Early years
Early childhood is the most rapid period of development in a human life. In DPR Korea, malnutrition has eroded the survival, growth and development of children. According to the most recent Nutrition Assessment carried out in 2002, the prevalence of wasting and stunting in children less than 7 years of age is 9% and 42%, respectively. An estimated 70,000 children are severely wasted and require hospitalization. The main causes of child mortality are diarrhoea and respiratory infections combined with malnutrition.
These very high levels of malnutrition indicate that there are serious problems for both the physical growth and psychosocial development of young children. These have far reaching consequences affecting the whole of their lives. Recent international research has shown that retarded growth and development in the youngest years cannot be later regained or compensated for. Maternal nutritional status and food intake seem to be associated with child stunting. The 2002 nutrition assessment reports maternal malnutrition of 32 percent. About one-third of mothers of children under 2 years of age in DPR Korea have either anaemia and/or low body mass as predicted by lower mid-upper arm circumference. The 2002 nutrition assessment found a mean rate of exclusive breast-feeding of children less than six months of 69.6 percent. Despite the high proportion of institutional deliveries, reports suggest that the initiation of breastfeeding is often late by 12-24 hours. Unfortunately, mothers commonly believe that giving their infant water does not detract from the exclusivity of breastfeeding. Furthermore, children in DPR Korea usually enter nurseries at the age of three months on the termination of the mandated period of maternity leave. Even though nurseries are in close proximity to workplaces, breastfeeding could be frequently rushed or disrupted. Disruptions of breastfeeding have obvious implications for the health and nutritional status of children. In addition to depriving them of antibodies present in breast milk, valuable psychosocial stimulation and bonding are reduced. The introduction of other foods at this early age also exposes children to sources of infection that are not present in breastfeeding. The challenge of maintaining hygiene standards in view of DPR Korea’s reduced water supply and poor sanitation facilities adds to these vulnerabilities.
In DPR Korea, institutional care during early childhood is the norm. The 2002 situation analysis noted that caregivers are under significant amounts of stress. Between six months and three years, children have high nutritional requirements. They are highly susceptible to infection and, having very small stomachs, need frequent feeding. This is also a time when children need a lot of care and attention. Caregivers face limitations in time and resources. Existing complementary food is not adequate to meet nutritional requirements of a child. Immunization rates have increased sharply since 1998 providing better protection for children from disease. A 1998 survey found coverage for DPT3 (three doses of vaccine against diphtheria, pertussis, and tetanus) at 37 per cent and for measles at 34 per cent. Ministry of Public Health figures in 2003 show coverage of 68 percent and 95 percent, respectively, for the same vaccines. Polio eradication activities have been very successful with 99.5 percent of children vaccinated.
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