Early identification and treatment of hearing impairments are essential for children’s development. International guidelines recommend a stepwise approach to conduct hearing screening in newborns. However, while the majority of countries worldwide implemented universal newborn hearing screening, inconsistencies remain in procedures and data management. In particular, Level 3 of the screening pathway—comprising diagnostic confirmation and therapeutic management—has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A–D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors—particularly the coordination between local and specialized facilities—produce “cascade” outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.

Background:Schools are widely recognized as key settings for health promotion interventions to address excessive weight among children and adolescents. This cross-sectional observational study evaluated the association between the presence or absence of health promotion practices in a representative sample of primary and secondary school classes in the Friuli-Venezia Giulia (FVG) region and students' weight status and dietary and physical activity (PA) habits. Methods:Data on nutritional status, dietary and PA habits, and on school health promotion initiatives, with or without family or local health unit (LHU) involvement, were derived from questionnaires completed by school principals, students and families as part of the 2023 OKkio alla Salute (children aged 8-9) and the 2022 Health Behaviour in School-aged Children (adolescents aged 11-17) surveys. Results:The prevalence of overweight or obesity was 25.1% among primary school children and 16.7% among adolescents. Most primary schools implemented nutrition (86.5%) and PA (97%) education, but with limited family and LHU involvement. The only significant difference was observed in eating habits, with higher consumption of adequate mid-morning snacks in children attending primary schools that implemented healthy eating initiatives involving parents (p < 0.001). In secondary schools, most of which reported implementing policies on nutrition (92.8%) and PA (97.3%), the only significant difference was fruit consumption ≥ once/day in adolescents attending schools with nutrition-related policies. Conclusion:While school-based health promotion practices and policies are widely implemented in the FVG region, their association with students' nutritional status, dietary habits and PA was limited. These findings highlight the limited benefits yielded by existing school practices and policies and underline the potential importance of stronger parental involvement, multi-sectoral collaboration and more structured school health policies.

OBJECTIVES:to provide a comprehensive and comparable assessment of life expectancy (LE), health-adjusted life expectancy (HALE), Years Lived with Disability (YLDs), Years of Life Lost (YLLs), and Disability-Adjusted Life Years (DALYs) across Italian regions from 1990 to 2023, identifying temporal, geographical, and sex-specific patterns to inform targeted public health strategies. DESIGN:descriptive epidemiological study using estimates from the Global Burden of Disease Study (GBD) 2023. SETTING AND PARTICIPANTS:the analysis covered the Italian population, stratified by sex, five macro-regions, and 21 subnational locations, including 19 Regions and 2 Autonomous Provinces. MAIN OUTCOME MEASURES:LE, HALE, all-age and age-standardized rates YLDs, YLLs, and DALYs per 100,000 population; all estimates were presented with their 95% uncertainty intervals. RESULTS:between 1990 and 2023, LE increased substantially across all regions and in both sexes, despite the temporary decline associated with the COVID-19 pandemic. In 2023, the highest LE was recorded in the North-East, with 81.4 years (95%CI 81.1-81.6) for males and 85.8 years (95%CI 85.6-86.1) for females, while the lowest values were found in the Islands, at 79.7 years (95%CI 79.3-80.1) for males and 84.2 years (95%CI 83.9-84.5) for females. However, differences diminished when considering HALE. YLDs increased steadily over time, reflecting not only population ageing but also the expanding burden of chronic and non-fatal conditions. In contrast, YLLs declined markedly in both sexes, driven particularly by substantial reductions in mortality from neoplasms and cardiovascular diseases. However, in 2023, ischemic heart disease remained the leading contributor to all-age DALYs among males, while Alzheimer's disease was the top cause among females. Anxiety disorders represented the leading cause of age-standardized DALYs in females and showed marked increases since 1990. Among males, ischemic heart disease continued to appear as the primary cause of age-standardized DALYs. CONCLUSIONS:health in Italy improved substantially over the past three decades, primarily due to declining premature mortality. However, the burden of disability increased, particularly among women, and important geographical and sex-specific inequalities persist. Strengthening prevention policies, addressing behavioural and metabolic risk factors and mental health, improving long-term care, and promoting healthy ageing are essential to reducing health disparities.

