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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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Impact of S. Typhi Genome Structure Upon Survival in Water

Gemma LangridgeQuadram Institute BioscienceNorwich, United Kingdom
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Gemma Langridge of Quadram Institute Bioscience in the United Kingdom, along with co-investigators Aaron Jenkins of the University of Sydney in Australia and France Daigle of the University of Montreal in Canada, will collect different isolates of S. Typhi, which causes typhoid fever, to analyze genomic structure, growth, and gene expression to better understand how it can survive at low levels in water, and determine how it can be reactivated for monitoring. Typhoid fever is a potentially fatal disease associated with exposure to contaminated water. S. Typhi, the bacteria causing the disease, exist in water in a so-called viable-but-non-culturable (VBNC) state, which makes it difficult to monitor for control efforts. Their previous analyses have shown that the VBNC bacteria undergo structural rearrangements of their genomes and changes in gene expression, which may explain the reduced growth. They will analyze the correlation between genome structure and growth of different S. Typhi isolates using samples isolated from around 25 typhoid fever cases, and a further 75 stored isolates across the endemic region. Of these, a selection will be tested for their ability to enter a VBNC state and survive in water from areas of high and low typhoid incidence. One isolate that has entered VBNC with a defined structural genotype will be tested to establish the conditions most suitable for resuscitation.

Immonotherapy 'On-the-Go'

Hasan UludagRJH Biosciences Inc.Edmonton, Alberta, Canada
Grand Challenges Explorations
EmergingTechnologies
1 Nov 2019

Hasan Uludag of RJH Biosciences in Canada will develop an affordable immunotherapy system based on genome-integrating transposons that works inside the body for the treatment of a wide variety of diseases such as cancer and diabetes. Emerging immunotherapies offer promising treatment for many diseases, but they require genetic modification of immune cells outside the body, and are thus labor intensive and expensive, limiting their utility in developing countries. They will use engineered nanoparticles in a new approach to immunotherapy that modifies immune cells inside the body. The nanoparticles are derived from polymeric materials that can encapsulate nucleic acids and proteins and release them into host cells. These nanoparticles will be dispersed in a hydrogel matrix with immunostimulatory molecules to create a living bioreactor inside the host that will attract and genetically modify immune cells. They will select polymers for their ability to deliver DNA-based transposons (to facilitate integration into the host genome) to immune cells and to stably express a reporter gene. Optimal polymers will be transferred into mice and they will evaluate transfection efficiency into immune cells with a fluorescent reporter gene. Finally, they will test the therapeutic efficacy of their in situ immune cell engineering approach in a mouse leukemia model.

Improving Vaccination Awareness and Coverage in Somalia (IVACS)

Andrew SealUniversity College London, Institute for Global HealthLondon, United Kingdom
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Andrew Seal of the Institute for Global Health and Development in the United Kingdom will test whether traditional female social groups in Somalia can adopt a participatory learning and action (PLA) approach to improve vaccine knowledge and coverage in humanitarian settings. Vaccine-preventable diseases are prevalent in Somalia; measles is the leading cause of death in children under five, yet less than 40% of children are immunized. This is due in part to lack of knowledge about the benefits of vaccination. The PLA approach is based on the idea that sustainable social change is possible if teachers and learners engage in meaningful dialogue and share ideas and experiences. Abbay-Abbay groups, common throughout Somalia, are social groups of 10-20 women, led by an elected Khalifada (lead woman). They meet regularly and have a core interest in the challenges of child rearing, with most women having direct or indirect experience with losing a child to measles. They will recruit coordinators to support Abbay-Abbay leaders, providing information and facilitating learning around vaccinations. They will evaluate their approach for improving attitudes to vaccination and reducing the incidence of measles via a randomized cluster study.

