Abstract Background Worldwide, anemia in children under-five is a major public health issue, particularly in sub-Saharan Africa. Sub-Saharan Africa also has the highest burden of malaria. This study aimed to develop an ensemble machine learning model to estimate anemia burden and potential predictors in under-five children in malaria-endemic sub-Saharan African countries. Method A cross-sectional study was conducted using Demographic and Health Survey data from sub-Saharan African countries. Samples were selected through a two-stage stratified cluster sampling method. Data analysis was performed using Python 3.8, with a total weighted sample of 21,249. The dataset was split into 80% for training and 20% for testing and validation purposes. To address class imbalance, a hybrid data balancing approach combining SMOTE (Synthetic Minority Over-sampling Technique) and Tomek Links was applied. Four machine learning algorithms were developed and evaluated using standard performance metrics. Recursive Feature Elimination with a Random Forest classifier was used to identify potential predictors of anemia among children under five living in malaria-endemic SSA countries. Result In this study, XGBoost showed the best performance, achieving an accuracy of 83.69%, a precision of 85.81%, and an F1 score of 83.19%. Additionally, XGBoost attained the highest ROC AUC of 90.1 and Precision Recall AUC of 90.0. According to Recursive Feature Elimination with a Random Forest classifier, region, birth order, child age, wealth index, and number of mosquito nets were identified as the associated factors of anemia among under-five children in malaria-endemic SSA countries. Conclusion To reduce anemia among under-five children in malaria-endemic regions of sub-Saharan Africa, interventions should prioritize implementing geographically targeted programs, focus on younger children and those with high birth orders by integrating anemia screening into routine check-ups. In addition, enhancing economic support for low-income families and distributing and educating families on the proper use of mosquito nets are essential.
Tekeba et al. (Mon,) studied this question.