Interpersonal violence against children and adolescents constitutes a significant public health issue associated with substantial morbidity and long-term disability. This study utilizes Global Burden of Disease (GBD) 2023 estimates to quantify the burden of interpersonal violence injuries among the population <20 years of age across the 27 European Union countries (EU27). We analysed incidence and Years Lived with Disability (YLDs) for injury types and age groups (<5, 5-14, and 15-19 years). A 'Disability Drivers' analysis compared injury frequency against disability burden to identify priority areas. Long-term (1990-2023), mid-term (2010-2023), and short-term trends (2020-2023) were analysed to distinguish systemic risks from emerging threats. The analysis reveals geographical and temporal heterogeneity. In 2023, Hungary reported the highest incidence rate (1085.7 per 100 000; 95% UI: 917.6-1295.5), while Italy reported the lowest (131.9 per 100 000; 95% UI: 94.3-175.5). Despite low overall incidence, Italy exhibited short-term spikes (2020-2023) in severe trauma among children aged <5, with severe chest injuries rising by 79.1% (95% UI: 66.4%-92.3%). Long-term analysis identified systemic worsening in Eastern Europe, notably in Romania, where poisoning in children <5 years increased by 77.9% (95% UI: 55.5%-96.0%) since 1990. Violence-related injuries among children in the EU27 show a polarized pattern, with chronic burdens in Eastern Europe and emerging acute escalations in Southern Europe. Prevention strategies should consider both injury frequency and disability burden to effectively allocate resources.

Objectives:the study aims to determine whether real-time ultrasound-guided umbilical venous catheter (UVC) insertion could enhance the accuracy of the procedure and reduce the number of x-ray, thereby minimizing radiation exposure of the newborn. Methods:A pre-post study was conducted, comparing outcomes before and after the introduction of ultrasound during catheter placement. All included newborns required placement of the UVC. In the study population (interventional group) the catheter tip was visualized using both ultrasound and radiography, whereas in the in historical cohort (control group) the catheter tip was visualized solely through radiography. Exclusion criteria included hemodynamic instability, known vascular malformations and major congenital malformations. Results:During the study period, 33 eligible neonates underwent tip navigation and were enrolled, all of whom had a centrally-placed UVC. Additionally, 36 newborns were retrospectively identified as control group. The median gestational ages were 34 weeks and 33 weeks respectively for the interventional and control group (p 0.74). The median birth weights were 2,087 (1,400-3,220) g and 1,966 (1,489-2,695) g respectively for the interventional and control group (p 0.67). The catheter was correctly positioned at first attempt in 29/33 (87%) patients with US guidance and 17/36 (47%) in the control group (p < 0.001). The mean numbers of x-rays taken were 1.1 and 1.8 respectively for the interventional and control group (p < 0.001). In the control group, the mean number of antero-posterior thoracoabdominal radiograph (TAR) ranged from 1 to 3 for each patient. Conclusion:In conclusion, ultrasound could be the standard of care for umbilical catheter placement, ensuring accurate vessel assessment and real-time visualization. Despite our limited sample, our findings highlight its superior precision and safety, reducing complications and the need for radiography. Integrating ultrasound into daily neonatal practice can improve catheter placement and patient outcomes.

Smoking is a leading risk factor for many preventable chronic diseases across the lifespan. Adolescence represents a critical period for the adoption of health-risk behaviours, including tobacco and nicotine products consumption. Evidence shows that adolescents who are susceptible to tobacco use are more likely to initiate and maintain smoking than their non-susceptible peers. This study examines factors associated with susceptibility to cigarettes, electronic cigarettes (e-cigs) and heated tobacco products (HTPs) in adolescents aged 13–15 years. Data were drawn from the 2022 Global Youth Tobacco Survey conducted in eight Italian regions. Susceptibility to tobacco products was measured through intentions to use tobacco and responses to hypothetical peer offers. Influencing factors (i.e. age, gender, having smoking friends or parents, exposure to tobacco advertising and to anti-smoking messages at school) were evaluated using a multivariable random intercept logistic regression to account for variability between macro-regions (North, Centre, South). The study included 17 713 participants from 738 schools and 1219 classes. Susceptibility to cigarettes was 27.8%, to e-cigs 36.6%, and to HTPs 29.5%. Regional differences emerged, with higher cigarette susceptibility in the South and higher e-cig susceptibility in the North. Having smoking friends was the strongest risk factor [cigarettes: odds ratio (OR) = 2.02, e-cigs: OR = 2.03, HTPs: OR = 2.22]. Anti-smoking messages at school were protective (cigarettes: OR = 0.92, e-cigarettes: OR = 0.91, HTPs: OR = 0.88). Individual factors had a stronger influence than geographical differences. The findings underscore the need for comprehensive tobacco control policies addressing the rising prevalence of poly-product use, stronger marketing regulations, and school-based and peer-led interventions.