AI and InfraRed Spectroscopy to Accelerate Malaria Control

Fredros OkumuIfakara Health InstituteIfakara, Tanzania
Grand Challenges Explorations
EmergingTechnologies
1 Nov 2019

Fredos Okumu of the Ifakara Health Institute in Tanzania will develop technology to evaluate mosquito control interventions using a combination of artificial intelligence, infrared spectroscopy, and entomology. Malaria caused over 400,000 deaths in 2017, the majority in the developing world, and an effective way to control the disease is to target the mosquitoes that transmit it. Current tools cannot precisely measure mosquito age or life-expectancy, and are therefore unable to predict the impact of mosquito control interventions. The biochemical composition of the mosquito exoskeleton varies with species and age; as the types of chemical bonds change so does the amount of light absorbed in the mid-infrared region. This can be measured with mid-infrared spectroscopy (MIRS), and they will combine this with machine learning to measure the age of mosquito populations. Using a dataset collected from over 25,000 lab-raised mosquitoes, they have developed a supervised machine learning model that accurately predicts mosquito age and species. They will optimize this model to work also on wild mosquito populations, develop an online platform for real-time analysis of mosquito MIRS data, and test its ability to measure the effectiveness of malaria control interventions.

Monitoring Windborne Activities of Disease Vectors, Pathogens, and Pests

Tovi LehmannNational Institutes of HealthBethesda, Maryland, United States
Grand Challenges Explorations
EmergingTechnologies
1 Nov 2019

Tovi Lehmann of the National Institute of Health in the U.S. will establish cross-country networks of aerial sampling stations in Africa to monitor windborne movement of insects and pests, and evaluate risks to public health, food safety, and ecosystem stability. Vector-borne disease is among Africa's top health priorities, and control of the insect vectors is the primary target for prevention. They will use a unique aerial sampling program to collect airborne insects across Mali and Ghana, and identify insects and pathogens within them by molecular analysis. Sticky nets mounted on helium balloons have shown, in a pilot project, to collect diverse samples, more representative of area fauna than ground sampling protocols. The same project showed that mosquitoes frequently travel (and may spread disease) over hundreds of kilometers. Overnight aerial sampling will be conducted ten nights per month for six months, followed by insect taxonomic identification and RNA/DNA sequencing to identify insects and pathogens. Weather data will be collected from the sampling stations at both ground level and sampling altitude and combined with population data for statistical analysis and simulation of flight patterns. They will produce dynamic, species-specific maps of select insects and pathogens with putative sites of origin, routes and destinations, which will be used to evaluate risks to public health and food security.

S. Typhi Mechanisms of Temperature- and Microbiota-Dependent Environmental Persistence

Denise MonackStanford UniversityStanford, California, United States
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Denise Monack of Stanford University in the U.S. will use a genetic approach to identify the molecular mechanisms that enable the typhoid fever-causing bacterium S. Typhi to survive in aquatic environments and to rapidly adapt to transmission to humans. Annually, S. Typhi causes over 20 million infections and 200,000 deaths, mostly among populations that lack access to clean drinking water. Understanding how S. Typhi persists in water and then quickly adapts to its human host is critical for controlling transmission. Bacteria use various mechanisms to adapt to environmental changes, including so-called RNA thermometers (RNATs), which form secondary structures in mRNAs that can rapidly activate gene expression when temperatures change. They will use their established genetic screening approach to identify new RNATs in S. Typhi and validate their ability to promote bacterial persistence within aquatic microbial communities by generating mutants. They will also follow up on past work in which a bioinformatics approach identified new RNATs that may regulate the expression of the chitinase enzyme, which is used by the cholera-causing bacterium to bind to plankton and create a protective environmental niche. They will evaluate whether chitin is also important for S. Typhi persistence and transmission.

Community Theatre for Immunization

Chijioke KaduruCorona Management SystemsAbuja, Nigeria
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Chijioke Kaduru of Corona Management Systems in Nigeria will use a human-centered approach to develop a community theater production that showcases real stories to educate caregivers on the value of vaccinations and increase childhood vaccine coverage. Almost half of caregivers in Nigeria lack awareness of the value of vaccines, which has increased the incidence of childhood diseases. To address this, they will stimulate social change by showcasing aspects of immunization - identifying concerns and discussing potential solutions - in a community theater production based at the income and education level of caregivers. They will work with stakeholders including immunization teams, community health workers, women's groups, and religious leaders to develop the production. The cast will be made up of community members with real experiences, and performances will be held in public places, traditional meeting spaces, schools, and places of religious worship, and be recorded for future airing. By better engaging caregivers with their human-centered approach, they expect to generate a greater demand for immunization services.

