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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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StandStrong - Sensing Technologies for Maternal Depression

Brandon KohrtGeorge Washington UniversityWashington, District of Columbia, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Brandon Kohrt of George Washington University in the U.S. will develop a tool using sensors associated with mobile phones that can identify and monitor young mothers suffering from perinatal depression in low-resource settings in Nepal so that personalized psychological treatments can be provided. The tool comprises a mobile phone for the mother and a small Bluetooth beacon attached to the baby's clothes. It can record location via GPS, the proximity between phone and beacon, and sound. They will build sensor data models that can associate specific activity recorded from the sensors with maternal depression, such as the length of time spent with the baby, the level of vocal interactions, and the frequency of outings. A community advisory board composed of young and older mothers, family members, and health workers will be established to evaluate the approach and help test and refine the tools. They will also co-develop a user-friendly interface with the mothers and health workers so that they can easily access the information and use it to improve their mental health.

Unstructured Supplementary Service Data Mobile Technology for Specimen Tracking and Results Delivery

Owens WiwaClinton Health Access InitiativeBoston, Massachusetts, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Owens Wiwa of the Clinton Health Access Initiative in Nigeria will develop an efficient and reliable system for tracking diagnostic samples and delivering results to improve the efficiency of HIV diagnosis and treatment of newborns in Nigeria. Over 3.5 million people in Nigeria are estimated to be living with HIV, and every year up to 40,000 newborns become infected. Many HIV-exposed infants are not properly diagnosed or monitored, leading to delays in treatment and worsening of the disease. With input from health workers and scientists amongst others, they will adapt an existing unstructured supplementary service data (USSD) platform linked to laboratory information management system (LIMS) software so that the health facilities and diagnostic laboratories can track individual samples and monitor results via mobile phone. They will select health facilities and train staff to pilot test the platform over 12 months.

Integrated Support Program Against Anti-Vaccine Narratives

Allya Paramita KoesoemaMasyarakat Elektronika Kesehatan & Telemedika IndonesiaBandung, Jawa Barat, Indonesia
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Allya Paramita Koesoema of the eHealth and Telemedicine Society in Indonesia will develop a pro-vaccination campaign to counteract the widespread negative views of vaccinations in Indonesia by engaging religious leaders and health workers in local communities to directly address misconceptions. Anti-vaccination narratives, many based on religious misconceptions, have spread through the country, largely via social media, leading to a decrease in child vaccination coverage. Health workers often do not have the knowledge to explain away these misconceptions to mothers when they refuse to have their children vaccinated. To address this, they will engage stakeholders to identify the anti-vaccination messages and build a database of effective reasoning to directly challenge those messages that can be accessed by health workers and other respected, senior community members. They will perform a randomized controlled trial in different districts in Indonesia, and supplement the pro-vaccination messengers with vaccination reminders and schedules sent directly to mothers via mobile phone. They will test the usability of their approach and its effect on the willingness of the mothers to vaccinate.

Enhanced Group Antenatal Care for Adolescents in Mali

Sarah MurrayJohns Hopkins Bloomberg School of Public HealthBaltimore, Maryland, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Sarah Murray and colleagues of Johns Hopkins Bloomberg School of Public Health and School of Nursing in the U.S. along with colleagues at the University of Bamako in Mali will develop a group approach to provide better antenatal care to pregnant adolescents in Mali and protect them from common mental disorders such as depression. Over half of adolescent girls in Mali have a child before their 18th birthday, and as a consequence are more likely to live in poverty, be uneducated, and experience violence. Although antenatal health services and support are available, they are limited. To address this, they will develop a group format for more efficient delivery of antenatal mental health care that encourages open discussions and provides social networks and support. This will be done in collaboration with adolescent mothers, their husbands, and health care providers. They will train health care workers to teach relevant coping strategies in a group format using cognitive behavioral therapy techniques, and pilot test their approach on small groups of pregnant adolescents with partners in Bamako, Mali.

"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.