Background:Type 1 diabetes mellitus is a lifelong condition with consequences that extend well beyond glycaemic control, often impacting individuals' socioeconomic status and overall quality of life. In Italy, the broader effects of early-onset type 1 diabetes on social and health-related outcomes have been insufficiently investigated. Therefore, this study aimed to investigate the socioeconomic impacts of type 1 diabetes among adults diagnosed with the condition before age 18. Methods:Using data from the Italian Behavioral Risk Factor Surveillance System (PASSI) collected between 2011 and 2018 and in 2023, we analyzed key outcomes in adults aged 18-50 who were diagnosed with type 1 diabetes before age 18 and were on insulin therapy. Each case was matched by age and sex to two non-diabetic controls. Descriptive statistics and multivariable logistic regression were used to compare key indicators. Results:Our sample included 993 participants (331 cases and 662 controls). Cases had significantly higher odds of being unemployed [OR = 1.57 (1.20-2.07)], experiencing severe financial difficulties [OR = 1.81 (1.05-3.13)], and reporting poor self-rated health [OR = 6.64 (2.53-17.43)]. Cases also had an increased likelihood of reporting physical impairment for 1-13 days [OR = 1.91 (1.30-2.81)] and ≥14 days [OR = 2.95 (1.54-5.65)], mental health impairment for 1-13 days [OR = 2.16 (1.46-3.19)], and daily activity limitations for 1-13 days [OR = 1.73 (1.06-2.82)]. Conclusions:These findings highlight the multifaceted burden of type 1 diabetes and the need for integrated approaches to care that address not only clinical but also socioeconomic and psychosocial dimensions of the disease.

BackgroundJuvenile type 1 diabetes can present lifelong challenges that may affect educational, employment, and health-related quality of life (HRQoL) outcomes in adulthood. This scoping review aims at exploring the long-term impact of juvenile-onset type 1 diabetes on education and career achievements and well-being in adulthood.MethodsA scoping review conducted using PubMed and PsycInfo (2005–2025) identified studies comparing adults diagnosed with type 1 diabetes during childhood and adolescence to controls without type 1 diabetes. Three studies focusing on educational attainment, employment, income, and HRQoL, met the inclusion criteria.ResultsThe studies included in the review show that university attendance is significantly lower among individuals with juvenile-onset type 1 diabetes, and this affects both men and women. Access to the labor market and earnings are similarly affected, especially in the case of women who experience both lower employment rates and income, compared to controls without diabetes. Men with type 1 diabetes have equal opportunities for workforce entry, but this does not translate into long-term income parity. Compared to healthy controls, HRQoL is lower among adults with type 1 diabetes, particularly in the school/work and emotional domains. Common challenges include low energy, forgetfulness, and concentration difficulties.ConclusionWhile it is a matter of debate how juvenile-onset type 1 diabetes affects academic achievements, there is general agreement that it leads to persistent disadvantages in employment and HRQoL in adulthood. Targeted support from diagnosis and during transition to adulthood is essential to mitigate the long-term impact of juvenile-onset type 1 diabetes on educational, employment and psychosocial outcomes for this population.

