确定孟加拉国五岁以下儿童营养不良的决定因素:来自2022年孟加拉国人口与健康调查横断面研究的见解

Identifying determinants of malnutrition in under-five children in Bangladesh: insights from the BDHS-2022 cross-sectional study.

作者信息

Tamanna Tanzila, Mahmud Shohel, Salma Nahid, Hossain Md Musharraf, Karim Md Rezaul

机构信息

Department of Statistics and Data Science, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.

Department of Statistics, Noakhali Science and Technology University, Noakhali, Bangladesh.

出版信息

Sci Rep. 2025 Apr 24;15(1):14336. doi: 10.1038/s41598-025-99288-y.

Abstract

Malnutrition remains one of the most pressing global health challenges, particularly in developing countries like Bangladesh, where it continues to significantly impact child health and contribute to chronic illness and high child mortality. Despite the potential of machine learning to improve malnutrition predictions, research in this area remains limited in the country. This study utilizes Bangladesh Demographic and Health Survey (BDHS) 2022 data to identify and quantify key determinants of under-five malnutrition (underweight, wasting, stunting) and evaluates various machine learning models for predicting malnutrition. By addressing a critical gap, this research provides deeper insights into the root causes of malnutrition in Bangladesh. Descriptive statistics were conducted to summarize the key characteristics of the dataset. Boruta algorithm was employed to identify important features related to malnutrition which were then used to evaluate several machine learning models, including K-Nearest Neighbors (KNN), Neural Networks (NN), Classification and Regression Trees (CART), XGBoost (XGBM), Support Vector Machines (SVM), and Random Forest (RF), in addition to the traditional logistic regression (LR) model. The best-performing model was selected to identify the most important factors contributing to malnutrition. The significance of these variables was further assessed using Feature Importance plot (Based on Gini Importance) and Shapley Additive Explanation (SHAP) values. Model performance was evaluated through various metrics, including accuracy, 95% Confidence Interval (CI), Cohen's kappa, sensitivity, specificity, F1 score and precision. The study examined a cohort of 7,910 children, reporting prevalence rates of 19% for stunting, 8% for wasting, and 17% for underweight. The Boruta algorithm identified 18 confirmed features for stunting, 22 for wasting, and 19 for underweight. For stunting, the Random Forest (RF) model outperformed other methods with an accuracy of 64.19%, 95% CI of (0.623, 0.666), Cohen's kappa of 0.158, sensitivity of 56.25%, specificity of 66.00%, F1 score of 0.750 and precision of 0.60. In wasting prediction, RF achieved the highest accuracy at 76.68%, 95% CI of (0.743, 0.787), Cohen's kappa of 0.049, sensitivity of 27.22%, specificity of 80.98%, F1 score of 0.865 and precision of 0.810. Similarly, for underweight, RF demonstrated superior performance with an accuracy of 68.18%, 95% CI of (0.662, 0.703), Cohen's kappa of 0.130, sensitivity of 43.02%, specificity of 73.48%, F1 score of 0.792 and precision of 0.735. Across all malnutrition types, the RF model consistently outperformed traditional logistic regression (LR) and other ML techniques in terms of accuracy, sensitivity, specificity, and other performance metrics. For stunting, key predictors identified in both the Shapley and Gini importance plots included mother's education, father's occupation, place of delivery, wealth index, birth order, and toilet facility; for wasting, significant predictors were antenatal care, unmet family planning, mother's BMI, birth interval, father's occupation, and television ownership; and for underweight, important factors included father's occupation, mother's education, child's age, birth order, wealth index, and place of delivery. This study highlights the effectiveness of Random Forest (RF) in predicting malnutrition outcomes-stunting, wasting, and underweight-using key features identified by the Boruta algorithm. While RF demonstrates moderate performance in predicting stunting and underweight, it shows strong predictive ability for wasting. This underscores RF's potential in guiding targeted interventions for wasting, though further improvements are needed for stunting and underweight predictions. Moreover, the study identifies key contributors for each malnutrition outcome. By pinpointing these determinants, the study provides actionable insights for designing targeted interventions to combat malnutrition more effectively. These findings align with the global development agenda, particularly Sustainable Development Goal (SDG) 2: Zero Hunger and SDG 3: Good Health and Well-being, reinforcing efforts to reduce malnutrition and improve child health outcomes in Bangladesh.

