“Kunika women are always sick”: views from community focus groups on short birth interval (kunika) in Bauchi state, northern Nigeria

Ansari, Umaira; Pimentel, Juan; Omer, Khalid; Gidado, Yagana; Baba, Muhd Chadi; Andersson, Neil; Cockcroft, Anne

doi:10.1186/s12905-020-00970-2

Cited by 6 publications

(5 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…– Multiple mechanisms to define the focus: researcher or stakeholder lead based on literature reviews; a direct request from communities [ 83 ]; discussions with communities, religious leaders [ 84 ] or advisory boards [ 32 ] based on local evidence; and funding agency [ 79 , 80 ] or public authority lead…”

Section: Resultsmentioning

confidence: 99%

Fuzzy cognitive mapping in participatory research and decision making: a practice review

Sarmiento,

Cockcroft,

Dion

et al. 2024

Arch Public Health

Self Cite

View full text Add to dashboard Cite

Background Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023. Results The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases. Conclusions A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.

show abstract

Section: Resultsmentioning

confidence: 99%

Fuzzy cognitive mapping in participatory research and decision making: a practice review

Sarmiento,

Cockcroft,

Dion

et al. 2024

Arch Public Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…All the mapping groups identified family dynamics as an important cause of kunika and identified modification of these dynamics as crucial to tackling kunika . These dynamics help to explain why people may continue to practise kunika , even when they know it has adverse consequences [ 10 ]. The category includes the interaction between spouses (including interactions between co-wives), motivations to have more children and the influence of extended family and neighbours.…”

Section: Discussionmentioning

confidence: 99%

“…Building and analysing fuzzy cognitive maps was part of our participatory research [ 54 ] into kunika in Bauchi State. Our partnership with community members, service providers, and health planners began by hearing the views and knowledge of community members through focus groups [ 10 ] and the fuzzy cognitive mapping described here. It went on to sharing the knowledge between stakeholders, and to proposing and implementing solutions.…”

Section: Discussionmentioning

confidence: 99%

“…Our recent community focus group discussions in Toro Local Government Area (LGA) in Bauchi State, Northern Nigeria, confirmed that men and women had a good understanding of the concept of kunika and considered it to be a bad thing, threatening the health and well-being of mothers, children, and fathers. The group participants also described how kunika could lead to economic hardship, conflict within families and social disapproval [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Short birth intervals, defined by the World Health Organization as less than 33 months, may damage the health and wellbeing of children, mothers, and their families. People in northern Nigeria recognise many adverse effects of short birth interval (kunika in the Hausa language) but it remains common. We used fuzzy cognitive mapping to systematize local knowledge of causes of kunika to inform the co-design of culturally safe strategies to address it. Methods Male and female groups in twelve communities built 48 maps of causes and protective factors for kunika, and government officers from the Local Government Area (LGA) and State made four maps. Each map showed causes of kunika or no-kunika, with arrows showing relationships with the outcome and between causes. Participants assigned weights for the perceived strength of relationships between 5 (strongest) and 1 (weakest). We combined maps for each group: men, women, and government officers. Fuzzy transitive closure calculated the maximum influence of each factor on the outcome, taking account of all relationships in the map. To condense the maps, we grouped individual factors into broader categories and calculated the cumulative net influence of each category. We made further summarised maps and presented these to the community mapping groups to review. Results The community maps identified frequent sex, not using modern or traditional contraception, and family dynamics (such as competition between wives) as the most influential causes of kunika. Women identified forced sex and men highlighted lack of awareness about contraception and fear of side effects as important causes of kunika. Lack of male involvement featured in women’s maps of causes and in the maps from LGA and State levels. Maps of protective factors largely mirrored those of the causes. Community groups readily appreciated and approved the summary maps resulting from the analysis. Conclusions The maps showed how kunika results from a complex network of interacting factors, with culture-specific dynamics. Simply promoting contraception alone is unlikely to be enough to reduce kunika. Outputs from transitive closure analysis can be made accessible to ordinary stakeholders, allowing their meaningful participation in interpretation and use of the findings. Plain English summary For people in Bauchi State, northern Nigeria, kunika describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. They recognise it is bad for children, mothers and households. We worked with 12 communities in Bauchi to map their knowledge of the causes and protective factors for kunika. Separate groups of men and women built 48 maps, and government officers at local and state level built four maps. Each group drew two maps showing causes of kunika or of no-kunika with arrows showing the links between causes and the outcome. Participants marked the strength of each link with a number (between 5 for the strongest and 1 for the weakest). We combined maps for women, men and government officers. We grouped similar causes together into broader categories. We calculated the overall influence of each category on kunika or no-kunika and produced summary maps to communicate findings. The maps identified the strongest causes of kunika as frequent sex, not using modern or traditional contraception, and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. The maps of protective factors mirrored those of the causes. The groups who created the maps approved the summary maps. The maps showed the complex causes of kunika in Bauchi. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps will help local stakeholders to co-design culturally safe ways of reducing kunika.

show abstract

“…The project in Bauchi will prioritize and systematize the concerns and knowledge of local stakeholders, especially adolescents, about ASRH risks and engage them to codesign and implement solutions that work within their cultural context. Our recent work on kunika (short birth interval) in Bauchi demonstrates how an approach of integrated knowledge translation and exchange can result in locally identified and culturally attuned interventions and communication materials for a sensitive issue (U Ansari, unpublished data, January 2022) [ 29 , 51 ].…”

Section: Introductionmentioning

confidence: 99%

Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial

Cockcroft¹,

Omer²,

Gidado³

et al. 2022

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

Background Adolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country. Objective In Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions. Methods The participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively. Results Focus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021). Conclusions Evidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research. Trial Registration ISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275 International Registered Report Identifier (IRRID) DERR1-10.2196/36060

show abstract

“Kunika women are always sick”: views from community focus groups on short birth interval (kunika) in Bauchi state, northern Nigeria

Cited by 6 publications

References 15 publications

Fuzzy cognitive mapping in participatory research and decision making: a practice review

Fuzzy cognitive mapping in participatory research and decision making: a practice review

Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping

Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial

Contact Info

Product

Resources

About