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Abstract
Life in urban areas presents special challenges for maternal child care practices.
Data from a representative survey of households with children less than 3 years of age in
Accra were used to test a number of hypothesized constraints to child care, including
various maternal (education, employment, marital status, age, health, ethnic group,
migration status) and household-level factors (income, calorie availability, quality of
housing and asset ownership, availability of services, household size, and crowding). An
age-specific child care index was created using recall data on maternal child feeding
practices and use of preventive health services. A hygiene index was created from spot
check observations of proxies of hygiene behaviors. Multivariate analyses showed that
maternal schooling was the most consistent constraint to both the care and the hygiene
index. None of the household-level characteristics were associated with the care index,
but better housing quality and access to garbage collection services were associated with
better hygiene. Female head of household and larger family size were associated with
poorer hygiene. The programmatic implications of these findings for nutrition education
and behavior change interventions in Accra are discussed. The focus is on using the
information to target the right practices to be modified as well as the main constraints to
their adoption.