The impact of polio eradication on routine immunization and primary health care: a mixed-methods study.

BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). METHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. RESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. CONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.

Methods for evaluating the impact of vertical programs on health systems: protocol for a study on the impact of the global polio eradication initiative on strengthening routine immunization and primary health care.

BACKGROUND: The impact of vertical programs on health systems is a much-debated topic, and more evidence on this complex relationship is needed. This article describes a research protocol developed to assess the relationship between the Global Polio Eradication Initiative, routine immunization, and primary health care in multiple settings. METHODS/DESIGN: This protocol was designed as a combination of quantitative and qualitative research methods, making use of comparative ethnographies. The study evaluates the impact of the Global Polio Eradication Initiative on routine immunization and primary health care by: (a) combining quantitative and qualitative work into one coherent study design; (b) using purposively selected qualitative case studies to systematically evaluate the impact of key contextual variables; and (c) making extensive use of the method of participant observation to create comparative ethnographies of the impact of a single vertical program administered in varied contexts. DISCUSSION: The study design has four major benefits: (1) the careful selection of a range of qualitative case studies allowed for systematic comparison; (2) the use of participant observation yielded important insights on how policy is put into practice; (3) results from our quantitative analysis could be explained by results from qualitative work; and (4) this research protocol can inform the creation of actionable recommendations. Here, recommendations for how to overcome potential challenges in carrying out such research are presented. This study illustrates the utility of mixed-methods research designs in which qualitative data are not just used to embellish quantitative results, but are an integral component of the analysis.

Recharge and Groundwater Flow Within an Intracratonic Basin, Midwestern United States.

The conservative nature of chloride (Cl- ) in groundwater and the abundance of geochemical data from various sources (both published and unpublished) provided a means of developing, for the first time, a representation of the hydrogeology of the Illinois Basin on a basin-wide scale. The creation of Cl- isocons superimposed on plan view maps of selected formations and on cross sections across the Illinois Basin yielded a conceptual model on a basin-wide scale of recharge into, groundwater flow within and through the Illinois Basin. The maps and cross sections reveal the infiltration and movement of freshwater into the basin and dilution of brines within various geologic strata occurring at basin margins and along geologic structures. Cross-formational movement of brines is also seen in the northern part of the basin. The maps and cross sections also show barriers to groundwater movement created by aquitards resulting in areas of apparent isolation/stagnation of concentrated brines within the basin. The distribution of Cl- within the Illinois Basin suggests that the current chemical composition of groundwater and distribution of brines within the basin is dependent on five parameters: (1) presence of bedrock exposures along basin margins; (2) permeability of geologic strata and their distribution relative to one another; (3) presence or absence of major geologic structures; (4) intersection of major waterways with geologic structures, basin margins, and permeable bedrock exposures; and (5) isolation of brines within the basin due to aquitards, inhomogeneous permeability, and, in the case of the deepest part of the basin, brine density effects.

Assessing Methane in Shallow Groundwater in Unconventional Oil and Gas Play Areas, Eastern Kentucky.

The expanding use of horizontal drilling and hydraulic fracturing technology to produce oil and gas from tight rock formations has increased public concern about potential impacts on the environment, especially on shallow drinking water aquifers. In eastern Kentucky, horizontal drilling and hydraulic fracturing have been used to develop the Berea Sandstone and the Rogersville Shale. To assess baseline groundwater chemistry and evaluate methane detected in groundwater overlying the Berea and Rogersville plays, we sampled 51 water wells and analyzed the samples for concentrations of major cations and anions, metals, dissolved methane, and other light hydrocarbon gases. In addition, the stable carbon and hydrogen isotopic composition of methane (δ13 C-CH4 and δ2 H-CH4 ) was analyzed for samples with methane concentration exceeding 1 mg/L. Our study indicates that methane is a relatively common constituent in shallow groundwater in eastern Kentucky, where methane was detected in 78% of the sampled wells (40 of 51 wells) with 51% of wells (26 of 51 wells) exhibiting methane concentrations above 1 mg/L. The δ13 C-CH4 and δ2 H-CH4 ranged from -84.0‰ to -58.3‰ and from -246.5‰ to -146.0‰, respectively. Isotopic analysis indicated that dissolved methane was primarily microbial in origin formed through CO2 reduction pathway. Results from this study provide a first assessment of methane in the shallow aquifers in the Berea and Rogersville play areas and can be used as a reference to evaluate potential impacts of future horizontal drilling and hydraulic fracturing activities on groundwater quality in the region.

Characterizing a sustainability transition: goals, targets, trends, and driving forces.

Sustainable development exhibits broad political appeal but has proven difficult to define in precise terms. Recent scholarship has focused on the nature of a sustainability transition, described by the National Research Council as meeting the needs of a stabilizing future world population while reducing hunger and poverty and maintaining the planet's life-support systems. We identify a small set of goals, quantitative targets, and associated indicators that further characterize a sustainability transition by drawing on the consensus embodied in internationally negotiated agreements and plans of action. To illustrate opportunities for accelerating progress, we then examine current scholarship on the processes that influence attainment of four such goals: reducing hunger, promoting literacy, stabilizing greenhouse-gas concentrations, and maintaining fresh-water availability. We find that such analysis can often reveal "levers of change," forces that both control the rate of positive change and are subject to policy intervention.

Long-term trends and a sustainability transition.

How do long-term global trends affect a transition to sustainability? We emphasize the "multitrend" nature of 10 classes of trends, which makes them complex, contradictory, and often poorly understood. Each class includes trends that make a sustainability transition more feasible as well as trends that make it more difficult. Taken in their entirety, they serve as a checklist for the consideration of global trends that impact place-based sustainability studies.