, Malawi, and Rwanda. Glob Health Sci Pract 2023; 11:e2200510. [PMID: 37640484 PMCID: PMC10461708 DOI: 10.9745/ghsp-d-22-00510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/13/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Limited information is available about the approaches used and lessons learned from low- and middle-income countries that have implemented inpatient services for small and sick newborns. We developed descriptive case studies to compare the journeys to establish inpatient newborn care across Ethiopia, India, Malawi, and Rwanda. METHODS A total of 57 interviews with stakeholders in Ethiopia (n=12), India (n=12), Malawi (n=16), and Rwanda (n=17) informed the case studies. Our heuristic data analysis followed a deductive organizing framework approach. We informed our data analysis via targeted literature searches to uncover details related to key events. We used the NEST360 Theory of Change for facility-based care, which reflects the World Health Organization (WHO) Health Systems Framework as a starting point and added, as necessary, in an edit processing format until data saturation was achieved. FINDINGS Results highlight the strategies and innovation used to establish small and sick newborn care by health system building block and by country. We conducted a gap analysis of implementation of WHO Standards for Improving Facility-Based Care. The journeys to establish inpatient newborn care across the 4 countries are similar in terms of trajectory yet unique in their implementation. Unifying themes include leadership and governance at national level to consolidate and coordinate action to improve newborn quality of care, investment to build staff skills on data collection and use, and institutionalization of regular neonatal data reviews to identify gaps and propose relevant strategies. CONCLUSION Efforts to establish and scale inpatient care for small and sick newborns in Ethiopia, India, Malawi, and Rwanda over the last decade have led to remarkable success. These country examples can inspire more nascent initiatives that other low- and middle-income countries may undertake. Documentation should give voice to lived country experience, not all of which is fully captured in existing, peer-reviewed published literature.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Cyril Engmann
- PATH, Seattle, WA, USA
- University of Washington, Seattle, WA
- Seattle Children’s Hospital, Seattle, WA
| |
Collapse
|
4
|
Perrin MT, Mansen K, Israel-Ballard K, Richter S, Bode L, Hampel D, Shahab-Ferdows S, Allen LH, Maggio FC, Njuguna E, Tran HT, Wesolowska A. Investigating donor human milk composition globally to develop effective strategies for the nutritional care of preterm infants: Study protocol. PLoS One 2023; 18:e0283846. [PMID: 37018290 PMCID: PMC10075430 DOI: 10.1371/journal.pone.0283846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/18/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Globally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle-income countries. In the absence of mother's milk, the World Health Organization recommends using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal disorder. The use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality, yet very little is known about the nutritional composition of DHM. Additional knowledge gaps include how DHM composition is influenced by milk banking practices, and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers. METHODS We designed a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings that will examine and compare a broad range of nutrients and bioactive factors in human milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM. We will then simulate the random pooling of 2 to 10 donors to evaluate the impact of pooling as a potential strategy for milk banks to manage nutrient variability in DHM. Finally, we will evaluate whether commercially available fortifiers meet nutrient recommendations when used with DHM. DISCUSSION We expect that results from this study will improve nutritional care globally for the growing number of preterm infants who receive donor human milk.
Collapse
Affiliation(s)
- Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Kimberly Mansen
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, WA, United States of America
| | | | - Scott Richter
- Department of Mathematics and Statistics, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Lars Bode
- Department of Pediatrics and Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, San Diego, CA, United States of America
| | - Daniela Hampel
- United States Department of Agriculture/Agriculture Research Service, Western Human Nutrition Research Center, Davis, CA, United States of America
- Department of Nutrition, University of California Davis, Davis, CA, United States of America
| | - Setareh Shahab-Ferdows
- United States Department of Agriculture/Agriculture Research Service, Western Human Nutrition Research Center, Davis, CA, United States of America
| | - Lindsay H Allen
- United States Department of Agriculture/Agriculture Research Service, Western Human Nutrition Research Center, Davis, CA, United States of America
| | | | - Emily Njuguna
- Pumwani Maternity and Referral Hospital, Nairobi, Kenya
| | - Hoang Thi Tran
- Human Milk Bank at Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Pediatrics, School of Medicine and Pharmacy, Da Nang University, Da Nang, Vietnam
| | - Aleksandra Wesolowska
- Department of Medical Biology, Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
5
|
Perrin MT, Gutierrez Dos Santos B, Mansen K, Israel-Ballard K. Global neonatal care and access to human milk. J Pediatr (Rio J) 2022; 98:545-547. [PMID: 35908657 PMCID: PMC9617274 DOI: 10.1016/j.jped.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Maryanne T Perrin
- University of North Carolina Greensboro, Department of Nutrition, Greensboro, United States.
