Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.
Yilan Ye from Tsinghua University in China will develop a small, self-adhesive menstrual product based on the suction cups of octopuses that can be fixed securely but reversibly inside the vaginal opening to block the flow of blood and enable its convenient disposal. They will design it specifically for women and girls in low- and middle-income countries by ensuring it is low-cost, re-usable, safe to apply, and does not require sanitation facilities. They will experiment with different commercialized, biocompatible thermoplastic polyurethanes (TPUs) as the raw materials to produce the adhesive polymers. They will first test these polymers for their ability to be strongly, reversibly and repeatedly stuck to the surface of porcine livers and hearts as surrogates that mimic the moist and irregular skin surface inside the vagina. Finally, they will develop an inject mold to manufacture a prototype for human testing that also contains a soft valve for convenient release.
Elly Munde of the Hospital and Health Administration Services in Kenya will integrate a multiplex PCR assay into an existing malaria molecular surveillance program to detect a specific variant in the causative malaria parasite Plasmodium falciparum, which is undetectable by most rapid diagnostic tests and is threatening successful disease control. The specific haplotype of concern has a deletion of the genes encoding for histidine-rich proteins 2 and 3 (hrp2/3). Individuals infected with this haplotype produce a false negative result on most diagnostic tests. They will integrate the PCR assay into an ongoing cohort study, and develop statistical analyses to genotype the samples and decision support tools for guiding future intervention strategies. They will also evaluate the emergence and spread of these new haplotypes by genotyping existing samples to determine the effect of previously deployed diagnostic policies on disease control. If successful, they will scale their approach up nationwide.
Moses Laman of the Papua New Guinea Institute of Medical Research will extend the national malaria surveillance platform, which maps infections across Papua New Guinea, to incorporate valuable genomic data of the malaria-causing parasites that can be used to better guide control and elimination efforts. They will enable the molecular data from the parasites generated by a central laboratory to be overlaid onto the clinical case data, so that transmission dynamics and parasite population diversity can be displayed on a web-based dashboard for easy access by program managers and health authorities. They will also provide training to relevant staff so they can use the new genomics data to inform their decisions on intervention strategies and outbreak containment.
Richard Bbaale of BanaPads Inc. in Uganda will recycle the discarded pseudo stems of banana plants to produce a non-toxic biopolymer and develop biodegradable sanitary pads for women and girls in underserved communities. Uganda produces roughly 10% of the world's bananas, which results in over 30 million tons per year of pseudo stem waste that is currently left to rot. They will extract the cellulose from the pseudo stem, which is the trunk of the banana plant that is cut off once the bananas have been picked, and use it to synthesize the biopolymer, carboxymethyl cellulose (CMC). This will then be combined with non-toxic additives to produce the different layers of a sanitary pad, namely the water-soluble film, an adhesive, fibrous elastic, and absorbent foam, that can be safely flushed down the toilet and gets degraded by bacteria in the septic sewage. Once the materials have been developed, they will produce a prototype pad for testing.
Issiaka Soulama of Groupe de Recherche Action en Santé in Burkina Faso will build a molecular surveillance platform for monitoring the emergence and spread of different strains of the malaria-causing parasite, Plasmodium falciparum, including drug-resistant ones, to support the National Malaria Control Program and improve the control of malaria. They will develop a web-based platform so that when a person tests positive at one of the existing monitoring sites, they can quickly and easily record the location of the infection. If given consent, they will also take a blood sample for genotyping the parasite at a central laboratory, and analyze them for potential drug resistant mutations. These data will be used for modelling near real-time transmission dynamics to inform future control policies and practices. The data will be shared with program managers who will be trained on how to interpret them to identify effective intervention strategies.
Naba Dutta of RMIT University in Australia will develop disposable sanitary pads from natural, biodegradable polymers and agricultural byproducts such as cellulose to decrease cost and waste production and improve safety. Disposable pads are generally made from synthetic superabsorbent material that is expensive, has a high carbon footprint and is associated with an increased risk of diseases such as pelvic inflammatory disease. Using their photo-crosslinking method, they will synthesize and test different protein-based hydrogels to produce the absorptive core of the pads, and also synthesize natural esters and test their ability to form an impermeable but breathable barrier layer. They will also test modified soy protein-based gels for adhesive properties, and jute fiber treated with polyphenols extracted from plants for the antibacterial layer. Once the components have been optimized, they will assemble them into a sanitary pad and test its performance compared to commercial pads.
Silvia Maria Di Santi at the São Paulo State Department of Health in Brazil will integrate genomics techniques into their routine malaria surveillance program to genetically characterize the parasite populations and monitor transmission dynamics in gold mining regions. Gold mining is associated with deforestation, which expands breeding sites for malaria-transmitting mosquitoes, poor housing conditions, and illegal activities, which makes eliminating malaria in these regions more difficult. They propose to use advanced sequencing technologies to better monitor the emergence of drug-resistant malaria-causing parasites and insecticide-resistant malaria vectors in a gold mining area in Pará, Brazil. They will collect samples from existing treatment and diagnosis sites and by recruiting miners, and collect Anopheles mosquitoes in different seasons. These will be subjected to whole genome and targeted amplicon sequencing, which will be implemented in a reference laboratory. They will also develop an interactive web browsing tool to visualize the raw sequencing data and reveal patterns of drug and insecticide resistance for informing interventions targeted to this region.
Martha Cecilia Suárez-Mutis of Fiocruz in Brazil will develop a molecular surveillance tool with genome sequencing to monitor the entry and subsequent spread of drug-resistant Plasmodium falciparum, the malaria-causing parasite, from across the country’s borders. Elimination of malaria requires close monitoring of the parasite population to track the emergence and spread of new genetic variants, particularly those resistant to the commonly used anti-malarial drugs, which will severely restrict elimination efforts. They will train local teams in five health posts close to selected country borders to collect blood samples from malaria patients, which will be sequenced in an established research laboratory to identify any known resistance mutations. They will also develop an analysis pipeline, tools, and an interactive web platform to translate the sequencing data into a user-friendly interface to assist decision-making by local and national managers.
Jennifer Edwards of Cardiff University in the United Kingdom will develop a low-cost material impregnated with a photo-active biocidal compound for producing reusable sanitary products that can be self-cleaned in the sun without the need for water or detergent. Many women and girls in low- and middle-income countries are unable to afford single-use sanitary pads or to properly clean reusable pads, which leads to many of them suffering from chronic infections. To address this, they have developed a series of non-toxic, metal and metal-oxide photoactive catalysts that produce reactive oxygen species when exposed to sunlight, and will test their ability to kill a range of bacterial and fungal pathogens, and to degrade other organic products, such as blood and odor. They will also evaluate cost-effective methods for incorporating them into different fabrics.
Wei Lu of the University of Michigan in the U.S. will develop a reusable sanitary pad from a highly hydrophobic material containing carbon nanofibers, which clot blood, and microfolds that trap it in small pockets on the surface and can be cleaned without water. Disposable pads are expensive and generate substantial waste, making reusable products more attractive in low- and middle-income countries. However, these all require washing with lots of clean water, which is often problematic. They will develop a material that, rather than promoting absorption, instead quickly immobilizes the blood in a solid state on the surface of the pad, which can be removed by simply stretching it. They will develop a prototype with optimized loading of the carbon nanofibers and with three-dimensional origami patterns that effectively capture the blood, protect the skin, and avoid leakage. The prototype will be tested for comfort and performance by volunteers.