At country level, the prevalence is a subject of concern in Albania (10.5 percent), Georgia (8.9 percent), and Tajikistan (7.8 percent). Household income and livelihoods largely affect economic access to food, but high market prices of basic food items also limit their economic access, particularly among lower-income groups who spend a large share of their income for purchasing food. Vulnerability is influenced by factors affecting one or more dimensions of food security - such as market shocks (prices and infrastructure), droughts or floods, or instability and conflicts -combined with poverty, low incomes, lower access to adequate social protection, and inequality due to gender or age group. When including children in these estimates, there were 19 million people in the region who suffered from severe food insecurity during the same period.