| | | | - Kimberly Mansen
- PATH; Maternal, Newborn and Child Health and Nutrition Program, Seattle, United States
| | | |
Collapse
|
6
|
Tyebally Fang M, Chatzixiros E, Grummer-Strawn L, Engmann C, Israel-Ballard K, Mansen K, O'Connor DL, Unger S, Herson M, Weaver G, Biller-Andorno N. Developing global guidance on human milk banking. Bull World Health Organ 2021; 99:892-900. [PMID: 34866685 PMCID: PMC8640695 DOI: 10.2471/blt.21.286943] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/27/2022] Open
Abstract
Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother’s own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low- and middle-income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth.
Collapse
Affiliation(s)
- Mirriam Tyebally Fang
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
| | - Efstratios Chatzixiros
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | | | - Marisa Herson
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
| |
Collapse
|
7
|
Shenker N, Staff M, Vickers A, Aprigio J, Tiwari S, Nangia S, Sachdeva RC, Clifford V, Coutsoudis A, Reimers P, Israel‐Ballard K, Mansen K, Mileusnic‐Milenovic R, Wesolowska A, van Goudoever JB, Hosseini M, Klotz D, Grøvslien AH, Weaver G. Maintaining human milk bank services throughout the COVID-19 pandemic: A global response. Matern Child Nutr 2021; 17:e13131. [PMID: 33403779 PMCID: PMC7883204 DOI: 10.1111/mcn.13131] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID-19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open-ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic-related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context-dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies.
Collapse
Affiliation(s)
- Natalie Shenker
- Department of Surgery and CancerImperial College LondonLondonUK
- Human Milk FoundationRothamsted InstituteHertfordshireUK
| | - Marta Staff
- The Centre for Simulation, Analytics and Modelling (CSAM)University of Exeter Business SchoolExeterUK
| | - Amy Vickers
- Mothers' Milk Bank of North Texas; Human Milk Bank Association of North AmericaFort WorthTexasUSA
| | - Joao Aprigio
- Ibero‐American Human Milk Bank Program, National Milk Bank Service of Brazil, Fernandes Figueira Institute, Oswaldo Cruz Foundation – FIOCRUZMinistry of Health – BrazilBrasíliaBrazil
| | - Satish Tiwari
- Human Milk Banking Association of IndiaDr Punjabrao Deshmukh Memorial Medical CollegeAmravatiIndia
| | - Sushma Nangia
- National Human Milk Bank, Department of NeonatologyLady Hardinge Medical College & Kalawati Saran Children's HospitalNew DelhiIndia
- Vatsalya Maatri Amrit Kosh ‐ the National Comprehensive Lactation Management Centre, Department of NeonatologyLady Hardinge Medical College and Kalawati Saran Children's HospitalNew DelhiIndia
| | | | - Vanessa Clifford
- Australian Red Cross Lifeblood MilkWest MelbourneVictoriaAustralia
| | - Anna Coutsoudis
- HMBASA (Human Milk Banking Association of South Africa)South Africa
- School of Clinical Medicine, University of KwaZulu‐NatalDurbanSouth Africa
| | - Penny Reimers
- HMBASA, iThembu Lethu Community Milk BankRossburghSouth Africa
| | | | - Kimberly Mansen
- Maternal, Newborn, Child Health and NutritionPATHSeattleWashingtonUSA
| | | | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research, Regional Human Milk Bank in Holy Family Hospital, Department of Medical BiologyMedical University of WarsawWarsawPoland
| | - Johannes B. van Goudoever
- Dutch National Human Milk Bank, Amsterdam UMCUniversity of Amsterdam, Emma Children's HospitalAmsterdamThe Netherlands
| | - Mohammadbagher Hosseini
