At least one in five children under the age of five in India have extremely low weight for their height, reflecting acute under-nutrition, according to the Global Hunger Index 2018. The only country with a higher prevalence of child wasting is the war-torn nation of South Sudan, says the report, which was released on Thursday.

Overall, India has been ranked at 103 out of 119 countries in the Index, with hunger levels in the country categorised as “serious”. India’s ranking, reflecting data from 2013-2017 has dropped three places from last year.

The hunger levels are calculated taking into consideration four main indicators—undernourishment (insufficient caloric intake), child wasting (low weight for height); child stunting (low height for age); and child mortality quotes a peer-reviewed publication released annually by Welthungerhilfe and Concern Worldwide. (The International Food Policy Research Institute was also involved with the publication until this year.)

India has shown improvement in three of the indicators over the comparable reference years. The percentage of undernourished people in the population has dropped from 18.2% in 2000 to 14.8% in 2018. The child mortality rate has halved from 9.2% to 4.3%, while child stunting has dropped from 54.2% to 38.4% over the same period.

However, the prevalence of child wasting has actually worsened in comparison to previous reference years. It stood at 17.1% in 2000, and increased to 20% in 2005 and 21% in 2018. South Sudan’s child wasting prevalence is at 28%.