Global Hunger Index
The Global Hunger Index (GHI) is a peer-reviewed annual report jointly published by the non-governmental organizations Concern Worldwide and Welthungerhilfe, designed to measure and track hunger at global, regional, and national levels through a composite score calculated from four indicators: the prevalence of undernourishment (proportion of population with insufficient caloric intake), child stunting (low height-for-age in children under five), child wasting (low weight-for-height in children under five), and under-five child mortality rates.[1][2] Scores range from 0 (no hunger) to 100 (worst), with categories including low (<5), moderate (5-9.9), serious (10-19.9), alarming (20-34.9), and extremely alarming (≥35); the 2024 global GHI score stands at 18.3, classified as moderate, reflecting minimal improvement from 18.8 in 2016 and stagnation in reducing undernourishment affecting an estimated 733 million people.[3][4] The index draws data primarily from sources like the Food and Agriculture Organization's Prevalence of Undernourishment estimates, Demographic and Health Surveys for child metrics, and UNICEF/World Bank child mortality figures, aiming to provide a multidimensional view beyond caloric deficits by incorporating outcomes linked to chronic and acute undernutrition.[1] This approach has been credited with raising awareness of persistent hunger challenges, particularly in regions like South Asia and sub-Saharan Africa where 42 countries recorded serious or alarming levels in 2024, but progress remains insufficient to meet the UN Sustainable Development Goal of zero hunger by 2030, with undernourishment rates rising in some areas due to conflicts, climate shocks, and economic disruptions.[3][5] Despite its intent, the GHI faces significant methodological criticisms for conflating hunger—defined as inadequate energy intake—with broader malnutrition factors like infections, poor sanitation, or genetic predispositions, as child stunting and wasting serve as imperfect proxies that do not directly quantify caloric deficits in adults or overall populations.[6] Governments, including India's, have rejected their rankings as erroneous, citing reliance on outdated surveys (sometimes over a decade old), unrepresentative sampling via telephone polls or small-scale studies, and exclusion of national data showing improvements in direct hunger metrics like food consumption patterns.[7][8] These flaws, compounded by the NGOs' advocacy roles which may incentivize highlighting crises to mobilize funding, undermine the index's reliability as a precise tool for policy evaluation, though it underscores the empirical reality that global food production exceeds needs while distribution failures and non-hunger stressors perpetuate undernutrition.[6][9]Overview
Purpose and Scope
The Global Hunger Index (GHI) constitutes an annual peer-reviewed report jointly published by the Irish nongovernmental organization Concern Worldwide and the German nongovernmental organization Welthungerhilfe, with the explicit aim of quantifying and monitoring hunger prevalence to inform advocacy, policy formulation, and resource allocation.[2] [1] It seeks to highlight disparities in nutritional outcomes, enabling stakeholders to assess progress against international targets such as Sustainable Development Goal 2 for ending hunger by 2030, while underscoring regions and nations requiring urgent intervention.[10] [11] In scope, the GHI evaluates hunger across global, regional, and country levels for approximately 136 nations in its 2025 edition where data sufficiency permits, deriving scores from a composite of four standardized indicators: the prevalence of undernourishment (proportion of population with insufficient caloric intake), child stunting (chronic undernutrition reflected in low height-for-age), child wasting (acute undernutrition via low weight-for-height), and under-five child mortality (linked to nutritional deficiencies).[1] [12] [11] These metrics, drawn from sources including the Food and Agriculture Organization, Demographic and Health Surveys, and UNICEF data, yield a 100-point scale where scores below 5 denote low hunger severity and those above 50 indicate alarming levels, facilitating temporal and cross-national benchmarking.[1] [13] The index's framework emphasizes both quantity (caloric deficits) and quality (micronutrient shortfalls inferred through child anthropometrics and mortality), though its reliance on modeled estimates for undernourishment has drawn scrutiny for potential overemphasis on aggregate data over localized causal drivers like agricultural productivity or conflict disruptions.[1] Nonetheless, it prioritizes empirical tracking over prescriptive solutions, serving as a diagnostic rather than a causal analysis tool.[14]Origins and Evolution
