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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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Blood Separator Device

David AndersonBurnet InstituteMelbourne, Victoria, Australia
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

David Anderson of the Macfarlane Burnet Institute for Medical Research in Australia will develop a low-cost, simple to use, sample collection device to improve sample quality and ensure accurate and timely diagnosis in remote, low-resource areas. Obtaining high quality serum samples needed for diagnosing a variety of diseases is challenging in these regions due to the lack of equipment and expertise to process the samples and stabilize them for transport to the diagnostic laboratories. They have developed a device comprising an integrated two-step process based on lateral flow chromatography that separates plasma from other blood cells and dries it on paper so it can be stably transported. The dried plasma samples can also be used directly in the laboratory, which accelerates analysis. They will modify the device to separate and store larger volumes of plasma using 25 healthy volunteers, and test its performance for diagnosing patients with different infections, including Hepatitis B and C, compared with fresh plasma.

Oral Swabs for TB Diagnosis: Stability, Transport, and Quality Control

Gerard CangelosiUniversity of WashingtonSeattle, Washington, United States
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

Gerard Cangelosi of the University of Washington in the U.S. will develop reagents to visually validate oral swabs and stabilize them for storage and transport to diagnostic laboratories in low-resource settings without the need for a cold chain. Oral swabbing to extract saliva is a non-invasive and effective method for diagnosing tuberculosis, and is faster and safer than traditional sputum collection. However, it is more difficult to review the quality of a swab sample as they are hard to see, and processing currently requires refrigeration. To address these limitations, they will develop a low-cost, quality control test with chemical reagents for detecting human mitochondrial DNA using human oral swabs from U.S. volunteers spiked with an avirulent strain of Mycobacterium tuberculosis. This will be coupled to a visual fluorescent readout that can be used to distinguish adequate from inadequate samples. They will also test different buffers for their ability to stabilize the swab samples at different temperatures for up to six months.

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.

Saliva and Dried Blood Spot Therapeutic Drug Monitoring for Multi-drug Resistant Tuberculosis

Jan-Willem AlffenaarUniversity Medical Center GroningenGroningen, Netherlands
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

Jan Willem Alffenaar of the University Medical Center Groningen in the Netherlands will develop two simple tests that measure the concentration of anti-tuberculosis drugs in treated patients in low-resource settings in order to optimize dosage and limit the emergence of deadly multi-drug resistant Mycobacterium tuberculosis (MDR-TB). The increased incidence of MDR-TB is due in part to low levels of anti-tuberculosis drugs, thus dosage optimization during treatment is important. However, doing this in low-resource settings is currently challenging. They will develop a method for use in Tanzania to measure the concentration of the anti-TB drug fluoroquinolone in saliva using a battery-operated UV spectrophotometer. They will also modify a high-performance liquid chromatography (HPLC) platform for detecting drug concentrations in dried blood spots, which are collected on filter paper and do not require refrigeration to remain stable. The on-site saliva test will allow detection of patients with too low levels of drug at risk for treatment failure, who can then have their dose optimized following the more detailed dried blood spot analysis at a centralized laboratory.

"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.

NETTALIS: One Sample-Endless Metadata

Amadou AlphaInstitut Pasteur de DakarDakar, Senegal
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

Amadou Alpha Sall of Institut Pasteur de Dakar in Senegal will add quantum dots to liquid patient samples for better tracking of results and to store diverse types of information relevant for diagnostics and research that can be retrieved in real-time. They will tag samples using stable semiconductor quantum dots to generate unique signatures that can be read by a mobile-based, lens-free, fluorescence microscope. They will develop algorithms to enhance the efficiency of encoding and decoding the data from the quantum dot signatures, and design a cloud-connected database using commercial infrastructures for sample data storage and retrieval. They will perform a field trial with a local laboratory network and real clinical samples to evaluate sample collection, tracking capability, and ease of use.

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.

Timeliness of Administering Birthdose Vaccines

Gershim AsikiAfrican Population and Health Research CenterNairobi, Kenya
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Gershim Asiki of the African Population and Health Research Centre in Kenya will develop a mobile phone application and centralized electronic database to link birth records with immunizations to increase the coverage of BCG and polio vaccines in newborns in Kenya. Births and immunizations are initially recorded on paper and then transferred to separate electronic databases, meaning that many infants fail to receive the standard vaccinations on time. They have developed an integrated database that collects both birth and immunization data directly from nurses and health workers via mobile phones. They will evaluate the feasibility of their approach by registering around 450 newborns from an urban slum, and train community health workers to register pregnancies, due dates and delivery dates using the mobile phone application. They will monitor the newborns up to two months after birth, and test the effect of their approach on the timeliness of vaccinations.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization

Jerome AteudjieuMeillerur Acces aux Soins de SanteYaounde, Cameroon
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Jerome Ateudjieu of Meillerur Acces aux Soins de Sante in Cameroon will test whether training community volunteers to record demographic movements and monitor births and immunizations of residents and visitors in their villages can improve timely childhood vaccination coverage in Cameroon. Many health districts in Cameroon have reported outbreaks of vaccine-preventable diseases. One underlying cause is that many people in these regions travel extensively, making it difficult for health facilities to identify newborns that need vaccinating, and to inform parents when and where the necessary vaccinations can be received. They will select 60 villages in the Noun Health District of West Cameroon, and train community volunteers to record the movements and immunization status of infants up to 11 months in their village. These records will be sent by the WhatsApp mobile messaging application to the relevant health facility to identify the children eligible for the next immunization session. The necessary appointments will then be communicated back to the parents by the community worker, who will also inform them of the importance of timely immunization, and encourage pregnant mothers to give birth in health facilities.

Ensuring Infant Immunization Timeliness and Completion in Urban Slums Through Older Women's Participation

Folusho BalogunUniversity of Ibadan, College of MedicineIbadan, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 May 2018

Folusho Balogun of the University of Ibadan in Nigeria will train older women who are traditionally involved in childcare in Nigeria to ensure infants in their communities are fully immunized. Many young children in Nigeria, particularly those in urban slums, are not fully immunized, or are immunized too late, leading to an unacceptably high under-five mortality rate. This is due in part to the mothers not understanding how critical immunizations are. In many African nations, the care of young children is also overseen by older women in the community such as grandmothers or neighbors. They hypothesize that training these older women to be formally involved in promoting immunizations will help to ensure all children complete the full package on time. They will select five urban slum communities in southwest Nigeria and use focus group discussions to explore the views of the older women on current immunization programs. They will use this to design a manual to train a group of older women who will be associated with pregnant women in the community, and evaluate the effect on immunization of the infants up to nine months.

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