Introduction Prenatal alcohol exposure (PAE) is a well-established risk factor for adverse neurodevelopmental outcomes, particularly at high levels of consumption. The impact of low-to-moderate PAE remains unclear, with mixed results reported. This study investigates the effects of low-level PAE on neurodevelopmental outcomes at 18 months in Italian mother-child pairs enrolled in the Italian Northern Adriatic Cohort II, a part of the ‘Public health impact of long-term, low-level, mixed element exposure in susceptible population strata’ project PHIME.Methods The study population consisted of 632 children, and their mothers, who were tested with the Bayley Scales of Infant and Toddler Development third edition (BSID-III) at 18 months of age. PAE, socio-demographic and lifestyle information was collected through questionnaires at different phases of follow-up. We analysed 605 children born at term (≥37 weeks) with BSID-III data and maternal pregnancy alcohol intake estimates. Multiple linear regression assessed associations between each BSID-III composite score (cognitive, motor, language) and PAE.Results Mothers’ alcohol consumption was very low. The median (25th percentile to 75th percentile) of the weekly alcohol intake of the 605 mothers was 0.3 (0–1.4) drinks and of the children’s cognitive, language and motor composite score were 105 (100–110), 97 (91–103) and 100 (97–107), respectively. No significant association was found between maternal alcohol intake and BSID-III cognitive nor language scores. Only a suggestive, non-consistent, inverse association was found between PAE and motor neurodevelopment. Maternal IQ and promotion of child autonomy were directly associated with all neurodevelopmental outcomes.Conclusion Low levels of PAE were not associated with neurodevelopmental impairment at 18 months, except for possible motor impairment at higher exposures: our findings highlight the predominant influence of maternal IQ and the home environment. Further research, including a broader range of alcohol exposure, is needed to better define potential safety thresholds of PAE on early-life neurodevelopment.

[This corrects the article DOI: 10.3389/fpubh.2025.1655035.].

Prenatal lead (Pb) and manganese (Mn) exposure can impair neurodevelopment, targeting the central nervous system. This study investigated the effects of prenatal exposure to Pb and Mn on neurodevelopment in children at 18 months of age, using data from 607 Italian mother–child pairs enrolled in the Northern Adriatic Cohort II (NAC-II). All children born at term (≥37 weeks) were assessed with the Bayley Scales of Infant and Toddler Development, third edition. Cord blood concentrations of Mn and Pb were categorized as low or high exposures based on the 75th percentile of their distribution. Sociodemographic and lifestyle information was collected via questionnaires. Using simple and multiple linear regressions, the study examined the relationship between the cognitive composite score (COGN) and Mn and Pb co-exposure, including their interaction. Stratified regressions explored how Mn exposure influenced the effect of Pb, in the whole cohort and by the child’s sex. Beta coefficients (β) and the 90% confidence interval (90% CI) were estimated. Boys showed an interaction effect between Mn and Pb, with a reduction in COGN (β = −5.78, 90% CI: −11.17; −0.40), further described as a negative effect of high Pb on cognition when Mn exposure was also high (β = −6.98, 90% CI: −10.93; −3.04). No clear effects were observed in girls or the entire cohort at these levels of exposure. The findings highlight the harmful impact of combined prenatal Pb and Mn exposure on cognitive development in boys.

Background/Objectives: Emerging evidence suggests the critical role of diet in shaping mental health outcomes, which are increasingly prevalent among children and adolescents worldwide. This study aims to investigate whether the dietary habits of children in the Italian multicenter Piccolipiù birth cohort at four years of age were associated with anxiety and depression symptoms. This analysis was conducted within the framework of the Global burden of disease Lifestyle And mental Disorder (GLAD) Project (DERR2-10.2196/65576). Methods: Data from 1726 children were analyzed. Emotional symptoms were assessed with the Child Behavior Checklist (CBCL), and diet was assessed using a food frequency questionnaire. Sociodemographic data, including per capita income, were also collected. Associations between food intake (grams per day) and clinical anxiety/depression (T-scores > 70) or total symptom scores were examined using univariate and multivariable logistic and robust linear regressions adjusted for sex and income. Results: In 1726 children (median age 4.4 years; 50% female), 3% exhibited clinical anxiety and 2% clinical depression. Higher grain intake was associated with increased odds of clinical anxiety (OR = 1.004; 95% CI: 1.001–1.007), while greater fish consumption reduced odds of clinical depression (OR = 0.946; 95% CI: 0.903–0.992). Vegetable intake was associated with lower anxiety and depression scores. Multivariable analyses confirmed that grain intake is positively associated with anxiety, while fish consumption is inversely associated with depression. Conclusions: Higher intake of vegetables, fruits, and fish may be associated with better emotional health in preschoolers, although effect sizes were modest. Early dietary interventions may offer a practical approach to improving children’s long-term mental health. Longitudinal studies are needed to confirm these associations and clarify underlying mechanisms.

