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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.

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"Help, the Mother Is Bleeding!" An Interactive Voice-Controlled Virtual Mentor to Support Birth Attendants in Resource-Constrained Settings

Tiffany LundeenPreterm Birth Initiative East AfricaSan Francisco, California, United States
Grand Challenges for Development
Saving Lives at Birth
1 Mar 2018

"Help, the Mother is Bleeding!" An interactive voice-controlled virtual mentor to support birth attendants in resource-constrained settings

"Just-Add-Water" Nucleic Acid Amplification

Apostolos AlissandratosThe Australian National UniversityActon, Australian Capital Territory, Australia
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

Apostolos Alissandratos of the Australian National University in Australia will develop a biotechnology platform for the low-cost production of simple, just-add-water diagnostic tests for the early detection of infectious diseases in resource-limited settings. Diagnosis of infectious diseases generally involves detecting pathogen-specific nucleic acids in human samples, which requires unstable reagents, costly procedures, and skilled workers. They have engineered a safe bacterium that produces the biochemical reagents needed to detect the pathogenic nucleic acids as an extract. They will develop a method to freeze-dry this extract so that it is stable at room temperature, simplifying production and storage, and a protocol for incorporating it into a reaction mixture that only requires the addition of water to an individual tube for a diagnostic polymerase chain reaction. They aim to reduce the cost per test by at least 100-fold, and will evaluate their approach for detecting a malaria-causing pathogen.

"Krik Krak": Mental Health for Pregnant Haitian Teens

Guitele RahillUniversity of South FloridaTampa, Florida, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Guitele Rahill and Manisha Joshi of the University of South Florida in the U.S. will harness the Haitian tradition of storytelling to produce online videos, brochures, and posters that support pregnant teenagers in Haiti who are at high risk of depression. There has been an increase in unplanned teenage pregnancies since the 2010 earthquake, due in part to the loss of parents, and a rise in transactional sex and sexual assaults facilitated by very limited resources. Pregnancy places a substantial additional stress on these children, which in turn causes long-term difficulties for their children. In Haiti, to tell a story you announce "Krik?", and to hear it you respond "Krak!" They will use this familiar story-telling framework and actors who resemble the target group to teach pregnant teenagers about childbirth, motherhood, and how to cope with depression. They will conduct two focus groups of six pregnant teens to identify the specific challenges they face, and use their feedback to help ensure the approach will work.

"Lego" like Sanitation System: Pit Latrines Made of Biocomposites

Antonio AvilaUniversidade Federal de Minas GeraisBelo Horizonte, Minas Gerais, Brazil
Grand Challenges Explorations
Sanitation Technologies
15 Apr 2011

Antonio Avila of Universidade Federal de Minas Gerais in Brazil proposes to develop building blocks made from biocomposites that will replace conventional brick and cement constructions for pit latrines. The team will test these building blocks strength and their rate of biodegradation to determine their suitability for building latrines that will decompose once the pits are filled, allowing for the eventual reintroduction of the land for farming and other community uses.

10+10+30 Infant Vaccines Communication via Radio in Ethiopia

Bernard AppiahTexas A&M School of Public HealthCollege Station, Texas, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Bernard Appiah of Texas A&M School of Public Health in the U.S. will produce a one-hour community radio program to be aired twice per week comprising a 10-minute radio drama serial on infant vaccines, a 10-minute panel discussion by community health workers, and a 30-minute phone-in by listeners, to improve on-time childhood vaccinations in Ethiopia. In 2016, on-time and full immunization coverage in Ethiopia was only achieved for 39% of children between one and two years of age, despite long-term efforts to improve it. One of the main reasons for this was lack of communication with mothers about immunizations. To address this, they will harness the popularity of community radio in Ethiopia. They will engage mothers, community health workers, and radio actors to help design a radio drama incorporating relevant topics on childhood immunizations, and train 20 health workers to be part of radio panel discussions. They will air the radio program for six months in two districts, and determine its impact on timely immunization coverage in a selected cohort of mothers with infants.

