Fighting Hunger Worldwide
Addressing Undernutrition
in the Democratic People’s
Republic of Korea
A Partnership for Nutritious Biscuits and Super Cereal
All photos WFP/Rein Skullerud
The right food, at the right place, at
the right time1
Undernutrition is a complex and multi-faceted problem and is caused by a
combination of both immediate and underlying causes2. Poverty often underlies all
other factors. A lack of access to a healthy and nutritious diet, poor hygiene and
inadequate health services may also contribute. Given its complex causes, any
response to address undernutrition needs to be multi-disciplinary and involve many
different actors. The contribution of the World Food Programme is essential –
providing the right food, at the right place, at the right time.
Undernutrition is defined as the immediate outcome of insufficient dietary intake
and repeated infectious diseases. It includes being underweight for age, too short for
age (stunted), dangerously thin relative to height (wasted) and deficient in vitamins
and minerals (micronutrient deficient). Globally, the three most common forms of
vitamin and mineral deficiencies are iron deficiency (anaemia), vitamin A deficiency
(xerophthalmia/night blindness) and iodine deficiency (goitre and cretinism).
Undernutrition contributes to over one third of all child deaths. It weakens the
immune system, and increases the risk and severity of infections. Children are at
particular risk of stunting and mortality when they lack access to food that meets
their full nutrient needs. Moreover, undernutrition can start before birth, because a
1 From the WFP Nutrition Policy.
2 Immediate causes: dietary intake not meeting nutrient needs, and disease causing nutrient losses and increasing
needs; Underlying causes: inadequate access to nutritious food, poor caring practices, inadequate environmental
hygiene and health services; Basic causes: poverty, poor governance, lack of human and financial resources, etc.
mother’s nutrition during pregnancy is closely linked to the health of her child.
Stunting is also passed between generations: stunted mothers tend to have babies
with low birthweight, who are likely to remain stunted.
Not only does undernutrition kill, it also prevents children growing up to live
productive lives. Children without access to an adequate diet can suffer irreversible,
long-term consequences, including impaired cognitive and physical development.
The Lancet medical journal has indicated that if undernutrition can be overcome especially during the first 1,000 days of life (between conception and 2 years of age)
– not only can lives be saved, but children have a greater chance of growing up to
realize their full potential.
In the Democratic People’s Republic of Korea (DPRK), the results of a multipleindicator cluster survey (MICS) supported by UNICEF in October 2009 indicated
high rates of undernutrition. Data from this survey indicate a 32 percent national rate
of stunting, with significant differences at provincial level. The stunting figures for the
provinces in the northeast reach from 38 to as high as 45 percent. According to the
World Health Organization benchmark a percentage between 30 and 39 for stunting
indicates a serious chronic undernutrition, while a percentage of 40 and above is
classified as severe. The data also provide a 5 percent rate for wasting or acute
malnutrition for children under five years of age, which is classified as poor by WHO.3
3 See - http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/AcuteMalnutrition-Summary-Sheet.pdf
Addressing undernutrition in DPRK:
a partnership for nutritious biscuits
and Super Cereal
WFP/Marcus Prior
Since 1998, the production of locally fortified food has been at the heart of WFP
efforts to address undernutrition and fight hunger in DPRK. A network of local
factories produce biscuits and Super Cereal that are enriched with vitamins and
minerals and are distributed as supplementary food to children and women. WFP
regularly revises the recipes of the various products and explores opportunities to
produce new products in the light of the latest scientific nutritional research.
WFP/Rein Skullerud
SDC/Simon Joss
Biscuits and Super Cereal – a unique
WFP/government partnership
The DPRK government contributes to the project by providing the factories,
warehouses, staff, electrical power and maintenance. Under WFP oversight, the
government is also responsible for the transportation of raw ingredients from the ports
to the factories, as well as for the distribution of biscuits and Super Cereal to
institutions, including nurseries, kindergartens, primary schools and hospitals.