Crowdsourcing to Rebuild Chinese Caregiver Trust in Childhood Vaccines

Joseph TuckerLondon School of Hygiene and Tropical MedicineLondon, United Kingdom
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Joseph Tucker of the London School of Hygiene and Tropical Medicine in the United Kingdom will hold a national crowdsourcing contest to develop a social media-based intervention to improve confidence in childhood vaccines and boost coverage in China. Expert-driven strategies have been launched to promote vaccination coverage in China, but have had limited effect. As an alternative approach, they will apply crowdsourcing to tap into the knowledge of individuals to design a more effective, online intervention. They will open the contest with a call for new ideas that use text, images, and videos to promote vaccinations; enable online evaluation of those ideas by crowd and expert judges; and assemble a steering committee of health experts to produce the finalists. The final content of the intervention will be developed by the finalists in an intensive 'designathon' event. They will test the new intervention in select community health centers in three cities in China and analyze its ability to improve confidence in vaccinations.

Immunization Strategies for Working Mothers

Olukemi AmoduCollege of Medicine, University of IbadanIbadan, Nigeria
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Olukemi Amodu, Mofeyisara Omobowale and Folakemi Amodu of the University of Ibadan College of Medicine in Nigeria will develop a three-part intervention to provide more convenient and accessible vaccinations for children of working mothers to increase the timeliness and completion of childhood vaccinations. Despite education campaigns, the demand for childhood vaccination in Nigeria is low, partly because working mothers have limited time to attend vaccination clinics. The three-part intervention comprises priority and more convenient immunization services at existing clinics, mobile vaccine clinics for the many mothers who work long hours in the marketplace, and a smartphone-based application to send vaccine reminders. They will test their approach in the city of Ibadan by setting up mobile clinics at three market places to provide weekly vaccination services and education counseling for mothers in their own shops. These mothers will also be supported with a savings program (VaccoSavings) to help them track money saved to pay for vaccines not paid for by the government. They will also enable mothers working in the formal sector to book vaccine appointments at more convenient times at a child welfare center where they will be attended to promptly. All mothers with smartphones will be supported by the VaccApp application to track vaccine schedules and provide automatic reminders. The impact of these combined strategies on the demand for vaccinations will be evaluated after one year.

S. Typhi Survival and Gene Acquisition in Biofilm Communities

Windy TannerUniversity of UtahSalt Lake City, Utah, United States
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Windy Tanner and Jim VanDerslice of the University of Utah in the U.S., together with colleagues from Mehran University of Engineering and Technology in Pakistan, will analyze water samples to determine the conditions that promote the survival of the typhoid fever causing bacterium Salmonella Typhi, and they will use metagenomic deconvolution to identify any gene exchange from other microbial species that may produce drug-resistant strains. S. Typhi is responsible for over 100,000 deaths each year, mostly in the developing world where fecal contamination of food and drinking water is common. The emergence of drug-resistant strains has limited the available treatment options. Biofilms are environmental niches with complex microbial communities and are ubiquitous in the environments where S. Typhi is commonly found. They will sample water and biofilms from a variety of these environments along the fecal-drinking water transmission route in the Sindh province of Pakistan and test for the presence of S. Typhi using qPCR and culture methods. They will also evaluate whether specific organisms stabilize and protect S. Typhi in these biofilms and could cause resistance gene exchange.

Does Phage Predation Shape Typhoid Ecology in Urban Water?

Jason AndrewsStanford UniversityStanford, California, United States
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Jason Andrews of Stanford University in the U.S. will study the association between the typhoid fever-causing bacterium Salmonella Typhi and its bacteriophage in both aquatic environments and the human gastrointestinal tract to see if they influence geographic and seasonal disease outbreaks in Bangladesh. The ecology and evolution of many know bacterial pathogens including V. cholerae are affected by the viruses (bacteriophage) that infect them. Indeed, seasonal cholera epidemics are inversely correlated with phage prevalence in water. They will study this relationship in S. Typhi, which contaminates half of city water supplies in Bangladesh. They will generate a library of local phage strains infecting S. Typhi and use a computational approach to identify indicator S. Typhi strains that may be susceptible to these phage, which they will then test experimentally. They will also characterize the abundance and strains of phage in municipal water supplies, and in stool samples from typhoid cases, and compare these with clinical cases of typhoid to determine if they shape temporal and spatial patterns of typhoid.