- Department of NeonatologyTabriz University of Medical Sciences, Neonatal and Perinatal Department, Alzahra Teaching HospitalTabrizIran
- Full Professor of Neonatology, Pediatric Health Research Center, Tabriz University of Medical SciencesTabrizIran
| | - Daniel Klotz
- Center for Pediatrics, Division of Neonatology and Pediatric Intensive Care Medicine, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Anne Hagen Grøvslien
- Milk Bank Manager, Norwegian Accredited Breastfeeding Consultant, Multi‐cultural Healthcare Consultant, Department of PediatricsOslo University HospitalOsloNorway
| | - Gillian Weaver
- Human Milk FoundationRothamsted InstituteHertfordshireUK
| | | |
Collapse
|
8
|
Mansen K, Nguyen TT, Nguyen NQ, Do CT, Tran HT, Nguyen NT, Mathisen R, Nguyen VD, Ngo YTK, Israel-Ballard K. Strengthening Newborn Nutrition Through Establishment of the First Human Milk Bank in Vietnam. J Hum Lact 2021; 37:76-86. [PMID: 32833551 PMCID: PMC7907997 DOI: 10.1177/0890334420948448] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tuan T Nguyen
- 1311 Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | | | - Chung T Do
- Alive & Thrive Southeast Asia, FHI 360, Danang, Vietnam
| | - Hoang T Tran
- Danang Hospital for Women and Children, Danang, Vietnam
| | | | - Roger Mathisen
- 1311 Alive & Thrive Southeast Asia, FHI 360, Hanoi, Vietnam
| | - Vinh D Nguyen
- Maternal and Child Health Department, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Yen T K Ngo
- Danang Department of Health, Danang, Vietnam
| | | |
Collapse
|
9
|
Parker ME, Zobrist S, Lutterodt HE, Asiedu CR, Donahue C, Edick C, Mansen K, Pelto G, Milani P, Soor S, Laar A, Engmann CM. Evaluating the nutritional content of an insect-fortified food for the child complementary diet in Ghana. BMC Nutr 2020; 6:7. [PMID: 32266077 PMCID: PMC7114796 DOI: 10.1186/s40795-020-0331-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/27/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Due to rising food insecurity, natural resource scarcity, population growth, and the cost of and demand for animal proteins, insects as food have emerged as a relevant topic. This study examines the nutrient content of the palm weevil larva (Rhynchophorus phoenicis), a traditionally consumed edible insect called akokono in Ghana, and assesses its potential as an animal-source, complementary food. METHODS Akokono in two "unmixed" forms (raw, roasted) and one "mixed" form (akokono-groundnut paste) were evaluated for their macronutrient, micronutrient, amino acid, and fatty acid profiles. RESULTS Nutrient analyses revealed that a 32 g (2 tbsp.) serving of akokono-groundnut paste, compared to recommended daily allowances or adequate intakes (infant 7-12 months; child 1-3 years), is a rich source of protein (99%; 84%), minerals [copper (102%; 66%), magnesium (54%; 51%), zinc (37%; 37%)], B-vitamins [niacin (63%; 42%), riboflavin (26%; 20%), folate (40%; 21%)], Vitamin E (a-tocopherol) (440%; 366%), and linoleic acid (165%; 108%). Feed experiments indicated that substituting palm pith, the typical larval diet, for pito mash, a local beer production by-product, increased the carbohydrate, potassium, calcium, sodium, and zinc content of raw akokono. Akokono-groundnut paste meets (within 10%) or exceeds the levels of essential amino acids specified by the Institute of Medicine criteria for animal-source foods, except for lysine. CONCLUSIONS Pairing akokono with other local foods (e.g., potatoes, soybeans) can enhance its lysine content and create a more complete dietary amino acid profile. The promotion of akokono as a complementary food could play an important role in nutrition interventions targeting children in Ghana.