BACKGROUND:Children and Youth with Special Health Care Needs (CYSHCN) represent a growing, though numerically limited, category of the paediatric population requiring care from multiple professionals across different settings. As such, they are at increased risk of experiencing fragmented care, lower quality of services, and unmet health needs. Continuity of care and care coordination are essential to ensure adequate assistance. This study aimed to assess the continuity and coordination of care for CYSHCN in a region of north-east Italy. METHODS:Over 21 months (2018-2020), CYSHCN meeting the inclusion criteria were enrolled at a public tertiary university hospital as part of a cross-sectional study. Data about care activities performed over 12 months by Family Paediatricians (FPs), General Practitioners (GPs), and Community Healthcare Professionals (CHPs) were collected using a structured tool. After 9-12 months, parents' perceptions of continuity of care were assessed using a 20-item questionnaire on a 5-point Likert scale. In 2020, families and professionals were also asked about perceived changes in care due to the COVID-19 pandemic. RESULTS:Most of the 51 children enrolled had oncological conditions (60.8%). FPs/GPs and CHPs reported 116 and 155 care activities respectively, with statistically significant differences in the type, setting, and intensity of care. Parents reported high levels of perceived continuity of care, though slightly lower ratings were observed for family paediatrician and care coordinator. Among 109 respondents (32 FPs/GPs, 20 CHPs, 32 parents), perceived changes in care during the pandemic were reported more frequently by professionals (58.4%) than by families (43.8%). However, most parents (85.7%) considered the care they received to be adequate. CONCLUSIONS:Continuity and coordination of care for CYSHCN were generally well maintained in the region, even during the pandemic. Nonetheless, gaps remain in the role of primary care providers and informational continuity. Strengthening care integration-especially through better communication systems and the use of ICT-may enhance coordination, particularly for children with complex needs and those in rural settings.

The burden of autism spectrum disorder (ASD) is increasing worldwide with genetic, epigenetic, and environmental factors being possibly responsible for the observed epidemiological figures. In the setting of environmental exposure, the city of Taranto, in Southern Italy, represents an interesting case study as it hosts well inside the city one of the biggest steel plants in Europe. This is a cross-sectional ecological study carried out in the year 2020 in the province of Taranto designed to estimate the burden of ASD in the municipalities of Taranto and Statte, classified as high environmental risk areas (Contaminated Site of National Interest-SIN), compared to the other 27 municipalities of the same province. Differences have been evaluated using the Chi Square Test. Children aged 6-11 years identified in SIN municipalities had a statistically significant higher prevalence of ASD than children of other municipalities (9.58 vs. 6.66/1000 respectively, p = 0.002). No statistically significant difference was observed for the 12-18 years group (3.41 vs. 2.54/1000, p = 0.12). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence.

Intestinal anti-endomysium antibodies are a specific marker of celiac disease. The diagnostic accuracy of this marker seems high in pediatric patients and has not yet been investigated in adults, so the aim of this prospective multicentric study was to evaluate the specificity and sensitivity of this marker in childhood and adulthood. Pediatric and adult patients undergoing intestinal endoscopy for any intestinal condition were enrolled. Serological celiac disease markers and HLA type were evaluated in all patients. Intestinal biopsies were analyzed for standard histology and for intestinal anti-endomysium antibodies with biopsy culture assay. In this study, 291 patients (145 adults and 146 children) were included. In the adult population, 34 were diagnosed with celiac disease, 105 were controls, and, in 6, celiac disease was not confirmed. In the pediatric population, 77 were diagnosed with celiac disease, 57 were controls, and, in 12, celiac disease was not confirmed. High diagnostic sensitivity and specificity of intestinal anti-endomysium antibodies were confirmed in children and additionally proven in adults. To conclude, we can affirm that intestinal anti-endomysium antibodies can be detected with high diagnostic accuracy in both children and adults. The implementation of this marker in the diagnostic work-up would help clinicians to correctly identify celiac disease.