Mobile Nudges to Increase Early Vaccination Coverage in Rural Areas - A Pilot Investigation

Günther FinkSwiss Tropical & Public Health InstituteBasel, Switzerland
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Günther Fink of the Swiss Tropical and Public Health Institute in Switzerland will develop a mobile phone-based system to improve the registration of births and the timeliness of childhood vaccinations in Ghana. Particularly in Northern Ghana, many women give birth at home and are less likely to ensure their infants get vaccinated on time, which exposes them to severe infectious diseases such as polio. Even in these low-resource settings, mobile phones are common, and have been successfully used to encourage healthy behavior. They will develop an automated mobile phone system that rewards users when they record a birth or obtain early vaccination, and sends text reminders to encourage mothers to get their infants vaccinated. They will conduct a pilot study with around 300 mothers and community volunteers in Northern Ghana to assess the feasibility and impact of their approach for improving birth tracking and for convincing mothers to get their child vaccinated within their first month of life.

Optimizing Mother and Child Health and Development in Botswana

Lisa ButlerUniversity of ConnecticutStorrs, Connecticut, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Lisa Butler of the University of Connecticut in the U.S. will develop an approach to improve the mental health of pregnant and new mothers between 15 and 19 years old in Botswana that incorporates interactive group sessions mediated by trained community workers, informative text messages, and an SMS-based mental health screening tool. Between 19-25% of women in low- to middle-income countries suffer from depression during pregnancy, which can also have serious effects on the child. In Botswana, there are large numbers of young, single mothers, who lack support and are particularly vulnerable to depression. They will develop the materials and format for their approach with support from a community working group of adolescent mothers and health providers to ensure it is culturally appropriate and addresses their specific needs. They will also incorporate a theoretical model designed to address the triggers and reduce the stigma of mental health disorders. Their approach will be field tested with 80 pregnant adolescents in a traditional village in Botswana to evaluate its feasibility and acceptability.

Building Resilience through Self-Help Groups for Adolescent Sex Workers with Young Children in Zimbabwe

Joanna BuszaLondon School of Hygiene and Tropical MedicineLondon, United Kingdom
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Joanna Busza of the London School of Hygiene and Tropical Medicine in the United Kingdom will help vulnerable young mothers who sell sex in Zimbabwe by involving them in designing self-help groups incorporating virtual meetings via social media to build support networks and teach them life skills such as money management and parenting. Adolescent sex workers who become mothers are at high risk of developing mental health problems such as anxiety and depression, and often have little support caring for their children. They will involve adolescent women in the design stage by holding interviews and group discussions to gather opinion on social media and group meetings, as well as identify the types of skills they most need and how best to teach them. They will train peer educators to lead six-month virtual support groups and recruit young, pregnant sex workers to pilot test the approach in two urban sites in Zimbabwe.

A Mobile-Based Training Platform for ASHA workers

Pushpendra SinghIIIT-DelhiNew Delhi, Delhi, India
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Pushpendra Singh of IIIT Delhi in India will develop interactive training and mentoring sessions for community health workers in India (ASHAs) using mobile phones and interactive voice response systems so they can provide better public healthcare in rural communities. Current training programs are run by medical professionals and require the workers to visit a health center, which may be inconvenient. The lack of medical experts has also reduced the frequency of these programs. These limitations could be overcome with online sessions whereby one expert trains multiple health workers remotely. They have already developed the format of the sessions, which involves an expert delivering a defined curriculum to groups of health workers followed by a question and answer session, and shown that it improved the knowledge and confidence of the health workers in a pilot test. They will now scale up the testing to 500 health workers, and also evaluate the platform as a peer-to-peer learning mechanism for health workers to share their experiences and learn from each other without the need for an expert.

Using Participatory Quality Improvement Methods to Improve Vaccine Timeliness

Tara HopkinsMali Health Organizing ProjectCambridge, Massachusetts, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Tara Hopkins of Mali Health in the U.S. will develop methods to improve vaccination coverage in rural communities in southern Mali by engaging community health workers together with traditional birth attendants who are present during home births. In southern Mali, particularly in rural communities, most children are born at home, so they are not registered with a health clinic or present for critical childhood vaccinations. Local health services have limited funds and resources to manage the health records of all the babies born in their communities, or to follow-up with families regarding the necessary vaccinations. This translates to low vaccine coverage of around 9% in some regions, and increased incidences of deadly infectious diseases. They will pilot the project in three rural health districts and create a quality improvement team in each, consisting of a coach, local health workers, birth attendants, and mothers. The teams will be given tools to engage in a group effort to identify the barriers to timely vaccinations, and generate solutions to test.

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