Journal List > J Korean Med Sci > v.40(19) > 1516090642

Jo: How to Reduce Diarrheal Diseases in North Korean Children?: Prioritizing From Limited Resources and Limited Data Resources
In this issue of the Journal of Korean Medical Science, an article reports on the clinical aspects of childhood diarrhea in North Korea (Democratic People’s Republic of Korea).1 The authors analyzed articles from major North Korean medical journals published during the years preceding the coronavirus disease 2019 pandemic. These journal articles were written in Korean and were typically just one or two pages long and often omitted critical scientific information on study subjects and research methods. These 43 articles were composed mainly of case-control studies (33 articles) and observational studies (9 articles). The major causes of diarrheal diseases were infectious (viral—including rotaviral, bacterial, and parasitic) and indigestion or malabsorption. Treatment modalities were various, i.e., rehydration solutions, antibiotics, probiotics, and vitamin supplements. These were similar to those in other developing countries, except for the trials involving North Korean traditional medicine (Koryo medicine) using extracts from herbs and animals, minerals, and/or manual therapies. However, as the authors noted with regret, accurate prevalence rates could not be elucidated from the analysis of North Korean journals.
According to recent data from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), the estimated under-five all-cause mortality rate in 2023 was 18 deaths per 1,000 live births in North Korea, significantly higher than in South Korea (2.76) and the United States (6.48).234 In addition, the estimated under-five diarrhea-caused mortality rate in 2021 was 0.340 per 1000 live births in North Korea (26 times that in South Korea and 3.6 times that in the US).567
The authors suggested that the use of rotavirus vaccines, supplemental zinc, and rehydration solutions could reduce the morbidity and mortality of diarrheal diseases in North Korean children.1 The World Health Organization (WHO) recommends that rotavirus vaccines be included in all national immunization programs (NIPs), especially in countries with high rotavirus-related fatality rates.8 However, the North Korean NIP does not currently include rotavirus vaccines.9
In countries or regions with poor infrastructure, maintaining the cold chain for vaccine storage and distribution remains a significant challenge. Recently, however, the WHO reported that North Korea’s NIP had successfully carried out a nationwide catch-up vaccination campaign to address missed childhood vaccinations due to the pandemic.10 The report also noted that all vaccine supplies were transported under proper cold chain management during the campaign.10
Although the current situation in North Korea remains unclear, introducing rotavirus vaccines could be one of the top priorities for improving child health in the country.

Notes

Disclosure: The author has no potential conflicts of interest to disclose.

References

1. Kim T, Jeon J, Ahn H, Moon JS. Childhood diarrheal diseases in North Korea: a narrative review on research topics and treatments. J Korean Med Sci. 2025; 40(19):e70.
2. UN Inter-agency Group for Child Mortality Estimation. All-Cause Mortality, Democratic People’s Republic of Korea. Accessed May 15, 2025. https://childmortality.org/all-cause-mortality/data?d_refArea=USA&refArea=PRK&type=RATE&causes=ASPHY_TRAUMA .
3. UN Inter-agency Group for Child Mortality Estimation. All-Cause Mortality, Republic of Korea. Accessed May 15, 2025. https://childmortality.org/all-cause-mortality/data?d_refArea=USA&refArea=KOR&type=RATE&causes=ASPHY_TRAUMA .
4. UN Inter-agency Group for Child Mortality Estimation. All-Cause Mortality, United States of America. Accessed May 15, 2025. https://childmortality.org/all-cause-mortality/data?d_refArea=USA&refArea=USA&type=RATE&causes=ASPHY_TRAUMA .
5. UN Inter-agency Group for Child Mortality Estimation. Causes of Death, Democratic People’s Republic of Korea. Accessed May 15, 2025. https://childmortality.org/causes-of-death/data?d_refArea=PRK&refArea=USA&causes=DIARRHOEAL&type=RATE .
6. UN Inter-agency Group for Child Mortality Estimation. Causes of Death, Republic of Korea. Accessed May 15, 2025. https://childmortality.org/causes-of-death/data?d_refArea=KOR&refArea=USA&causes=DIARRHOEAL&type=RATE .
7. UN Inter-agency Group for Child Mortality Estimation. Causes of Death, United States of America. Accessed May 15, 2025. https://childmortality.org/causes-of-death/data?d_refArea=USA&refArea=USA&causes=DIARRHOEAL&type=RATE .
8. World Health Organization. Rotavirus Vaccines: WHO Position Paper – July 2021. Wkly Epidemiol Rec. 2021; 96(28):301–319.
9. World Health Organization. Immunization Dashboard—Democratic People’s Republic of Korea. Democratic People's Republic of Korea Vaccination coverage over-time. Accessed May 15, 2025. https://immunizationdata.who.int/dashboard/regions/south-east-asia-region/PRK .
10. World Health Organization. Nationwide Catch-up Immunization Campaign in DPR Korea. Updated 2023. Accessed May 15, 2025. https://www.who.int/dprkorea/news/detail/26-04-2023-nationwide-catch-up-immunization-campaign-in-dpr-korea .
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