Collapse
Affiliation(s)
- Megan E. Parker
- PATH, Maternal, Newborn, and Child Health and Nutrition, 2201 Westlake Ave, Suite 200, Seattle, WA 98121 USA
| | - Stephanie Zobrist
- PATH, Maternal, Newborn, and Child Health and Nutrition, 2201 Westlake Ave, Suite 200, Seattle, WA 98121 USA
| | - Herman E. Lutterodt
- Department of Food Science and Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cyril R. Asiedu
- Department of Food Science and Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Chantal Donahue
- PATH, Maternal, Newborn, and Child Health and Nutrition, 2201 Westlake Ave, Suite 200, Seattle, WA 98121 USA
| | - Connor Edick
- PATH, Maternal, Newborn, and Child Health and Nutrition, 2201 Westlake Ave, Suite 200, Seattle, WA 98121 USA
| | - Kimberly Mansen
- PATH, Maternal, Newborn, and Child Health and Nutrition, 2201 Westlake Ave, Suite 200, Seattle, WA 98121 USA
| | - Gretel Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | | | | | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Cyril M. Engmann
- PATH, Maternal, Newborn, and Child Health and Nutrition, 2201 Westlake Ave, Suite 200, Seattle, WA 98121 USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington & Seattle Children’s Hospital, Seattle, Washington, USA
| |
Collapse
|
10
|
Israel-Ballard K, Cohen J, Mansen K, Parker M, Engmann C, Kelley M. Call to action for equitable access to human milk for vulnerable infants. Lancet Glob Health 2019; 7:e1484-e1486. [PMID: 31607455 PMCID: PMC7613495 DOI: 10.1016/s2214-109x(19)30402-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/30/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | | | | | - Michael Parker
- Ethox Centre/Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Cyril Engmann
- University of Washington, Seattle 98195, WA, USA; PATH, Seattle, WA, USA
| | - Maureen Kelley
- Ethox Centre/Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Groenenboom AE, Parker ME, de Vries A, de Groot S, Zobrist S, Mansen K, Milani P, Kort R, Smid EJ, Schoustra SE. Bacterial community dynamics in lait caillé, a traditional product of spontaneous fermentation from Senegal. PLoS One 2019; 14:e0215658. [PMID: 31075124 PMCID: PMC6510411 DOI: 10.1371/journal.pone.0215658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/07/2019] [Indexed: 11/19/2022] Open
Abstract
Spontaneously fermented food products contain a complex, natural microbial community with potential probiotic activity. The addition of a health-promoting, probiotic bacterium to these products ensures the delivery of that probiotic activity to consumers. Here, we assess the microbial community of a traditional Senegalese milk product produced by spontaneous fermentation, called lait caillé. We produced the lait caillé in a traditional way and added a probiotic starter containing Lactobacillus rhamnosus yoba 2012 to the traditional process. We found various species that are known for their ability to ferment milk, including species from the genera Lactobacillus, Acetobacter, Lactococcus, and Streptococcus. Our results show that the addition of L. rhamnosus to the inoculum, can result in detectable levels of this strain in the final product, ranging between 0.2 and 1 percent of the total bacterial population. Subsequent rounds of fermentation using passive back-slopping without the addition of new L. rhamnosus led to a loss of this strain from the community of fermenting bacteria. Our results suggest that the addition of probiotic strains at every fermentation cycle can enrich the existing complex communities of traditionally fermented lait caillé while traditional bacterial strains remain dominant in the bacterial communities.
Collapse
Affiliation(s)
- Anneloes E. Groenenboom
- Laboratory of Genetics, Wageningen University and Research, Wageningen, The Netherlands
- Laboratory of Food Microbiology, Wageningen University and Research, Wageningen, The Netherlands
- * E-mail:
| | | | | | - Suzette de Groot
- Laboratory of Genetics, Wageningen University and Research, Wageningen, The Netherlands
| | | | | | | | - Remco Kort
- Microbiology and Systems Biology, TNO, Amsterdam, The Netherlands
- Yoba for Life Foundation, Amsterdam, The Netherlands
- Department of Molecular Cell Biology, VU University Amsterdam, Amsterdam, The Netherlands
- ARTIS-Micropia, Amsterdam, The Netherlands
| | - Eddy J. Smid
- Laboratory of Food Microbiology, Wageningen University and Research, Wageningen, The Netherlands
| | - Sijmen E. Schoustra
- Laboratory of Genetics, Wageningen University and Research, Wageningen, The Netherlands
- Department of Food Science and Nutrition, University of Zambia, Lusaka, Zambia
| |
Collapse
|
12
|
Brandstetter S, Mansen K, DeMarchis A, Nguyen Quyhn N, Engmann C, Israel-Ballard K. A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding. Front Pediatr 2018; 6:324. [PMID: 30430103 PMCID: PMC6220111 DOI: 10.3389/fped.2018.00324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023] Open
Abstract
Despite decades of breastfeeding promotion, exclusive breastfeeding rates for the first 6 months of life remain low: around 40% globally. Infants that are admitted to a neonatal ward are even less likely to be exclusively breastfed. Lactogenesis is frequently delayed in mothers that deliver early, with the added burden of separation of the unstable newborn and mother. For such vulnerable infants, donor human milk is recommended by the World Health Organization, UNICEF, and professional organizations as the next best alternative when mother's own milk is unavailable and can serve as a bridge to full feeding with mother's own milk. Hospital support of optimal breastfeeding practices is essential with thoughtful integration of donor human milk policies for those infants that need it most. We propose a decision tree for neonatal wards that are considering the use of donor human milk to ensure donor human milk is used to replace formula, not to replace mothers' own milk. By first evaluating barriers to full feeding with mother's own milk, healthcare workers are encouraged to systematically consider the appropriateness of donor human milk. This tool also seeks to prevent overuse of donor human milk, which has the potential to undermine successful lactation development. In settings where donor human milk supplies are limited, prioritization of infants by medical status is also needed. Readily available and easy-to-use tools are needed to support healthcare staff and mothers in order to improve lactation development and neonatal nutrition.