In turn, WFP provides the basic raw materials for biscuit and Super Cereal production,
a cooking mix (iodized salt and baking soda), and a micronutrient premix (vitamins and
minerals) to fortify the food. WFP also supplies packaging materials, spare parts and
technical expertise in food processing and fortification. Local production is considerably
cheaper than sourcing these specialized products from outside DPRK. Over the many
years of partnership, WFP has successfully built the expertise of its local partners in
DPRK and seen capacity and skills become rooted in the national production network.
Periodically, WFP holds workshops for factory staff, including managers, accountants
and warehouse stock-keepers. These have proved useful for the exchange of best
practices and lessons learned among staff from different factories.
The cost of the daily ration
for one school child is
6 US cents a day, equal to
US$15 for a child for the
entire school year.
What are nutritious biscuits and Super
Cereals and who receives them?
1. Biscuits
Children in primary schools and kindergartens receive four biscuits per day
(60 grams). The biscuits are served as mid-morning/afternoon snacks in primary
schools and kindergartens to ensure children receive a minimum amount of
micronutrients and vitamins, such as vitamin A, iron and iodine which are essential
for mental and physical growth.
The nutritious biscuits are made of wheat flour, oil, sugar and enriched with
vitamins and micronutrients.
Well over one million children receive these snacks every day during the school
year. WFP food aid monitors visit the factories on a regular basis. They also monitor
delivery to the schools.
All photos WFP/Rein Skullerud
2. Super Cereal
Young children in institutions such as orphanages, nurseries and kindergartens, as
well as pregnant and nursing mothers, receive Super Cereal on a daily basis.
Depending on age group, a daily ration is typically between 100-150 grams.
Corn-soya milk (CSM) blend is composed of five ingredients: maize, soybean,
dried skimmed milk, sugar and vegetable oil.
Cereal-milk blend (CMB) is composed of four ingredients: wheat flour, dried
skimmed milk, sugar and vegetable oil.
Both Super Cereals are fortified with a premix of vitamins and minerals and can be
used in numerous ways, often to make porridge, bread and pancakes.
Rice-milk blend (RMB) is a highly nutritious and digestible product for
malnourished children admitted to paediatric hospitals and wards. It is also
provided for younger children4 as it is easily digestible. RMB powder is composed
of cooked rice, milk powder, oil and sugar, fortified with vitamins and minerals.
The daily ration is around 100 grams. RMB needs only to be mixed with warm
water to be ready for consumption.
4 Children under 6 months of age are recommended to continue being exclusively breastfed.
Production line:
from port to plate
WFP either receives donations in-kind (such as maize, wheat, and sugar) or
procures the necessary ingredients to produce biscuits and Super Cereal through a
competitive tender process. The raw materials arrive in one of DPRK’s three main
ports: Nampo on the West coast, or Hamhung and Chongjin on the East. From the
port, transportation is arranged based on an agreed distribution plan to ensure all
factories receive what they require according to their monthly quota. The raw
materials are then stored in the factory warehouses.
WFP/Rein Skullerud
WFP food aid monitors visit the warehouses on a regular basis, and carry out checks
of raw materials and finished products. These visits also allow WFP to meet with the
factory staff and address other issues, including quality control, general
maintenance and power supply.
WFP/Marcus Prior
WFP/Rein Skullerud
WFP/Marcus Prior
WFP/Rein Skullerud
On average, 80 percent of staff working in the factories are women, who are
provided with gloves, aprons and caps to ensure hygienic food processing. In most
cases, the factories are operational six days a week and have three different shifts of
eight hours each, pausing one hour each day for maintenance.
Each factory has an agreed monthly production quota, based on its storage capacity,
available machinery, staff, electrical power supply and other operational factors.
The biscuits and Super Cereal are packed and stored in the factory warehouse until
the end of each month. At that moment and depending on the actual production of
the month, WFP prepares a targeted distribution plan to reach children from
6 months to 16 years old, and pregnant and nursing women throughout the country.
