{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:46:26Z","timestamp":1767797186777,"version":"3.49.0"},"reference-count":31,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,16]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Malnutrition among under-5 children is a major challenge in low-income and middle-income countries, contributing to poor growth and development. Growth monitoring and promotion (GMP) is recommended by WHO for early detection, yet its implementation remains weak due to limited resources and health system gaps. While many studies focus on utilisation, little is known about facility readiness, especially from multicountry analyses. This study aimed to assess the readiness of health facilities to provide growth monitoring (GM) service and associated factors using nationally representative data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of existing cross-sectional survey data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Secondary data from service provision assessment surveys of Afghanistan, Bangladesh, Ethiopia, Haiti, Nepal and Tanzania was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and outcome measure<\/jats:title>\n                    <jats:p>We included 6595 health facilities, which have complete information. Health facilities\u2019 readiness score was constructed as a counting score with regard to the availability of essential indicators required to provide GM services by using WHO service availability and readiness assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Among 6595 health facilities, 28.5% (95% CI 27.4% to 29.6%) of the facilities reported at least 75% of the relevant items for GM service provision. The factors associated with health facilities\u2019 readiness to provide GM service were quality assurance activities (incident rate ratio (IRR): 1.15; 95%\u2009CI 1.07 to 1.24), separate user fees (IRR: 1.10; 95%\u2009CI 1.00 to 1.20), fixed user fees (IRR: 1.20; 95%\u2009CI 1.10 to 1.31) and presence of trained health provider at facility 24 hours (IRR: 1.09; 95%\u2009CI 1.02 to 1.17).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Health facilities in six countries showed low readiness for GMP services. Strengthening facility capacity, staffing, equipment and quality assurance is essential to improve readiness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110617","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T06:30:37Z","timestamp":1767076237000},"page":"e110617","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Health facilities readiness and associated factors to provide growth monitoring services in low-income and middle-income countries: evidence from national service provision assessment surveys of six countries"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3753-4845","authenticated-orcid":false,"given":"Darik Temesgen","family":"Assefa","sequence":"first","affiliation":[{"name":"Depatment of Public Health, Arba Minch University, Arba Minch, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9838-6583","authenticated-orcid":false,"given":"Nigus Kabtu","family":"Belete","sequence":"additional","affiliation":[{"name":"Depatment of Public Health, Arba Minch University, Arba Minch, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehert Kitaw","family":"Gebretsadik","sequence":"additional","affiliation":[{"name":"Depatment of Public Health, Arba Minch University, Arba Minch, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"2026010703491798000_15.12.e110617.1","article-title":"The impact of growth monitoring and promotion on health indicators in children under five years of age in low- and middle-income countries","volume":"10","author":"Taylor","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"2026010703491798000_15.12.e110617.2","unstructured":"United Nations Children\u2019s Fund (UNICEF) WHO, International Bank for Reconstruction and Development\/The World Bank . Levels and trends in child malnutrition:UNICEF \/ WHO \/ World Bank Group Joint Child Malnutrition Estimates. Key findings of the 2025 edition. 2025."},{"key":"2026010703491798000_15.12.e110617.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60032-4"},{"key":"2026010703491798000_15.12.e110617.4","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1038\/s41586-023-06501-x","article-title":"Causes and consequences of child growth faltering in low-resource settings","volume":"621","author":"Mertens","year":"2023","journal-title":"Nature New Biol"},{"key":"2026010703491798000_15.12.e110617.5","unstructured":"World Health Organization . Child Growth, 2025. 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Cochrane Database Syst Rev 2017;1. doi:10.1002\/14651858.CD010102.pub2","DOI":"10.1002\/14651858.CD010102.pub2"},{"key":"2026010703491798000_15.12.e110617.11","unstructured":"Afghanistan Ministry of Public Health, ICF . Afghanistan service provision assessment 2018-19: key findings. Rockville, Maryland, USA: Ministry of Public Health, Afghanistan and ICF, 2019."},{"key":"2026010703491798000_15.12.e110617.12","unstructured":"National Institute of Population Research Training (NIPORT), Tanzania Ministry of Health Family Welfare, ICF . Bangladesh health facility survey 2017. Dhaka, Bangladesh: NIPORT, ICF, 2020."},{"key":"2026010703491798000_15.12.e110617.13","unstructured":"Ethiopian Public Health Institute, Ethiopia Ministry of Health, ICF . Ethiopia service provision assessment 2021\u201322. Ethiopia, and Rockville, Maryland, USA: Addis Ababa, 2023."},{"key":"2026010703491798000_15.12.e110617.14","unstructured":"Haitian Institute of Childhood (IHE), ICF . 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National nutrition strategy, Ethiopia. 2008."},{"key":"2026010703491798000_15.12.e110617.19","first-page":"2223601","article-title":"Conflict and social determinants of health: would global health diplomacy resolve the Afghanistan healthcare conundrum?","volume":"8","author":"Singh","year":"2023","journal-title":"Global Security: Health, Sci Policy"},{"key":"2026010703491798000_15.12.e110617.20","doi-asserted-by":"crossref","first-page":"923","DOI":"10.59188\/jurnalsostech.v4i10.27615","article-title":"Analysis of Challenges and Opportunities for Improving the Health System in Afghanistan: Innovative Approaches and Sustainable Solutions","volume":"4","author":"Mazloum Yar","year":"2024","journal-title":"Jurnal Sostech"},{"key":"2026010703491798000_15.12.e110617.21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.15171\/hpp.2018.24","article-title":"Healthcare workers\u2019 perceptions of an organizational quality assurance program implemented in a resource-limited setting: a qualitative study","volume":"8","author":"Henker","year":"2018","journal-title":"Health Promot Perspect"},{"key":"2026010703491798000_15.12.e110617.22","doi-asserted-by":"crossref","unstructured":"Rhoda Luhalima TT . The importance of quality assurance in rural public healthcare facilities. In: Qamar SZ , Al-Hinai N , eds. Quality control and quality assurance - techniques and applications. Rijeka: IntechOpen, 2024.","DOI":"10.5772\/intechopen.113992"},{"key":"2026010703491798000_15.12.e110617.23","unstructured":"Institute of Medicine (US) Committee . Current quality assurance and improvement strategies. In: Feasley FC , ed. Best at home: assuring quality long-term care in home and community-based settings. 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Essential nutrition actions. 2013."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:53:46Z","timestamp":1767786826000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":31,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,29]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-110617"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110617","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}