with zero being the best with higher scores indicating worse performances. According to Save the Children, each of the indicators was chosen because it was easily accessible, universally understood, and clearly indicative of child wellbeing. Health measures under-five mortality rate; nutrition measures the percentage of children under five who are moderately or severely underweight (which is two standard deviations below the median weight for age of the reference population); and education measures the percentage of primary school-age children that are not enrolled in school. In terms of opportunities and capabilities, CDI is the most appropriate measurement of child poverty. Of the estimated 2.2 billion children worldwide, about a billion, or every second child, live in poverty. Of the 1.9 billion children in developing nations, 640 million are without adequate shelter; 400 million are without access to safe water; 270 million have no access to health services. In 2003, 10.6 million children died before reaching the age of five, which is equivalent to the total child population of France, Germany, Greece, and Italy. 1.4 million die each year from lack of access to safe drinking water and adequate sanitation while 2.2 million die each year due to lack of immunizations. The Child Development Index also illustrates relative child poverty compared across all regions of the world (see Measuring child poverty). World performance: CDI = 17.5 Africa: CDI = 34.5 Middle East/North Africa: CDI = 11.2 Central/East Europe and Central Asia: CDI = 9.2 South Asia: CDI = 26.4 East Asia: CDI = 8.5 Latin America and Caribbean: CDI = 6.8 Developed Countries: CDI = 2.1 The CDI in Africa is twice that of the world average, and South Asia also fares poorly in relation to the global performance. In contrast, the CDI in developed countries is one-ninth of the world CDI, indicating a clear distinction between developing and developed nations. However, in 2013, child poverty reached record high levels in the United States, with 16.7 million children, more than 20%, living in food insecure households. 47 million Americans depend on food banks, more than 30% above 2007 levels. Households headed by single mothers are most likely to be affected. Worst affected are the District of Columbia, Oregon, Arizona, New Mexico and Florida, while North Dakota, New Hampshire, Virginia, Minnesota and Massachusetts are the least affected. More recently in 2021, it is estimated that nearly 11 million children live in poverty in