Growth Monitoring Gaps Among Preschool Children in Tripoli, Libya: A Cross-Sectional Study

Abstract

Routine anthropometric assessment can identify abnormal growth trajectories before they become clinically apparent, yet information on the coverage of height-and-weight measurement among preschool children in Libya is scarce. This study assessed recent growth monitoring among kindergarten-enrolled children in Tripoli. It examined child, household, and service-access characteristics associated with having both height and weight measured at a health centre during the previous six months. Data were drawn from a cross-sectional study of 131 eligible children aged 24–60 months conducted across Tripoli between November 2025 and April 2026. Caregiver questionnaires were linked to standardised anthropometric measurements. Recent growth monitoring was defined as caregiver-reported height and weight measurements at a health centre within the preceding six months. Of the 131 children, 129 had complete outcome data (two had missing outcome information and were excluded from outcome analyses); 52 of these 129 had been monitored (40.3%; exact 95% CI 31.8–49.3), leaving a monitoring gap of 59.7%. Although 123/129 children (95.3%) lived within 30 minutes of a health centre and 91/128 (71.1%; one child had missing data) reportedly received regular health care, only 44/91 (48.4%) of those receiving regular care had recent anthropometric measurements. Among children classified as stunted, 8/23 (34.8%) had been monitored. Regular health-care attendance was associated with recent measurement in unadjusted analysis (OR 4.01, 95% CI 1.60–10.06; n=128), although this variable was not entered into the primary multivariable model because the questionnaire item itself referenced growth monitoring/vaccinations. In the adjusted model (n=126 complete cases; three children with missing household income excluded), none of the prespecified demographic or access variables showed a statistically significant independent association with recent monitoring. The findings indicate that physical proximity to services does not translate reliably into routine anthropometric surveillance. Integrating standardised height and weight measurement into preschool and primary-care encounters may reduce missed opportunities for early detection of growth problems in Tripoli.