Clasificación de la mutilación genital femenina en 11 países del África subsahariana mediante datos de encuestas...

Female Genital mutilation (FGM) has been associated with numerous negative health effects like sexual dysfunction, chronic pain, infections, infertility, and an increased risk of maternal mortality. To date, no recognized studies in sub-Saharan Africa (SSA) have combined machine learning (ML) models with nationally representative Demographic and Health Survey (DHS) data to classify FGM. Therefore, this study aims to identify the most effective ML model for classifying FGM in SSA. ML offers the significant advantage of handling extremely large and complex datasets with numerous variables and interactions, providing more accurate classifications than conventional statistical methods. This study used secondary data from the DHS collected between 2015 and 2023 in 11 SSA countries. The DHS employs a cross-sectional study design. A total of 62,249 women who had at least one daughter were included in the analysis. Seven classification algorithms, including Logistic Regression, Decision Tree, Random Forest (RF), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), XGBoost (XGB), and Naive Bayes (NB), were used to classify FGM. The RF classifier yielded the highest performance, achieving 0.85 accuracy, 0.83 precision, 0.88 recall, 0.85 F1 score, and 0.93 AUC. Random Forest (Brier score = 0.1319) and Decision Tree (0.1328) showed best calibration. The SHAP plots provide a comprehensive interpretation of the features influencing the model's classification of whether a mother reports that at least one daughter has undergone FGM. The bar plot shows the global importance of each feature, with opinion on FGM (+ 0.14), country of residence (+ 0.13), respondent's circumcision status (+ 0.11), and religious justification for FGM (+ 0.07) contributing the most on average to the classification of FGM. This study applied seven machine ML techniques to classify FGM in SSA, with the Random Forest classifier demonstrating the best performance. SHAP interpretability findings indicated that maternal opinion on FGM, country of residence, religious justifications for FGM, and the respondent's circumcision status contributed most, on average, to the classification of FGM. These results suggest that education and advocacy efforts aimed at mothers particularly those who have had FGM themselves or who believe that the practice is justified by religion should be given top priority in interventions. Implementing community engagement initiatives that challenge accepted conventions and ideas around FGM may be particularly beneficial, especially when these practices are rooted in religious or cultural justifications.