Predictive modelling of linear growth faltering among pediatric patients with Diarrhea in Rural Western Kenya: an explainable machine learning approach

IntroductionStunting affects one-fifth of children globally with diarrhea accounting for an estimated 13.5% of stunting. Identifying risk factors for its precursor, linear growth faltering (LGF), is critical to designing interventions. Moreover, developing new predictive models for LGF using more recent data offers opportunity to enhance model accuracy, interpretability and capture new insights. We employed machine learning (ML) to derive and validate a predictive model for LGF among children enrolled with diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) study and the Enterics for Global Heath (EFGH) & horbar; Shigella study in rural western Kenya.MethodsWe used 7 diverse ML algorithms to retrospectively build prognostic models for the prediction of LGF (>= 0.5 decrease in height/length for age z-score [HAZ]) among children 6-35 months. We used de-identified data from the VIDA study (n = 1,106) combined with synthetic data (n = 8,894) in model development, which entailed split-sampling and K-fold cross-validation with over-sampling technique, and data from EFGH-Shigella study (n = 655) for temporal validation. Potential predictors (n = 65) included demographic, household-level characteristics, illness history, anthropometric and clinical data were identified using boruta feature selection with an explanatory model analysis used to enhance interpretability.ResultsThe prevalence of LGF in the development and temporal validation cohorts was 187 (16.9%) and 147 (22.4%), respectively. Feature selection identified the following 6 variables used in model development, ranked by importance: age (16.6%), temperature (6.0%), respiratory rate (4.1%), SAM (3.4%), rotavirus vaccination (3.3%), and skin turgor (2.1%). While all models showed good prediction capability, the gradient boosting model achieved the best performance (area under the curve % [95% Confidence Interval]: 83.5 [81.6-85.4] and 65.6 [60.8-70.4]) on the development and temporal validation datasets, respectively.ConclusionOur findings accentuate the enduring relevance of established predictors of LGF whilst demonstrating the practical utility of ML algorithms for rapid identification of at-risk children.