摘要

营养不良仍然是全球最紧迫的健康挑战之一,在孟加拉国等发展中国家尤为如此,该国营养不良继续严重影响儿童健康,导致慢性病和儿童高死亡率。尽管机器学习有潜力改善营养不良预测,但该国在这一领域的研究仍然有限。本研究利用2022年孟加拉国人口与健康调查(BDHS)数据,识别和量化五岁以下儿童营养不良(体重不足、消瘦、发育迟缓)的关键决定因素,并评估各种机器学习模型对营养不良的预测能力。通过填补这一关键空白,本研究对孟加拉国营养不良的根本原因提供了更深入的见解。进行描述性统计以总结数据集的关键特征。采用Boruta算法识别与营养不良相关的重要特征,然后将这些特征用于评估几种机器学习模型,包括K近邻(KNN)、神经网络(NN)、分类与回归树(CART)、极端梯度提升(XGBM)、支持向量机(SVM)和随机森林(RF),此外还包括传统的逻辑回归(LR)模型。选择表现最佳的模型来识别导致营养不良的最重要因素。使用特征重要性图(基于基尼重要性)和夏普利值(SHAP)进一步评估这些变量的重要性。通过各种指标评估模型性能,包括准确率、95%置信区间(CI)、科恩卡方值、灵敏度、特异度、F1分数和精确率。该研究调查了7910名儿童,报告发育迟缓患病率为19%,消瘦患病率为8%,体重不足患病率为17%。Boruta算法确定了18个发育迟缓的确认特征、22个消瘦的确认特征和19个体重不足的确认特征。对于发育迟缓,随机森林(RF)模型的表现优于其他方法,准确率为64.19%,95% CI为(0.623,0.666),科恩卡方值为0.158,灵敏度为56.25%,特异度为66.00%,F1分数为0.750,精确率为0.60。在消瘦预测中,RF的准确率最高,为76.68%,95% CI为(0.743,0.787),科恩卡方值为0.049,灵敏度为27.22%,特异度为80.98%,F1分数为0.865,精确率为0.810。同样,对于体重不足,RF表现出卓越性能,准确率为68.18%,95% CI为(0.662,0.703),科恩卡方值为0.130,灵敏度为43.02%,特异度为73.48%,F1分数为0.792,精确率为0.735。在所有营养不良类型中,RF模型在准确率、灵敏度、特异度和其他性能指标方面始终优于传统逻辑回归(LR)和其他机器学习技术。对于发育迟缓,在夏普利和基尼重要性图中确定的关键预测因素包括母亲的教育程度、父亲的职业、分娩地点、财富指数、出生顺序和卫生设施;对于消瘦,重要预测因素是产前护理、未满足的计划生育需求、母亲的体重指数、生育间隔、父亲的职业和电视拥有情况;对于体重不足,重要因素包括父亲的职业、母亲的教育程度、孩子的年龄、出生顺序、财富指数和分娩地点。本研究强调了随机森林(RF)在利用Boruta算法识别的关键特征预测营养不良结果(发育迟缓、消瘦和体重不足)方面的有效性。虽然RF在预测发育迟缓和体重不足方面表现中等,但在预测消瘦方面显示出很强的预测能力。这突出了RF在指导针对消瘦的有针对性干预措施方面的潜力,不过在发育迟缓和体重不足预测方面还需要进一步改进。此外,该研究确定了每种营养不良结果的关键因素。通过确定这些决定因素,该研究为设计更有效的对抗营养不良的有针对性干预措施提供了可操作的见解。这些发现与全球发展议程一致,特别是可持续发展目标(SDG)2:零饥饿和SDG 3:良好健康与福祉,加强了孟加拉国减少营养不良和改善儿童健康结果的努力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3c2f/12022098/7fa8d3a43797/41598_2025_99288_Fig1_HTML.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索