Under WFP monitoring, the products are transported to institutions such as baby
homes, nurseries, primary schools or paediatric hospitals which then proceed to
direct distribution to people selected for assistance. Pregnant and nursing mothers
receive their rations through the national network of Public Distribution Centres.
WFP food is not part of the Government Public Distribution System, but WFP uses
the outlets as distribution points. A comprehensive monitoring system is in place to
allow WFP food aid monitors access to distribution points and households.
WFP/Sneha Lata
Case study
Sim Mun-Sop oversees work at Chongnam Gu People’s Hospital in DPRK’s
South Pyongan province. On a recent visit to the institution, WFP’s
monitoring staff heard how nutritional assistance has been helping young
children return to health.
“If there is no health there would be no value to wealth,” says Sim. In recent
months, the hospital has received Super Cereal – specialized blended food
rich in vital nutrients and vitamins – as well as soya beans and wheat. The
foods have been given to child in-patients as part of efforts to combat
malnutrition, especially amongst the most vulnerable.
“Mothers come to the hospital with gloomy faces, carrying their sick children,
but they return home smiling with healthy children. I love to see the mothers’
happy faces. WFP’s nutritious food assistance makes it possible for the
mothers and their children to smile.
“We mill the wheat otherwise it is hard to digest, and then prepare wheat
flour soup for the children, which they like very much. Their mothers seem to
be happy as their children like the meal.
“As the person in charge of the hospital, I also am happy to see that decent
meals are served to the child patients here. I am personally very thankful to
WFP for providing the food for sick children,” said Sim.
WFP is targeting over 8,000 children per month in paediatric hospitals in
DPRK for specialized nutrition assistance.
Undernutrition encompasses a range of conditions, including
acute malnutrition (wasting), chronic malnutrition (stunting),
and micronutrient deficiency.
Wasting:
- Wasting (acute malnutrition) results from rapid weight loss or failure to gain
weight. Wasted children are at increased risk of morbidity and mortality.
- Wasting refers to both inadequate weight relative to height (weight for
height – WFH), where a child is thin for his/her height; and an inadequate
muscle tissue and fat stores in the body indicated by a low Mid-Upper Arm
Circumference (MUAC).
- Wasting can be divided into two types:
Moderate acute malnutrition (MAM) is identified by moderate wasting
(WFH < -2 z-score and ≥ -3 z-score or MUAC < 125 mm and ≥ 115 mm for
children below 5 years).
Severe acute malnutrition (SAM) is identified by severe wasting
(WFH < -3 z-score or MUAC < 115 mm for children below 5 years) or the
presence of bilateral pitting edema.
Global acute malnutrition (GAM) is the prevalence of both MAM and
SAM in a population.
Stunting:
- Stunting (chronic malnutrition) stems from a slow growth of the fetus and
the child, resulting in failure to achieve desired height as compared to a
healthy, well-nourished child of the same age.
- Stunting refers to low height-for-age (HFA), where a child is short for
his/her age. It reflects past growth failure and carries long-term
developmental risks.
- In children under 5 years of age, it is identified by moderate stunting
(HFA < -2 and ≥ -3 z-score) and severe stunting (HFA < -3 z-score)
- In children over 2 years of age, the impact of stunting may not be
reversible as it accumulates during the first 1,000 days of life.
Micronutrient Deficiency:
Micronutrient deficiencies are a form of malnutrition caused by an insufficient
uptake of vitamins and minerals (also known as micronutrients), which are
essential for human health, growth and development. Micronutrient
deficiencies put people at increased risk of early mortality, disease and
disability. The most common types of micronutrient deficiencies found in the
developing world are iodine deficiency, vitamin A deficiency, iron deficiency
anaemia and zinc deficiency.
Printed: October 2012
Cover: WFP/Rein Skullerud Back cover: WFP/Bithika Biswas
WFP in the Democratic People’s Republic of Korea
21 Munsudong, Pyongyang, DPR Korea
Tel: +850 2 3817219 / +850 2 3817217
Fax: +850 2 3817639
Email: [email protected]
October 2012