The Global Hunger Index (GHI) originated from earlier efforts to quantify nutritional deprivation comprehensively. In April 2000, researchers at the Center for Development Research (ZEF) at the University of Bonn, including Doris Wiesmann, released the Global Nutrition Index (GNI), a precursor metric that combined indicators of caloric deficits, child malnutrition, and mortality to assess global nutritional status.[11] This index was featured in academic publications evaluating hunger trends, such as a 2006 Food Consumption and Nutrition Division discussion paper that ranked countries based on 1998-2000 data.[15] The GNI laid the groundwork for a standardized, multidimensional approach but was limited by data availability and focused primarily on nutrition rather than broader hunger dimensions. The formal GHI debuted in 2006, produced by the International Food Policy Research Institute (IFPRI) in partnership with the NGOs Concern Worldwide and Welthungerhilfe.[16] The inaugural report calculated scores for 1981, 1990, 1995, and 2003, using three indicators: the prevalence of undernourishment, child underweight rates, and under-five mortality, to track reductions in hunger amid Millennium Development Goals progress.[17] IFPRI's involvement stemmed from its expertise in food policy research, while the NGOs provided field insights and advocacy platforms; Welthungerhilfe, founded in 1962 as the German arm of the Freedom from Hunger Campaign, emphasized practical hunger alleviation.[18] This collaboration aimed to create a tool for policymakers, though early scores relied on modeled estimates due to patchy national data, particularly in low-income regions. Over time, the GHI evolved through annual iterations, with the 2025 edition marking the 20th report, published each October to align with UN hunger-related events.[19] Methodological refinements addressed limitations in original indicators; for instance, eight years after launch, IFPRI initiated a 2014 review, resulting in 2015 updates that replaced child underweight with separate measures of stunting (chronic malnutrition) and wasting (acute malnutrition) for better granularity on child-specific hunger forms, while retaining undernourishment and mortality.[20] [21] These changes improved sensitivity to nutritional outcomes but increased dependence on survey data from sources like Demographic and Health Surveys, potentially amplifying estimation errors in data-sparse countries. Publishing shifted post-IFPRI's lead role, with Concern Worldwide and Welthungerhilfe assuming primary responsibility alongside the Institute for International Law of Peace and Armed Conflict at Ruhr University Bochum for recent editions, reflecting a pivot toward integrating conflict analysis into hunger assessments.[1] Despite these adaptations, the core framework has remained a composite score normalized to 100, categorizing hunger from low to alarming, enabling trend tracking but inviting scrutiny over subjective weighting and NGO-driven priorities.[16]Methodology
Indicators and Metrics
The Global Hunger Index (GHI) employs four equally weighted indicators to quantify hunger multidimensionally: the prevalence of undernourishment, child stunting, child wasting, and under-five child mortality. These metrics, averaged after normalization to a 100-point scale, aim to reflect both caloric deficits and broader nutritional deficiencies affecting calorie utilization, with data typically drawn from three-year averages to mitigate annual fluctuations.[1][11] The equal weighting assumes each indicator captures complementary aspects of undernutrition, though this approach has drawn scrutiny for not directly measuring subjective hunger experiences or immediate caloric shortfalls.[6] Prevalence of undernourishment (PoU) measures the percentage of a population whose caloric intake falls below minimum dietary energy requirements, estimated via FAO's Food Balance Sheets adjusted by factors like food losses and unequal distribution.[1] In the 2025 GHI, global PoU stood at 9.4% for the period 2021–2023, signaling insufficient progress from prior years.[11] This indicator proxies aggregate food availability but overlooks micronutrient gaps or over-reliance on low-quality calories. Child stunting, defined as the percentage of children under five with height-for-age more than two standard deviations below WHO median growth standards, indicates chronic undernutrition from prolonged inadequate nutrition or recurrent infections.[1] Data derive from the UNICEF-WHO-World Bank Joint Malnutrition Estimates (JME), with 148 million children affected globally in recent assessments.[3] Stunting persists as a marker of intergenerational impacts, correlating with cognitive impairments, yet it conflates nutritional deficits with non-dietary factors like sanitation.[11] Child wasting captures acute undernutrition as the percentage of children under five with weight-for-height below two standard deviations of WHO standards, reflecting recent severe weight loss often tied to food shortages or illness.[1] Global figures hovered at approximately 45 million children in 2022 estimates, sourced from JME datasets.