DPRK 2004 Nutrition Assessment Report of Survey Results Prepared by Central Bureau of Statistics Institute of Child Nutrition Democratic People’s Republic of Korea February 2005 Foreword The government of DPRK, in collaboration with UNICEF and WFP, conducted the DPRK 2004 Nutrition Assessment in October 2004. This assessment was carried out by the Central Bureau of Statistics and Institute of Children Nutrition, with financial and technical support from UNICEF and WFP. We extend our sincere gratitude to UNCEF, WFP, the National Co-ordination Committee of DPRK, the consultants, Dr. Michael John Dibley, University of Newcastle, Australia, and Mr. Tran Than Do, National Institute of Nutrition, Vietnam, who provided the invaluable assistance and support, and the survey team members. Democratic People’s Republic of Korea Central Bureau of Statistics November 2004 Table of Contents DPRK 2004 National Nutrition Assessment Contents Forward............................................................................................................................................. 2 Summary of Survey Findings.......................................................................................................... 8 SURVEY METHODOLOGY........................................................................................................ 8 SURVEY POPULATION AND DATA QUALITY ..................................................................... 8 CHILD NUTRITIONAL STATUS ............................................................................................... 9 MATERNAL NUTRITIONAL AND HAEMOGLOBIN STATUS ........................................... 10 FOOD AVAILABILITY.............................................................................................................. 11 MATERNAL AND CHILD CARE ............................................................................................. 11 WATER AND SANITATION..................................................................................................... 12 1 Introduction ............................................................................................................................ 13 2 Aims......................................................................................................................................... 14 3 Survey Methodology ..............................................................................................................15 3.1 Design .............................................................................................................................. 15 3.2 Sampling design…………………………………………………………………………15 3.3 Survey measurements ....................................................................................................... 16 3.3.1 Questionnaires.......................................................................................................... 16 3.3.2 Anthropometry ......................................................................................................... 16 3.3.3 Haemoglobin ............................................................................................................ 17 3.3.4 Measurement of salt iodination ................................................................................ 17 3.4 Survey factors and outcome indicators ............................................................................ 17 3.4.1 Anthropometric indicators in children ..................................................................... 17 3.4.2 Anthropometric indicators in women....................................................................... 18 3.4.3 Measurement of infant feeding practices ................................................................. 19 3.5 Survey organisation.......................................................................................................... 19 3.6 Training ............................................................................................................................ 20 3.7 Data processing ................................................................................................................ 20 3.8 Data analysis .................................................................................................................... 20 4 Results ..................................................................................................................................... 23 4.1 Survey population ............................................................................................................ 23 Table of Contents Page 3 DPRK 2004 National Nutrition Assessment 4.2 Assessment of data quality ............................................................................................... 26 4.2.1 Quality of age data.................................................................................................... 26 4.2.2 Quality of anthropometric measurements................................................................. 26 4.3 Child nutritional status...................................................................................................... 29 4.3.1 Weight-for-age ......................................................................................................... 29 4.3.2 Height-for-age .......................................................................................................... 32 4.3.3 Weight-for-height ..................................................................................................... 35 4.3.4 Factors associated with child malnutrition ............................................................... 38 4.3.5 Trends in child malnutrition ..................................................................................... 42 4.4 Maternal nutritional status................................................................................................ 48 4.4.1 Maternal malnutrition............................................................................................... 48 4.4.2 Maternal haemoglobin status.................................................................................... 54 4.5 Food availability...............................................................................................................56 4.6 Maternal and child care .................................................................................................... 59 4.6.1 Child feeding patterns............................................................................................... 59 4.6.2 Use of micronutrients ............................................................................................... 61 4.6.3 Immunisations of child ............................................................................................. 64 4.6.4 Childhood illnesses................................................................................................... 65 4.6.5 Pregnancy care.......................................................................................................... 68 4.7 Water and sanitation ......................................................................................................... 69 5 Conclusions and Recommendations...................................................................................... 72 6 References ............................................................................................................................... 73 Appendix A – List of Selected Clusters ........................................................................................ 74 Appendix B – Survey teams........................................................................................................... 78 Appendix C – Detailed Results...................................................................................................... 80 Appendix D- Questionnaires ......................................................................................................... 91 Page 4 Table of Contents DPRK 2004 National Nutrition Assessment Tables Table 1 Design of multistage cluster sampling ................................................................................ 15 Table 2 Classification of prevalence levels for child anthropometric indicators ............................. 18 Table 3 Sampling weights................................................................................................................ 21 Table 4 Number of clusters, women and children surveyed in each province................................. 23 Table 5 Number of household members and children < 6 years...................................................... 24 Table 6 Age and sex distribution of children with anthropometric measurements.......................... 24 Table 7 Age distribution of women and percentage with nutrition measurements.......................... 25 Table 8 Education levels of surveyed mothers................................................................................. 25 Table 9 Assessment of quality of anthropometric measurements by team ...................................... 27 Table 10 Comparison of data quality between Nutrition Assessments, 2002 and 2004 .................. 28 Table 11 Prevalence of malnutrition in children aged less than 72 months by gender .................... 29 Table 12 Trends in the prevalence of child malnutrition - DPRK 2002 to 2004 ............................. 43 Table 13 Prevalence of maternal malnutrition by background characteristics................................. 50 Table 14 Body