3-D Human Small Intestinal Organoid for Enteric Infections

Cirle WarrenUniversity of VirginiaCharlottesville, Virginia, United States
Grand Challenges Explorations
Enteric Disease Models
15 Apr 2014

Cirle Warren of the University of Virginia in the U.S. will develop a three dimensional cell culture model (organoid) of the human intestine to study diarrheal diseases. They will build the organoids in a bioreactor using three intestinal cell types, and test different scaffolds to simulate the complex cellular and structural architecture of the human gut. The organoids will then be infected with Cryptosporidium, a common cause of diarrhea in developing countries, and analyzed for altered structural and molecular characteristics to gain insight into the host infection response. This model could also be used to identify new drug targets and evaluate candidate drugs.

99DOTS: Using Mobile Phones to Monitor and Improve Adherence to Tuberculosis Medications

Bill ThiesInnovators in Health (India)Patna, Bihar, India
Grand Challenges India
Tuberculosis Treatment
12 Aug 2014

Bill Thies and the team of 99DOTS aim to achieve 99% TB drug adherence using a combination of basic mobile phones and augmented blister packaging to provide real-time medication monitoring at drastically reduced cost. The approach is to utilize a custom envelope, or blister card, into which each pack of medication is inserted and sealed by the care provider. When the patient dispenses medication from the blister pack, the pills also break through perforated flaps on the blister card. On the back side of each flap is a hidden number. Patients submit these numbers using their mobile phone as evidence that they have dispensed medication. To avoid incurring any mobile charges, the numbers are used to complete a phone number and deliver a "Missed call" (Missed calls are free if they are not pointed to a VoiceMail). Using this system patients also receive a series of daily reminders (via SMS and automated calls). Missed doses trigger SMS notifications to care providers, who follow up with personal, phone-based counseling. Real-time adherence reports are also made available on the web.

A "Smart Diaphragm" for the Early Detection of Preterm Labor

Larry RandUniversity of California San FranciscoSan Francisco, California, United States
Grand Challenges Explorations
Mothers and Newborns
18 Apr 2011

Larry Rand and colleagues at the University of California, San Francisco in the U.S. will develop a vaginal diaphragm to detect changes in cervical collagen and wirelessly alert health providers before preterm labor begins. This device would identify a new pre-labor "window" during which intervention could reduce mortality and disability resulting from preterm birth among at-risk pregnant women. In Phase I, they designed an easy to use and low-cost device incorporating electrical impedance detection circuitry and fiber optic cable to accurately measure collagen concentration in the cervix of pregnant women over time. Prototypes were built for clinical tests to evaluate the capacity for identifying pregnant women at risk of preterm birth, as well as comfort and acceptability. In Phase II they will optimize the device to make it more robust and user-friendly and expand clinical testing to rural settings in South Africa. They will also develop phone-to-cloud technology for wirelessly collecting the measurements from the device through a mobile phone to a server (cloud) for analysis, and to enable return of the prognosis.

A Bacteriophage Platform for Programmable Killing of Bacteria

Chase BeiselNorth Carolina State UniversityRaleigh, North Carolina, United States
Grand Challenges Explorations
Bacteriophage
1 Nov 2015

Chase Beisel of North Carolina State University in the U.S. will exploit non-lytic bacteriophage for promoting infant gut health and treating enteric infections in low-resource settings. Generally, lytic phage are being studied for treating diseases, but they suffer from a number of limitations including causing resistance and the release of endotoxins, which can damage healthy cells. They will use the CRISPR-Cas9 defense system to engineer non-lytic P1 phage to specifically target the bacteria Shigella sonnei, which is a leading cause of enteric diseases in children in the developing world. The engineered phage, which can be produced at low cost, will be tested for ability to efficiently infect and kill the targeted bacteria.

A Blended Intervention: Digital Mental Health Game and Mentoring for Treatment of Common Perinatal Mental Disorders in Adolescent Refugee Mothers

Rebecca DempsterHIASSilver Spring, Maryland, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Rebecca Dempster of HIAS in the U.S. will develop an online game- and mentorship-based intervention to improve the mental health of refugee adolescent mothers in Kenya that integrates into their daily lives and helps them develop new skills. Digital games can help treat mental health disorders such as depression particularly in young people because they have a natural appeal and are easy to access from home. They will recruit ten young mothers, a psychologist, and software programmers to design a mental health game so that it can be used to identify those with mental health disorders and connect them with counselors, and provides interactive challenges to help treat and protect against those disorders as well as build relevant life skills. They will then train these young mothers to act as mentors to support the online game, and pilot test their approach on a sample of 15 refugee adolescent mothers over three months to evaluate feasibility, acceptability, and effect on maternal depression.

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