The Routine Immunization Buddy System (RIBS)

Itoro AtaSolina Center for International Development and ResearchAbuja, Nigeria
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Itoro Ata of the Solina Center for International Development and Research in Nigeria will implement a program to support unemployed mothers in Nigeria by linking education on the importance of vaccinations with vocational skills education and training to improve immunization coverage. Many rural areas in Nigeria have consistently low rates of routine immunization and large populations of unemployed, stay-at-home mothers whose children are at risk of vaccine-preventable disease. They will create a direct link between community health systems and economic empowerment programs focused on vocational skill development by creating the Routine Immunization Buddy System (RIBS). Mothers in the program will be placed in small support groups and paired with another woman within the group. The lead woman of each group will be trained by community health workers to provide practical information on vaccines using a teaching tool called Hannun Rigakafi (the immunization hand). Women in the RIBS groups will also be taught about possible work options, such as farming, and offered associated tools and training. Pairing education on vaccines with vocational training should help boost the confidence of the mothers and better motivate them to complete the five routine childhood immunizations for their children. The program will be piloted in the Kaduna state of Nigeria and evaluated for improving vaccination knowledge and demand.

SALUBONG: Building Vaccine Confidence in the Philippines

Shannon McMahonUniversity of HeidelbergHeidelberg, Germany
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Shannon McMahon of the Heidelberg Institute of Global Health in Germany and Mark Donal Reñosa of the Research Institute for Tropical Medicine in the Philippines will create and test an intervention based on narrative and imagery to re-establish trust in vaccinations in Western Visayas, Philippines. Confidence in the safety of vaccines has recently dropped in the Philippines, exacerbated by controversy with a dengue vaccine in 2017. The country is now facing a measles outbreak, with a 3000% increase in cases in some areas. They will develop Salubong, a program named for an important Filipino term, to improve confidence in vaccines. It is a word that means to welcome someone into one’s life. An intervention of this name is implicitly rooted in understanding and compassion, rather than in blunt scientific logic, and is expected to be effective at encouraging wary families to reconsider their views. Also an acronym for its own development, Salubong will be developed through Share Appraising (focus groups with parents and community members), Life Stories and Uncovering (in depth interviews with parents and storyboard and think-aloud exercises), Bridging and Optimizing (presentation of the results to community health workers) and Navigating and Gaining (testing of the model in urban and rural areas with measles outbreaks).

A Malaria Mosquito Gut On-a-Chip

Pietro AlanoIstituto Superiore di SanitàRome, Italy
Grand Challenges Explorations
EmergingTechnologies
1 Nov 2019

Pietro Alano of the Instituto Superiore de Sanità in Italy will develop a biochip that mimics the midgut of the Anopheles mosquito and can be used to more easily and quickly test candidate anti-malarial compounds for blocking transmission of the causative Plasmodium parasite. Malaria is a potentially fatal infection caused by parasites transmitted between humans through the bites of infected mosquitoes. When a mosquito bites an infected person, immature Plasmodium gametocytes enter the mosquito and transform into an invasive ookinete stage in its midgut. They then traverse the gut wall to the external gut lumen, where they enter their parasite stage. To eliminate malaria, compounds are needed that block the transmission of Plasmodium. However, current methods to evaluate the candidate transmission-blocking drugs or vaccines that are under development are slow and involve feeding malaria-infected blood to mosquitoes, which is potentially dangerous. As an alternative, they will create a biochip to reproduce the mosquito midgut environment that can support the development of parasites, and develop a bioluminescent antibody-based technique to count successfully traversing ookinetes. They will test the performance of the biochip using known anti-transmission drugs.

