North Korea’s infant mortality rate topped 33 deaths per 1,000 live births in 2012, a study showed Thursday, reflecting the country’s chronic food shortages and lack of widespread, adequate health care services.

The finding resulted from analyzing nutrition surveys conducted jointly by the Pyongyang government and international organizations from 1998-2012. Lee Joung-hee, a professor at Kyonggi University’s graduate school of education in Suwon, Gyeonggi Province, released the work in Review of the North Korean Economy, a monthly journal published by the state-run Korea Development Institute.

The infant mortality rate follows the number of deaths of infants under 1 year old per 1,000 live births on a yearly basis, and can offer a glimpse into health conditions in a country.

The 2012 figure marks a sharp increase from 22.5 in 2000. The CIA World Factbook put its 2014 estimate at 24.5 for North Korea and 3.93 for the South. The number of deaths of North Korean infants under 5 years old per 1,000 live deaths is expected to have exceeded 53, up from 48.2 in 2000, the report said.