Under-nutrition remains a key concern in Sri Lanka. While stunting rates (13%) are lower than other countries in the region, including Afghanistan and Pakistan, higher than other middle-income Asian countries such as China, Thailand and Malaysia. Critically, both wasting and underweight have increased since 2009 and trends indicate that wasting is serious (more than 15 per cent) in 24 out of 25 districts. About half of stunted children and 27 per cent of wasted children are younger than age two and disparities exist between region and income quintiles. About 2.3 per cent of under-5 children (40,000) suffer from Severe Acute Malnutrition (SAM), while more than four million Sri Lankans, particularly women and children, are anemic. Poor nutrition also negatively affect school participation and performance. A quarter of children under-five are underweight and 13% of all children under five are stunted.