Machine Learning-Based Prediction of Childhood Stunting in Bangladesh: Fairness and Temporal Robustness Assessment

Child malnutrition remains a major public health challenge in low- and middle-income countries, particularly in South Asia, where early identification of vulnerable children is critical for timely intervention and resource allocation. This study aims to evaluate the feasibility, fairness, and temporal robustness of using a pretrained large language model (LLM) in a zero-shot setting for child stunting prediction using population health survey data. Using Bangladesh Demographic and Health Survey (BDHS) data collected between 2007 and 2022, we transformed maternal, child, healthcare, and household characteristics into semantically interpretable prompt-based representations and evaluated GPT-4o-mini for zero-shot stunting prediction, comparing its performance against a random forest baseline and assessing fairness across demographic and socioeconomic groups as well as temporal robustness across survey waves. The results demonstrate that zero-shot inference using GPT-4o-mini achieved comparable balanced accuracy to the supervised baseline while exhibiting substantially higher sensitivity for identifying stunting cases, relatively consistent performance across child sex groups, and stable predictive behaviour across BDHS waves; however, important fairness disparities were observed across residence and household wealth categories, highlighting the need for further investigation before deployment of foundation models in public health prediction settings.

Childhood anemia affects around 40% of children aged 6-59 months globally and arises from heterogeneous factors, limiting model generalizability. We evaluate a transformer-based tabular foundation model against classical supervised methods under cross-country and data-scarce settings. We used DHS data from 16 countries across Africa, Asia, Latin America, the Caucasus, and the Middle East (n=68,856). We compared Logistic Regression, XGBoost, LightGBM, and TabPFN v2.6. Performance was assessed using AUC-ROC, Brier score, and ECE. Generalization was evaluated using leave-one-country-out (LOCO), reverse-LOCO, and few-shot settings. Subgroup analyses included sex, age, residence, maternal education, and wealth. Feature importance was estimated using SHAP. TabPFN outperformed classical models in low-data regimes (<200 samples), showing higher discrimination and better calibration. Across countries, it achieved the lowest Brier score (0.042) and ECE (0.203). Under full-data settings, AUC-ROC ranged from 0.59-0.76 with small between-model differences ($\leq 0.05$). LOCO performance was stable (0.58-0.69), driven by country context. Reverse-LOCO showed asymmetric transferability. Subgroup performance was consistent with no systematic demographic bias. SHAP identified child age, altitude, and height-for-age z-score as dominant predictors, followed by wealth and maternal education. Performance in childhood anemia prediction is driven more by population variation than model choice. TabPFN provides advantages in low-resource settings through improved discrimination and calibration, highlighting foundation models as promising tools for data-scarce global health prediction.

ML classifiers deployed in high-stakes domains produce predictions whose quality varies systematically across subgroups. For granular subgroups defined by intersections of multiple features, predictions are often inconsistent with the observed data: the model's outputs contradict the evidence available for that subgroup. This problem is exacerbated by regularisation, which improves aggregate performance by collapsing small subgroups into larger groups, disproportionately affecting demographic minorities. We define two requirements for consistent prediction: determinism (identical individuals receive identical predictions) and statistical consistency (we cannot reject, at significance level alpha, the hypothesis that the predictions for a subgroup were drawn from the Bayesian optimal target distribution inferred for that subgroup). From these requirements we derive the Fair Bayesian classifier, which enforces both across every group and subgroup simultaneously and abstains whenever no consistent deterministic prediction is possible. On three benchmark datasets (Adult, COMPAS, and Bank Marketing), standard classifiers produce statistically inconsistent predictions for a substantial proportion of subgroups. Our classifier achieves zero consistency error by construction while exceeding baseline accuracy and multicalibration on every dataset tested. Statistical consistency provides a principled foundation for prediction quality with direct implications for algorithmic fairness. Minority demographics are disproportionately concentrated in small subgroups, precisely where frequentist inference is least reliable; addressing this inference problem is therefore a necessary step toward fair ML. By enforcing Bayesian consistency at the finest resolution the data supports, the our classifier demonstrates that exhaustive subgroup fairness with principled abstention is achievable in practice.