[3] While predictive of elevated mortality risk, wasting's episodic nature limits its utility for tracking sustained hunger trends. Under-five mortality rate (U5MR), expressed as deaths per 1,000 live births, serves as a proxy for the health and nutritional environment, where malnutrition contributes to roughly 45% of such deaths per WHO analyses.[1] Sourced from UN Inter-agency Group for Child Mortality Estimation, the metric averaged nearly 5 million annual deaths worldwide in recent years.[3] Critics contend U5MR indirectly gauges hunger, as declines often stem from vaccines and sanitation rather than food access alone, potentially overstating nutritional causality.[6] Prior to 2015, the GHI incorporated child underweight instead of wasting, but methodological revisions favored wasting for its sensitivity to acute deficits, alongside retaining mortality to enhance multidimensionality despite debates over indicator specificity.[16] Overall, the framework prioritizes child-focused metrics (75% weighting via stunting, wasting, and mortality) to emphasize vulnerable populations, though this skews away from adult undernourishment prevalence.[1]Calculation Framework
The Global Hunger Index (GHI) score for a given country or aggregate is derived from four complementary indicators that proxy different dimensions of hunger: the prevalence of undernourishment (POU), which measures the percentage of the population with insufficient caloric intake; child stunting, the percentage of children under age five with low height-for-age indicating chronic undernutrition; child wasting, the percentage of children under age five with low weight-for-height indicating acute undernutrition; and under-five child mortality, the proportion of children dying before age five, partially attributable to undernutrition.[1] These indicators are selected to capture both overall population-level hunger and its manifestations in child nutritional status, with data drawn from United Nations agencies such as the Food and Agriculture Organization (FAO) for POU, the World Health Organization (WHO) and UNICEF for stunting and wasting, and the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) for mortality rates.[1][3] The calculation follows a three-step process to produce a score on a 100-point scale, where 0 signifies no hunger and 100 the worst possible outcome. First, raw values for each indicator are obtained from the most recent available data, typically spanning 2019–2023 for recent scores, with provisional estimates used where country-level data are incomplete.[1] Second, these values are normalized to a 0–100 scale using predefined thresholds set slightly above historical maxima to prevent ceiling effects: 80% for undernourishment, 70% for stunting, 30% for wasting, and 35% for mortality. The normalization formula for each indicator is (raw value ÷ threshold) × 100.[1] Third, the normalized values are combined into the GHI score using unequal weights to emphasize population-wide aspects: undernourishment and child mortality each receive a weight of 1/3, while stunting and wasting together account for 1/3 (1/6 each), reflecting their role as proxies for undernutrition severity. The aggregation formula is thus: GHI = (normalized undernourishment × 1/3) + (normalized stunting × 1/6) + (normalized wasting × 1/6) + (normalized mortality × 1/3).[1][3]| Indicator | Threshold (%) | Weight | Data Source(s) |
|---|---|---|---|
| Undernourishment (POU) | 80 | 1/3 | FAO |
| Child Stunting | 70 | 1/6 | WHO/UNICEF |
| Child Wasting | 30 | 1/6 | WHO/UNICEF |
| Child Mortality | 35 | 1/3 | UN IGME |
Data Sources and Reliability Issues
The Global Hunger Index (GHI) relies on four primary indicators sourced from United Nations agencies and affiliated surveys: prevalence of undernourishment from the Food and Agriculture Organization (FAO), using three-year averages such as 2022–2024; child stunting and child wasting from the World Health Organization (WHO), UNICEF, Demographic and Health Surveys (DHS), and Multiple Indicator Cluster Surveys (MICS), drawing from the closest available survey years like 2024 or averages thereof; and under-five child mortality from the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), with reference years including 2023.[1][3] These data are aggregated into a composite score, with undernourishment and child mortality weighted at one-third each, and stunting and wasting at one-sixth each, standardized against observed ranges.[1] Official methodology acknowledges limitations, including missing data for up to 13 of 136 countries in recent reports due to violent conflict or political instability, leading to provisional severity classifications based on partial indicators, historical GHI values, and supplementary reports like the Global Report on Food Crises; such gaps may underestimate aggregate hunger severity.