S. Typhi in Water and Role of Microbial Partners

France DaigleUniversité de MontréalMontreal, Quebec, Canada
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

France Daigle of the University of Montreal in Canada will identify the microorganisms that enable the survival of the typhoid fever-causing bacterium, Salmonella enterica serovar Typhi, at low levels in water, and thereby enhances disease spread. Typhoid fever spreads through contaminated food and water, and results in over 125,000 deaths annually worldwide. S. Typhi are so-called auxotrophic bacteria because they rely on an external source of the essential amino acids that they need to grow. Microbial interactions may provide nutrients and also increase bacterial fitness and support persistence by protecting them from the environment, thereby increasing the rate of disease transmission. They will assemble a microbial community in water consisting of three components: one protozoan (from a group known to promote bacterial survival); a defined consortium of bacteria representative of the human fecal microbiota; and fluorescently-tagged S. Typhi. They will evaluate the ability of S. Typhi to grow in these microcosms, and how they grow, such as in biofilms or inside the protozoa. They will also determine whether these persistent S. Typhi are better able to infect and survive in human cells. Finally, water samples from an endemic region in East Africa will be analyzed for the presence of S. Typhi and identified beneficial microbial partners using quantitative PCR.

Genome Sequencing of S. Typhi in Protistan Reservoirs

Andrew JacksonUniversity of LiverpoolLiverpool, United Kingdom
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Andrew Jackson of the University of Liverpool in the United Kingdom will determine whether the amoeba, Acanthamoeba, which is commonly found in water and soil, acts as a host for Salmonella Typhi bacteria, which cause typhoid fever, to support growth and disease spread in Malawi. Typhoid fever is a systemic, potentially fatal illness, usually contracted by consuming contaminated drinking water. An estimated 11-21 million cases occur worldwide each year. Acanthamoeba is known as the 'Trojan Horse' of the microbial world for its ability to host a number of human pathogens, including S. Typhi. It is speculated that Acanthamoeba acts as an environmental reservoir to facilitate the survival of S. Typhi, and perhaps other human pathogens. They will prove the widespread presence of Acanthamoeba-Salmonella associations directly by using single-cell DNA sequencing. Individual amoeba will be isolated from water and soil samples from typhoid hotspots in Malawi using fluorescence-activated cell sorting. Total DNA in each amoeba will be sequenced in order to identify carriage of S. Typhi strains. Single nucleotide polymorphism analysis will be used to compare these with bacteria in local clinical isolates to determine the role of Acanthamoeba in disease transmission.

On-Demand, Cell-Free Biomanufacturing of Conjugate Vaccines

Matthew DeLisaCornell UniversityIthaca, New York, United States
Grand Challenges Explorations
EmergingTechnologies
1 Nov 2019

Matthew DeLisa of Cornell University in the U.S. will create a cell-free synthetic biology platform for low-income settings that produces thermostable polysaccharide-based conjugate vaccines against diarrheal pathogens upon the addition of water to a single tube. Half-a-million children under age five die each year from diarrhea and dysentery, the majority in low- and middle-income countries. Two major causes of bacterial diarrhea are enterotoxigenic E. coli (ETEC) and Shigella strains. Conjugate vaccines combine multiple antigens into one vaccine to increase its activity. However, they require a complex manufacturing process, living cells, and refrigerated storage, which limit their application in developing countries. They will develop the materials and methods for manufacturing thermostable anti-diarrheal vaccines in single tubes that only require the addition of water just ahead of administration. The tubes will contain a plasmid that can express an FDA-approved carrier protein, along with selected O-antigen-polysaccharides from ETEC or Shigella strains, and an enzyme that can conjugate the two via glycosylation, all within a freeze-dried pellet. Following development, they will test the safety, scalability and portability of the vaccines, and characterize their ability to generate effective antibodies that can kill the bacteria. The system is expected to reduce conjugate vaccine costs, and its modular nature will facilitate expansion to other vaccine-preventable diseases.

