Background
In 2011, the WHO published guidelines on the Optimal feeding of low birthweight infants in low-and middle-income countries, recommending that LBW infants, including those with VLBW, who cannot be fed mother's own milk should be fed donor human milk. This recommendation was qualified as being relevant for settings where safe and affordable milk-banking facilities are available or can be set up, reflecting a concern that the costs of ensuring that donor human milk is free of HIV and other infections may be prohibitive in very resource-limited settings.
The 2018 WHO/UNICEF implementation guidance on the Baby-friendly Hospital Initiative similarly stated that “Infants who cannot be fed their mother’s own milk, or who need to be supplemented, especially low-birthweight infants, including those with very low birth weight and other vulnerable infants, should be fed donor human milk.” The American Academy of Pediatrics, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition, and other national and global policy groups also call for use of donor human milk as the feeding of choice, if mother’s own milk is insufficient, unavailable or contraindicated.
There is growing interest in creating and sustaining human milk banks globally to fulfil the need for donor human milk. Human milk banks have now been established in over 60 countries globally, with a small but increasing number of milk banks operating in low-income and middle-income countries.
WHO and the University of Zurich co-sponsored an international expert meeting in 2019 to examine issues on the implementation, operation, and regulation of human milk banks. The meeting identified a need for global guidance on the quality and safety of human milk banking. Significant questions need to be addressed on selection and screening of potential donors, transportation, storage and handling of milk, processing procedures, pasteurization, and equitable distribution. The meeting emphasized that the use of donor human milk must be managed in the context of protecting, promoting, and improving use of mother’s own milk wherever possible.
WHO plans to develop guidelines on donor human milk banking during 2022-23. The guidelines will follow the process outlined in the WHO handbook for guideline development. This process will include the creation of a multidisciplinary guideline development group, identification of critical questions for the guidelines to address, systematic literature reviews, examination of values, preferences, resources, and feasibility, and a peer-review process. Key expertise needed will include human tissue banking, maternity health care, nutrition services, and child development.
The Department of Nutrition and Food Safety (NFS) is seeking a contractor to assist in the preparations of the guidelines.
Scope of work
Under the supervision of the Unit Head, Food and Nutrition Action in Health Systems, Department of Nutrition and Food Safety, the vendor will support activities to develop updated guidelines on the quality and safety of donor human milk banking.
More specifically, tasks will consist of:
- Elaboration of an overall plan for the development of the guidelines, detailing what aspects should be covered.
- Planning for an initial meeting of the Guidelines Development Group, including:
- Identification of GDG members
- Communication with potential GDG members
- Identification of relevant background papers to establish a common understanding among GDG members
- Development of a draft approach to conducting literature reviews on the key elements of the proposed guideline
- Drafting of an agenda for the meeting
- Participation in the initial meeting of the Guidelines Development Group and preparation of meeting notes
- Preparation of a planning proposal to be submitted to the WHO Guidelines Review Committee.
- Preparation of a solicitation for systematic literature reviews
- Communication with potential authors of systematic reviews to finalize methodology
Concept note and budget
Interested author(s)/teams are invited to submit a concept note (2-3 pages) by sending an email to WHO at nutrition@who.int no later than 15 February 2022. The subject heading of the email should read as, “Preparations for human milk banking guidelines”.
The concept note should include a proposal describing (preferably in a single document) the following:
- The lead expert and host institution with overall responsibility for the contract and any supporting contributors. The specific competencies and contributions of each team member should be explicitly stated.
- The contractor’s/team’s experience in:
- Preparation of guidance documents on health actions to support clinical service delivery
- Preparation of guidance documents on health actions to support clinical service delivery
- Providing technical assistance to governments on topics related to the guidelines, esp. donor human milk banks, blood banks, maternal and newborn care, or management of feeding low birthweight babies
- Overall approach to completing the proposed tasks.
- Budget (US $). This should outline the total amount and an approximate breakdown of personnel vs. institutional/other costs.
Proposed timeline:
15 February 2022 – Interested contractors or teams submit concept note and budget
25 February 2022 – WHO review of proposals complete and contractors/teams contacted
30 April 2022 – First guideline development group meeting conducted virtually
15 May 2022 – Draft planning proposal completed
31 May 2022 – Systematic review authors identified