[1][3] Comparability across years is restricted, as revisions to underlying data or methodological adjustments—such as updated normalization thresholds—render scores from non-specified benchmark periods (e.g., 2000, 2008, 2016, 2024/2025) incomparable.[1] Undernourishment estimates, derived from FAO models of dietary energy supply, incorporate assumptions about food distribution and consumption that may not capture household-level access or micronutrient deficiencies.[3] Critics, including the Indian Council of Medical Research, argue that the indicators fail to directly measure hunger—defined as insufficient caloric intake—but instead proxy broader malnutrition outcomes, with stunting and wasting reflecting chronic conditions influenced by sanitation, infections, and genetics rather than food scarcity alone, potentially conflating non-dietary factors.[6] Child mortality, while correlated with undernutrition, is affected by healthcare access and disease prevalence, diluting its specificity to hunger.[6] This multidimensional approach risks inclusion errors by incorporating elements extraneous to acute food deprivation, which could mislead policy prioritization toward child-specific interventions over adult caloric deficits.[22] Data timeliness poses further reliability challenges, as GHI often incorporates outdated surveys; for instance, child wasting and stunting figures for countries like India have relied on pre-2021 data despite more recent National Family Health Surveys (NFHS-5, 2019–2021) showing declines, with small sample sizes in DHS/MICS exacerbating non-representativeness in heterogeneous populations.[23][24] Governments, including India's, have contested rankings for discrepancies with national statistics, attributing higher GHI scores to reliance on secondary estimates over primary domestic measurements that indicate progress.[23][24] FAO undernourishment prevalence, modeled from supply-side data, may overestimate shortfalls in nations with improved distribution systems but limited consumption surveys.[7] Published by non-governmental organizations Concern Worldwide and Welthungerhilfe, the GHI's advocacy orientation raises questions about selective emphasis on severity to influence funding and policy, though UN-sourced data provide a standardized baseline absent comprehensive global caloric intake registries.[2] Independent analyses affirm the index's utility for tracking trends but caution against overinterpreting absolute scores due to these proxies' indirectness and data lags.[22][6]Empirical Context of Global Hunger
Long-Term Reductions
The global GHI score declined from 28.2 in 2000—classified as serious—to 19.0 in 2016, indicating marked long-term progress in reducing hunger through improvements in its core indicators of undernourishment prevalence, child stunting, child wasting, and under-five mortality.[2] This overall reduction reflects broader empirical trends in hunger metrics, with the prevalence of undernourishment in developing countries dropping from around 33% in 1970 to 12% by 2015, based on FAO data.[25] Absolute numbers of undernourished people also decreased by approximately 200 million between 1991 and 2017, even as the global population grew by 2.1 billion.[26] Child-specific indicators further underscore these gains. Global child stunting rates—a proxy for chronic malnutrition—fell by one third over the two decades prior to 2024, averting stunting in 55 million children through enhanced maternal and child nutrition efforts.[27] Child wasting rates, signaling acute undernutrition, have similarly trended downward in aggregate, though data variability limits precise global quantification beyond regional declines reported in FAO and WHO assessments. Under-five mortality, where undernutrition contributes to roughly 45% of deaths, halved from 93 per 1,000 live births in 1990 to around 38 by 2020, per UN Inter-agency Group for Child Mortality Estimation figures integrated into GHI calculations.[25][2] These reductions were most pronounced in East and South Asia, where rapid economic expansion and agricultural advancements lifted hundreds of millions from hunger, contrasting with slower progress in sub-Saharan Africa.[25] However, the GHI methodology's reliance on modeled estimates for undernourishment and wasting—derived from household surveys and vital registration—introduces potential over- or underestimation in data-sparse regions, as noted in FAO critiques of survey-based prevalence metrics. Despite such limitations, the convergence of independent datasets from FAO, WHO, and UNICEF confirms the substantive scale of pre-2020 hunger alleviation.Primary Causal Factors