Collapse
Affiliation(s)
- Shelley Brandstetter
- School of Nursing, University of Washington, Seattle, WA, United States
- Maternal Newborn Health and Nutrition, PATH, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Seattle Children's Hospital, Seattle, WA, United States
| | - Kimberly Mansen
- Maternal Newborn Health and Nutrition, PATH, Seattle, WA, United States
- Seattle Children's Hospital, Seattle, WA, United States
| | | | | | - Cyril Engmann
- Maternal Newborn Health and Nutrition, PATH, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Seattle Children's Hospital, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Kiersten Israel-Ballard
- Maternal Newborn Health and Nutrition, PATH, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
13
|
Parker M, Zobrist S, Donahue C, Edick C, Mansen K, Hassan Zade Nadjari M, Heerikhuisen M, Sybesma W, Molenaar D, Diallo AM, Milani P, Kort R. Naturally Fermented Milk From Northern Senegal: Bacterial Community Composition and Probiotic Enrichment With Lactobacillus rhamnosus. Front Microbiol 2018; 9:2218. [PMID: 30298060 PMCID: PMC6160551 DOI: 10.3389/fmicb.2018.02218] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022] Open
Abstract
A variety of foods fermented with lactic acid bacteria serve as dietary staples in many African communities; yet, their bacterial profiles are poorly characterized. The integration of health-promoting probiotics into naturally fermented milk products could make a profound impact on human health. Here, we characterize the bacterial community composition of a naturally fermented milk product (lait caillé) from northern Senegal, prepared in wooden bowls (lahals) with a bacterial biofilm to steer the fermentation process. We incorporated a probiotic starter culture containing the most documented probiotic strain Lactobacillus rhamnosus GG (generic strain name yoba 2012) into the local fermentation process. Bar-coded 16S rRNA amplicon sequencing of lait caillé samples indicated that the bacterial community of lait caillé has high species richness with over 100 bacterial genera; however, few have high abundance. In contrast to the diverse bacterial compositions of other characterized naturally fermented milk products, the composition of lait caillé predominantly consists of the lactic acid bacteria Streptococcus and Lactobacillus, resembling the bacterial composition in regular yogurt. The bacterial community composition of lait caillé varies geographically based on the presence of some genera, including Lactoccoccus, Enterococcus, Bifidobacterium, and Bacillus, but this trend is not consistent within production communities. The diversity of bacterial communities is much higher in the lahal biofilm than in the naturally fermented milk products, which is in turn greater than in commercial yogurts. Addition of a starter culture with L. rhamnosus yoba 2012 to milk in lahals led to substantial growth of this probiotic bacterium during the fermentation process. Two independent quantitative PCR-analyses specific for L. rhamnosus yoba 2012 indicated a 20- to 60-fold increase in the total number of probiotic bacteria in the first batch after inoculation. A similar increase of the probiotic was observed in a variation of lait caillé prepared with carbohydrate-rich millet granules (thiakry) added prior to fermentation. This study shows the feasibility of integrating health-promoting probiotic strains into naturally fermented foods produced in regions with a high prevalence of malnutrition.
Collapse
Affiliation(s)
| | | | | | | | | | - Mehdi Hassan Zade Nadjari
- Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Amsterdam, Netherlands
| | - Margreet Heerikhuisen
- Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Amsterdam, Netherlands
| | | | - Douwe Molenaar
- Department of Molecular Cell Biology, VU University Amsterdam, Amsterdam, Netherlands
| | - Abdoulaye Moussa Diallo
- Department of Sociology, Université Cheikh Anta Diop de Dakar, Dakar, Senegal.,Helite SARL, Dakar, Senegal
| | | | - Remco Kort
- Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Amsterdam, Netherlands.,Yoba for Life Foundation, Amsterdam, Netherlands.,Department of Molecular Cell Biology, VU University Amsterdam, Amsterdam, Netherlands.,ARTIS-Micropia, Amsterdam, Netherlands
| |
Collapse
|