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Istituto Superiore di Sanità
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Epidemiology for public health - ISS

Epidemiological aspects

In Italy

The National Surveillance System for Children Aged 0-2 years provides information on the main health determinants in children in this age group. The investigation is conducted in the form of a sample survey aimed at producing representative estimates at regional level and, for some Regions, also at the level of local health units. Data are collected through an anonymous questionnaire, completed by the mothers at vaccination centres during a scheduled immunization session (1st, 2nd and 3rd doses of the hexavalent DTP vaccine and 1st dose of MMRV). During the latest survey, between December 2018 and April 2019, data were collected from 29,492 mothers in the 11 Regions that had already joined the Surveillance: Piedmont, Valle d’Aosta, Autonomous Province (AP) of Trento, Marche, Lazio, Campania, Apulia, Calabria, Basilicata, Sicily and Sardinia (Tuscany took part in the Surveillance with the results of its ongoing maternity pathway survey). The response rate exceeded 95% across all Regions. Less than one quarter (23.6%) of children at 4-5 months of age were exclusively breastfed. The prevalence of continued breastfeeding at 12-15 months of age was 31.3%. Finally, 11.7% of all children in the age group monitored by the Surveillance had not been breastfed. The percentage of exclusively breastfed children aged 4-5 months ranged from 16.6% in Campania to 44.7% in the AP of Trento. A lower prevalence was observed in the southern regions. The prevalence of breastfeeding at 12-15 months varied from 22.4% in Campania to 40.8% in Piedmont, and tended to decrease from the northern to the central and southern regions. The proportion of children who had never been breastfed was higher than expected and tended to be higher in the southern regions, ranging from 5.0% in Marche to 18.4% in Sicily. Some Regions (e.g. Friuli Venezia Giulia, Lombardy and Emilia-Romagna) have had their own survey systems in place for some time now.


No standardized indicators, definitions or methods have yet been agreed in Europe to estimate breastfeeding initiation, exclusivity and duration rates, which makes it difficult to compare data. The EU project “Promotion of Breastfeeding in Europe” highlights the need to develop standardized criteria for monitoring and evaluating breastfeeding prevalence, practices of healthcare and social services, implementation of policies, laws and codes, as well as coverage and effectiveness of information, education, communication and training activities. For more details, please refer to the document “EU Project on Promotion of Breastfeeding in Europe. Protection, promotion and support of breastfeeding in Europe: a blueprint for action (revised)” (pdf 596 kb). European Commission, Directorate Public Health and Risk Assessment, Luxembourg, 2008.


In line with this need, between 2008 and 2011, the Istituto Superiore di Sanità conducted two separate surveys, as part of the project “Maternity care: promoting and evaluating the quality of operating models”, to assess maternity pathway indicators. In December 2014, the National Institute of Statistics (ISTAT) conducted a study of maternity care, as part of its multi-purpose survey.


Publication date: 15 november 2021