Conflicts and armed violence constitute the leading driver of acute food insecurity worldwide, disrupting agricultural production, supply chains, and humanitarian access while displacing populations and exacerbating poverty in affected regions. In 2024, conflict fueled food crises in 20 countries, impacting nearly 140 million people facing high levels of acute hunger, with hotspots including Gaza, Sudan, and parts of the Sahel where ongoing wars have halved food output in some areas.[28] [27] Empirical analyses from the Food Security Information Network indicate that violence directly correlates with Phase 4 (Emergency) and Phase 5 (Famine) classifications in the Integrated Food Security Phase Classification, as seen in Yemen and South Sudan where conflict-related blockades reduced caloric availability by over 30% in peak years.[29] Economic shocks, including inflation in food prices and macroeconomic instability, rank as a close secondary factor, limiting household purchasing power and access to markets even in non-conflict zones. Between 2022 and 2024, such shocks drove acute insecurity for over 59 million people across 15 countries, with global food price indices rising 28% post-2022 due to export disruptions and fertilizer costs, pushing 100 million additional individuals into extreme poverty and undernourishment.[30] [31] Data from the World Bank highlight that in low-income nations, where 70% of hunger persists, stagnant wages and debt burdens amplify these effects, with undernourishment rates correlating inversely with GDP per capita growth rates below 2% annually.[32] Climate extremes, such as droughts and floods, contribute significantly by reducing crop yields and livestock viability, particularly in rain-fed agricultural systems dominant in sub-Saharan Africa and South Asia. From 2015 to 2023, weather-related shocks affected 307 million people in Africa alone, with events like the 2022 Horn of Africa drought slashing maize production by 20-40% in Ethiopia and Kenya, leading to a 15% rise in undernourishment prevalence.[33] [27] FAO assessments link these variability patterns to El Niño cycles and longer-term aridification, though adaptive measures like irrigation have mitigated impacts in higher-income contexts, underscoring that institutional capacity modulates climate's causal role.[34] Underlying structural issues, including poverty traps and inadequate agricultural investment, perpetuate chronic hunger by constraining productivity and resilience. Globally, 733 million people faced hunger in 2023, with prevalence exceeding 20% in regions where public spending on agriculture remains below 5% of GDP, hindering yield improvements from technologies like high-yield seeds that boosted output 50% in adopter countries since 2000.[27] World Bank data reveal that in agrarian economies, smallholder farmers—comprising 80% of the rural poor—face credit access barriers, resulting in fertilizer use rates 5-10 times lower than in industrialized farming, directly tying low investment to caloric deficits.[35] These factors interact causally, as conflicts and economic downturns erode fiscal space for infrastructure, amplifying vulnerability to shocks in governance-weak environments.[36]Recent Stagnations and Reversals
Global hunger reduction, which had accelerated in prior decades, began stagnating around 2015-2016, with the prevalence of undernourishment (PoU) hovering near 8-9% of the world population thereafter.[25] According to the Food and Agriculture Organization (FAO), the global PoU stood at approximately 8.9% in 2019 before rising sharply to 9.8% in 2020 amid the COVID-19 pandemic, marking a reversal of prior gains and affecting an additional 150 million people compared to 2019 estimates.[37] This uptick persisted, with PoU remaining elevated at around 9.2% through 2022, driven by pandemic-induced supply chain disruptions, income losses, and lockdowns that constrained agricultural production and food access in low-income regions.[38] Subsequent years saw partial recovery but entrenched stagnation, as the 2024 PoU declined modestly to 8.2% (affecting 673 million people), down from 8.5% in 2023, yet still far above pre-2015 lows and insufficient to meet Sustainable Development Goal 2 targets.[39] The Global Hunger Index (GHI) corroborates this, reporting a global score of 18.3 in 2025—only a 0.7-point improvement from 19.0 in 2016—indicating negligible overall progress despite localized declines.[2] Regional disparities exacerbated the trend, with PoU rising in Africa (to over 20% in sub-Saharan areas) and Western Asia due to compounding shocks, while Asia saw slower reductions.[39] Primary drivers of these stagnations and reversals include armed conflicts, which disrupted food production and exports—such as the 2022 Russia-Ukraine war elevating global grain and fertilizer prices by 20-30%—alongside climate-induced events like droughts and floods that reduced yields in vulnerable regions by up to 10-15% annually in affected areas.[40] [41] Economic factors, including post-COVID inflation peaking in 2022-2023 (with food price hikes outpacing general inflation), further strained affordability for 2-3 billion people in low- and middle-income countries, while policy responses like export bans and subsidies proved unevenly effective.[40] FAO projections indicate that, absent accelerated interventions, around 512 million people will remain undernourished by 2030, underscoring the risk of prolonged stagnation.[42]GHI Scores and Analysis
