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Classification tree analysis of stunting in Malian adolescent girls

This study examines relationships between growth data and energy expenditure, economic status, and family structure among Malian adolescent girls, aged 10–17 years living in the Segou Region of Mali. Classification and regression trees (CART) were used as the primary methodology to identify high‐risk subgroups for stunting (measured as height‐for‐age) in a sample of 1,103 Malian adolescents. Because CART has been used rarely to examine growth and development, this study provides a new way to better understand how economic status, family structure, and energy expenditure related factors influence stunting in Mali. The findings indicate that the greater the number of sisters and women in a household, the poorer the nutritional status of adolescent girls. The data also show that the presence of servants within the household may predict better nutritional success of young girls. Energy expenditure was an important predictor in the context of family structure regarding the number of sisters and the presence of servants. Wealth indicators did not appear in the final tree, suggesting that wealth may not play as great a role in predicting poor growth and nutritional status as family size and structure. In conclusion, classification trees may assist in understanding the interactive nature of predictive factors of stunting in this population, and further provide evidence for intervention programs aimed at improving the health and nutritional status of Malian adolescent girls. Am. J. Hum. Biol., 2008. © 2008 Wiley‐Liss, Inc.