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Clifford Silver Tarimo,1,2 Soumitra S Bhuyan,3 Quanman Li,1 Weicun Ren,4 Michael Johnson Mahande,5 Jian Wu1 1Department of Epidemiology and Health Statistics, Zhengzhou University, Zhengzhou, People’s Republic of China; 2Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania; 3Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA; 4College of Sanquan, Xinxiang Medical University, Xinxiang, People’s Republic of China; 5Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, TanzaniaCorrespondence: Jian Wu Email jianwu17@163.comObjective: The goal of this study was to establish the most efficient boosting method in predicting neonatal low Apgar scores following labor induction intervention and to assess whether resampling strategies would improve the predictive performance of the selected boosting algorithms.Methods: A total of 7716 singleton births delivered from 2000 to 2015 were analyzed. Cesarean deliveries following labor induction, deliveries with abnormal presentation, and deliveries with missing Apgar score or delivery mode information were excluded. We examined the effect of resampling approaches or data preprocessing on predicting low Apgar scores, specifically the synthetic minority oversampling technique (SMOTE), borderline-SMOTE, and the random undersampling (RUS) technique. Sensitivity, specificity, precision, area under receiver operating curve (AUROC), F-score, positive predicted values (PPV), negative predicted values (NPV) and accuracy of the three (3) boosting-based ensemble methods were used to evaluate their discriminative ability. The ensemble learning models tested include adoptive boosting (AdaBoost), gradient boosting (GB) and extreme gradient boosting method (XGBoost).Results: The prevalence of low (< 7) Apgar scores was 9.5% (n = 733). The prediction models performed nearly similar in their baseline mode. Following the application of resampling techniques, borderline-SMOTE significantly improved the predictive performance of all the boosting-based ensemble methods under observation in terms of sensitivity, F1-score, AUROC and PPV.Conclusion: Policymakers, healthcare informaticians and neonatologists should consider implementing data preprocessing strategies when predicting a neonatal outcome with imbalanced data to enhance efficiency. The process may be more effective when borderline-SMOTE technique is deployed on the selected ensemble classifiers. However, future research may focus on testing additional resampling techniques, performing feature engineering, variable selection and optimizing further the ensemble learning hyperparameters.Keywords: low Apgar score, labor induction, machine learning, ensemble learning, resampling methods, imbalanced data