Thinking Out-of-Box in Addressing Communication and Service Delivery Challenges: Use of a Traditional Communication Method for Improving Immunization Coverage in Remote Rural Hard-to-Reach Areas of India

Sirmaur district in the state of Himachal Pradesh in India is a hard-to-reach area situated in the western Himalayas having an extreme landscape with snow-laden mountains and extensive river systems that makes the delivery of immunization services extremely challenging. Vaccinators needed a long walk through the hilly terrain to reach outreach sites. Community mobilizers were unable to go house to house to inform the caregivers to bring children to the site for vaccination. Caregivers were unaware when the vaccinators arrive at the site. As a result, many children missed vaccination or were not vaccinated timely. Age-appropriate vaccination coverage (according to national immunization schedule) in the Sirmaur district was the lowest in the state. Thinking out-of-box to address the communication barriers with the caregivers, the traditional drum beating was used, for the first time in India, in two blocks of the Sirmaur district (Rajpura and Shillai). The initiative was planned and implemented by the district health system with the support of the local community leaders. An exit interview was conducted to know the reach of the drum beating to caregivers, and a baseline and end line household survey was conducted to know the outcome of the initiative on age-appropriate vaccination coverage. Analysis of exit interviews data indicated a very high reach of a drum beating to the caregivers;more than 97% of caregivers in Rajpura and 100% in Shillai heard drum beating, and almost 95% of caregivers in Rajpura and 98% in Shillai knew the purpose of drum beating. Analysis of immunization data from baseline and end line surveys showed improvement in age-appropriate vaccination coverage for all vaccines in Rajpura (by 2.2% for BCG, 15.3% for Pentavalent 1, 14.9% for Pentavalent 2, 14.1% for Pentavalent 3, and 6.5% for Measles/MR). In Shillai, age-appropriate vaccination coverage improved for Pentavalent 1 (by 3.4%), Pentavalent 2 (by 5%) and Measles/MR (by 1.7%). In addition, dropout rates were reduced in both the blocks, particularly in Rajpura Pentavalent 1 to Measles dropout rate was reduced by 13.5%. Both health workers and community leaders had positive perceptions of the drum beating initiative. However, another important lesson learned from the initiative was that both the access and demand-side barriers need to be addressed for the desired improvement of age-appropriate immunization coverage. In Shillai, there was lower coverage improvement and a reduction in dropout rates attributed to vacant positions of vaccinators that caused an issue with access to immunization services to people.

Distribution assessment of soil erosion with revised RUSLE model in Tianshan Mountains

aSoil degradation caused by soil erosion is one of the world's most critical environmental issues.Soil erosion in the Tianshan Mountains has caused various environmental problems in the surrounding areas.This study used remote sensing data to analyze the distribution of the factors influencing soil erosion,and the revised universal soil loss equation(RUSLE)to calculate the total amount and distribution characteristics of soil erosion in the Tianshan Mountains in 2019.Due to the large error of RUSLE in soil erosion estimation in mountainous areas,this study modified RUSLE equation based on the characteristics of snow cover in the Tianshan Mountains.The results show that the average soil erosion was 1690.3 t/(km^(2)·year),of which insignificant erosion,slight erosion and moderate erosion accounted for 42,8%,22.4%and 9.9%,respectively.Severe erosion and above accounted for 13.3%.The accuracy of the soil erosion modulus calculated by the RUSLE was only 61.9%,with an average error of 1631.9 t/(km^(2)·year).The average error of the double-coefficient correction method was 1259.1 t/(km^(2)·year),and the average error of the modified formula method was reduced by 40.3%compared with the RUSLE,reaching 973.7 t/(km^(2)·year),and its accuracy reached 76.2%.Very severe erosion and catastrophic erosion are distributed on mountain ridges with higher elevation and on the northern area with higher precipitation.Snow cover has a certain inhibitory effect on soil erosion,and snow cover in alpine mountains is a factor that cannot be ignored in soil erosion research.