Global and Regional Patterns
The Global Hunger Index (GHI) score for the world declined from 28.2 in 2000, classified as serious, to 18.3 in 2025, classified as moderate, reflecting overall long-term reductions in hunger severity driven by improvements in undernourishment, child stunting, wasting, and mortality rates.[11] However, progress has stalled markedly since 2016, with the score improving only slightly from 19.0 to 18.3, as global undernourishment levels have risen amid conflicts, climate shocks, and economic disruptions, rendering the UN Sustainable Development Goal of zero hunger by 2030 unattainable at current rates.[11][43] This global pattern masks persistent disparities, with aggregate improvements obscuring reversals in vulnerable populations and data gaps in conflict zones like Sudan and Yemen that likely underestimate true severity.[11] Regionally, Africa South of the Sahara exhibits the highest hunger levels, with a 2025 GHI score of 27.1, categorized as serious, down from 37.5 (alarming) in 2000 but showing slowed gains since 2016 due to elevated undernourishment (over 20% prevalence) and child mortality rates exceeding those in other regions.[11][44] South Asia follows closely with a 2025 score of 24.9, also serious, representing a steeper historical decline from 32.4 in 2000 but recent stagnation, including rising undernourishment since 2016 linked to economic inequality and agricultural vulnerabilities.[11][44] In contrast, Latin America and the Caribbean achieved a low 2025 score of 7.9, improved from 13.8 in 2000, though child stunting has ticked upward since 2016 amid stalled overall progress.[11] East and Southeast Asia maintain moderate hunger levels at 8.2 in 2025, with historical fluctuations but persistent internal disparities tied to rapid urbanization and dietary shifts.[11] West Asia and North Africa score 12.5 (moderate) in 2025, little changed from prior decades, as undernourishment has increased due to protracted conflicts.[11] Europe and Central Asia record the lowest regional score of 5.5 (low) in 2025, reflecting steady improvements from already low baselines, bolstered by economic stability and agricultural productivity.[11] These patterns underscore that while global and most regional scores have trended downward over 25 years, recent exacerbations in high-burden areas like sub-Saharan Africa—where 10 countries saw hunger worsen since 2016—highlight the influence of non-agricultural factors such as governance failures and external shocks over purely caloric deficits.[11][45]Country-Level Rankings
The Global Hunger Index assigns country-level rankings based on composite GHI scores calculated from four indicators: the prevalence of undernourishment (weighted one-third), child stunting (one-third), child wasting (one-sixth), and under-five child mortality (one-sixth). Scores range from 0 to 100, with lower values indicating less severe hunger; countries are grouped into severity categories rather than strictly ordinal ranks when scores tie, and those with insufficient recent data are excluded from annual rankings. In the 2024 report, sufficient data existed to compute and rank scores for 127 countries out of 136 assessed, with 22 nations achieving scores below 5 collectively assigned the top rank group due to negligible differences in performance.[3][1] Countries with low hunger levels (GHI <10) predominate among higher-income or rapidly developing economies that have prioritized agricultural productivity, sanitation, and public health investments, such as China (score <5), Chile (<5), Belarus (<5), Turkey, Romania, Hungary, and the United Arab Emirates. These rankings reflect long-term declines in undernourishment prevalence, often below 2.5% of the population, alongside child malnutrition rates under 5% for stunting and wasting. Moderate hunger (10–19.9) affects nations like Thailand (10.1) and South Africa (12.5), where progress has stalled amid economic pressures or uneven policy implementation. Serious hunger (20–34.9) characterizes 36 countries, including India (27.3) and Pakistan (27.9), driven by high child stunting rates exceeding 30% in some cases, despite caloric availability improvements. Alarming levels (35–49.9) persist in six conflict-affected states like Somalia (44.1), Yemen (41.2), and Burundi, where undernourishment exceeds 40% and child mortality remains above 10%. No country registered an extremely alarming score (≥50) in 2024, though historical data from earlier decades showed such extremes in regions like sub-Saharan Africa.[3][12]| Hunger Severity | GHI Score Range | Number of Countries (2024) | Example Countries |
|---|---|---|---|
| Low | <10 | 22 | China, Chile, Belarus, Turkey |
| Moderate | 10–19.9 | ~60 (inferred from totals) | Thailand, South Africa, Egypt |
| Serious | 20–34.9 | 36 | India, Pakistan, Kenya |
| Alarming | 35–49.9 | 6 | Somalia, Yemen, Burundi |
| Extremely Alarming | ≥50 | 0 | None |