Overcome Hysteresis Effect by Social Network Targeting

Feng FuDartmouth CollegeHanover, New Hampshire, United States
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Feng Fu of Dartmouth College in the U.S. will use social networks to promote positive attitudes and overcome negative views of vaccinations and thereby increase demand. The success of vaccinations has led to steep declines in the incidence of many serious diseases. However, this has decreased the perception of disease risk and thereby lowered vaccination coverage as parents concerns switch to other factors, such as cost and the perceived risk of the vaccination itself, which are fueled via social media channels. These current low vaccination rates exhibit so-called hysteresis whereby the past concerns about safety or necessity prevent the rates from increasing even when the concerns have been disproven. To overcome this, they will use computer modeling approaches to test the ability of targeting social networks to leverage social "contagion" (i.e., spread) of positive attitudes to vaccine knowledge. They will use a healthcare intervention dataset from a network of rural villages in Honduras to model how one or more health-related behaviors or beliefs of an individual affects the group to simulate the social contagion process related to vaccines. They will also evaluate the potential positive impact of influential individuals who publicly support vaccination. The results will be used to develop social network targeting algorithms to increase the demand for vaccination. Their modeling results will be validated using the real data from the village networks.

Leveraging Food Distribution Networks to Increase Knowledge

Jessica CraigCenter for Disease Dynamics, Economics & PolicyWashington, District of Columbia, United States
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Jessica Craig of the Center for Disease Dynamics, Economics and Policy in the U.S. will use existing food distribution networks in low-income countries to publicize the importance of vaccination and inform caregivers when, where, and how to access local vaccine services by printing them on food labels, food and water carrying tools, and receipts. They will test whether their approach can improve vaccination rates using one rural and one urban area each in Kenya and in the Central African Republic. They will map their food distribution systems and health service clinics and consult local healthcare workers on the design of vaccine information materials to reach both literate and illiterate populations. They will evaluate the number of caregivers interacting with the materials using surveys in clinics, as well as the change in vaccination rate before and after a six-month period with materials in circulation. The approach is relatively simple and cost-effective because it leverages an existing network with a wide audience, and requires no additional work from frontline healthcare workers. It is also adaptable to any setting with a food distribution network, and can be expanded to deliver other types of health information.

Improving Frontline Worker and Caregiver Skills in Vaccination Pain Management

Caroline AuraUniversity of NairobiNairobi, Kenya
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Caroline Aura from the University of Nairobi in Kenya will teach frontline health workers and caregivers new skills so they can apply simple techniques such as swaddling and rocking to lessen the pain and distress of infants during injections to improve vaccination rates. Vaccination rates are still too low in many low-resource settings, which may be due in part to the discomfort they cause infants. This in turn makes caregivers reluctant to obtain all the recommended vaccinations for their children. Methods exist to reduce the associated pain of injections, but health workers lack the knowledge and skills to implement them. To test their approach, they will recruit vaccinators and community health workers at four rural immunization centers and use seminars and workshops to teach them pain-relieving techniques, including using specific positions and making soothing sounds. They will also develop audio-visual training tools and illustrative guides to help teach the techniques to parents for them to use at home as well. All healthy children under 12 months old visiting the centers for a vaccination will also receive one of the pain relief techniques. They will evaluate the ability of the health workers to manage pain, the level of distress of the infants, and the experience of the caregivers.

S. Typhi and Protozoa in Contaminated Water in Zimbabwe

Robert KingsleyQuadram Institute BioscienceNorwich, United Kingdom
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Robert Kingsley of the Quadram Institute Bioscience in the United Kingdom will locate the typhoid fever-causing bacteria S. Typhi in water reservoirs in Harare, Zimbabwe, and identify any associated protozoa species present in the water that may be supporting disease spread. Typhoid fever is endemic in Zimbabwe, with several major outbreaks reported in the last decade. The bacteria persist in unclean aquatic environments, possibly supported by protozoa, and are transmitted to humans through ingestion of contaminated drinking water. They will detect S. Typhi in sewage effluent and low-quality drinking water in hotspots of typhoid transmission by enrichment culture and PCR, and use whole genome sequencing to establish the phylogenetic relationship between these bacteria and clinical typhoid isolates in the same city. They will also amplify 18S rDNA from the sewage and drinking water samples to characterize the microbial community in water and define the protozoa population. These data will help identify potential synergistic interactions between S. Typhi and other microbes to inform prevention strategies.