Background/Objectives: Endometriosis is a female chronic inflammatory disease in which endometrial tissue develops outside the uterine cavity. It is a complex pathology, which significantly contributes to morbidity in premenopausal women, leading to chronic pain, infertility, and subfertility negatively impacting physical and emotional well-being and the overall quality of life. The public health burden of endometriosis remains elusive and challenging to determine, and this uncertainty can lead to inadequate healthcare services and treatments. The objective was to estimate the incidence and prevalence of endometriosis in Italy using the hospital discharge records database via a population-based retrospective study, nationwide between 2011 and 2020. Methods: From the National Hospital Discharge Database, we selected all admissions with a diagnosis of endometriosis (ICD-9-CM, codes 617.x), supported by the presence of a procedure code of laparoscopy or any other surgical procedure allowing for direct visualisation of the lesions. The main outcomes measured: incidence and prevalence of endometriosis were estimated for the entire 2011–2020 period and by individual year, analysing the time trend and variability in different geographical areas of Italy. Results: There were a total of 134,667,646 women aged 15–50 years with one or more hospitalisations for endometriosis in all Italian hospitals. The incidence of endometriosis in Italy during this period was 0.839 per 1000 women (CI95% 0.834–0.844), exhibiting a statistically significant decreasing trend over the years. A discernible north–south gradient was observed, with higher rates documented in the northern regions. The prevalence rate stood at 14.0 per 1000 during the same period, and a similar north–south geographical gradient was identifiable in the prevalence rates as well. Conclusions: The utilization of national-level hospital data enables the generation of incidence and prevalence data for endometriosis without variations in methods and definitions, facilitating the evaluation of temporal trends and regional comparisons. Understanding and quantifying this phenomenon is essential for appropriate healthcare planning in various Italian regions.

Lead (Pb) is a global contaminant associated with multiple adverse health effects. Humans are especially vulnerable during critical developmental stages. During pregnancy, exposure to Pb can occur through diet and release from maternal bones. Apolipoprotein E gene (APOE) variants (ɛ2, ɛ3, ɛ4 alleles) may influence sex steroid hormones, bone metabolism, and Pb kinetics.We examined the interplay among maternal APOE (mAPOE) genotypes, fetal sex, parity, and Pb in maternal and cord blood (mB-Pb, CB-Pb) using linear regression models. Our study involved 817 pregnant women and 772 newborns with measured adequate levels of zinc and selenium. We compared carriers of the ε2 and ε4 alleles to those with the ε3/ε3 genotype.The geometric means (range) of mB-Pb and CB-Pb were 11.1 (3.58–87.6) and 9.31 (1.82–47.0) ng/g, respectively. In cases with female fetuses, the maternal mAPOE ε2 allele was associated with higher, while the mAPOE ε4 allele was associated with lower mB-Pb and CB-Pb levels. Nulliparity increased the strength of the observed associations. These findings highlight the significance of mAPOE genetics, fetal sex, and parity in prenatal Pb kinetics. Notably, the maternal ε2 allele may increase the risk of Pb exposure.

Background The Mothers’ Milk Tool, developed and launched by the Australian National University and Alive & Thrive in 2022, allows to estimate the volume and value of breastmilk using prevalence rates of breastfeeding by month of age from birth to 36 months. The objective of this study was to obtain these estimates for three cohort studies conducted in a region of Italy. Methods Breastfeeding data from three cohort studies carried out in 1999, 2007 and 2016, with follow-up to 12, 24 and 36 months of 842, 400 and 265 children, respectively, were entered into the downloadable version of the tool. Breastfeeding rates charts and tables with estimates of breastmilk production and value for breastfeeding of children aged 0–36 months were produced. Results The rates of initiation of breastfeeding were similar in the three cohorts, while the rates of any breastfeeding at subsequent ages increased over the years. The volumes and values of breastmilk per child increased accordingly, from around 130 L (13,000 USD) in 1999, to 200 L (20,000 USD) in 2007, to 226 L (22,600 USD) in 2016. The percentage of lost breastmilk decreased from 67.7% to 55.4% to 43.7%, respectively. Overall, the 1507 mothers of the three cohorts produced an estimated 250,000 L of breastmilk for their children aged 0–36 months. At 100 USD per litre, this would add up to around 25 million USD. Conclusions Our study shows that the Mothers’ Milk Tool can be used to estimate per child volumes and values of breastmilk produced and lost at local levels, and to provide simple indicators of the effects of breastfeeding interventions using the percentage of lost breastmilk, where datasets on rates of breastfeeding by month of age are available. The results of such studies can be used to advocate for better and adequately funded programmes for the protection, promotion and support of breastfeeding.