Mobile Solutions for Mobile Populations: Closing the Gap

Ernest DarhokBroadReachCape Town, South Africa
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Ernest Darhok of Broadreach in South Africa will use mobile technology to improve access to child immunization services for populations living on the Kenya-Uganda border and help ensure all children are fully vaccinated. Refugee populations living in cross-border settings and migrant communities are particularly difficult to cover because of limited access, poor coordination across borders, and lack of efficient tracking. They have been using a human-centered approach to understand what these populations need to vaccinate their children, and have pilot tested the use of near-field communication cards with an immunization application that holds a child’s vaccination and health data for caregivers, which they can also use to plan more convenient appointments. This card can then be viewed and updated by health workers on both sides of the border using a mobile system. They will extend this pilot study to a wider population in Kenya and Uganda to evaluate the effect on vaccination rates against polio, and apply machine learning methods to better forecast vaccination needs at cross-border facilities to avoid stocks running out. They will obtain user feedback at all stages to help improve their approach.

Missed Opportunities for Vaccination Equity (MOVE)

Anita ShetJohns Hopkins University Bloomberg School of Public HealthBaltimore, Maryland, United States
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Anita Shet of Johns Hopkins School of Public Health in the U.S. will seek to increase childhood vaccination coverage in India and Nigeria by identifying opportunities for catch-up vaccinations when under-vaccinated children are hospitalized. Of the three million people who die each year from vaccine-preventable diseases, about half are children under the age of five, many of whom live in areas where vaccinations are available, but inequitably distributed. Inadequately vaccinated children frequently become sick and are hospitalized, yet most leave the hospital without receiving catch-up vaccines because of physical and policy barriers, or perceived contraindications. They will engage stakeholders, including hospital policy makers and community workers to launch MOVE (Missed Opportunities for Vaccine Equity) to identify and correct missed opportunities for vaccination by using child hospital visits to provide vaccine education and access. MOVE has three components: inpatient in-reach, where MOVE staff check immunization records and inform hospital personnel of missing vaccines; immunization service linkage to inpatient care, which ensures that vaccines are available and provides a vaccination schedule at discharge; and community outreach to provide follow-up reminders and education. They will modify an immunization application and reminder tool to record the data and maintain a cloud-based registry, and test their approach in two large community hospitals in India and Nigeria.

Community-Championed Social Norms Marketing

Amos KahwaDamax Solutions Company LtdDar es Salaam, Tanzania
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Amos Kahwa of Damax Solutions Company Ltd. in Tanzania will use human-centered design principles to develop a community-supported, social marketing approach that breaks down misconceptions and psychosocial barriers to immunization in developing countries and thereby increases demand. Research has identified several causes of the current low demand for vaccinations including misconceptions about safety, inadequate knowledge of schedules, and negative experiences at clinics. Current approaches designed to increase demand such as better education and incentives have had a limited effect. As an alternative, they propose to directly target the misperceptions and societal influences and empower the communities to help. They will first consult with community members and local government to gain further insight into the drivers of low demand that will be used to design a prototype package of interventions in collaboration with the local community. They will perform several rounds of testing and refining this package, and they will evaluate its ability to improve perceptions and social norms towards vaccinations and ultimately to improve demand.

Improving Child Immunization Coverage in Underserved, Urban, Extreme Poor Populations of Bangladesh

Tapash RoyIRD GlobalSingapore, Singapore
Grand Challenges Explorations
Immunization Demand
1 Nov 2019

Tapash Roy of IRD Global in Singapore will improve child immunization coverage among the homeless, or floating, populations in urban slums in Bangladesh by offering vaccines during evening sessions at existing shelters. The mortality rate for children under five in Bangladesh is high, and many deaths would be preventable with better vaccination coverage. The lack of an integrated public healthcare delivery system in urban areas has resulted in a large inequity between the rich and poor, and the vaccination rate among the floating population of approximately 25,000 is well below the national average. They will develop and test a plan to provide vaccination services in Pavement Dweller Centres (PDCs) during convenient hours. PDCs have been established on city property to provide temporary shelter, safe drinking water, and sanitation services to the homeless. They will use this infrastructure to provide free, tablet-based vaccinations during evenings, so visitors don't need to miss work to spend time traveling to a healthcare center. The program will be executed by personnel trained in communication to pre-empt any apprehensions by caregivers, and will involve educating visitors on the importance of vaccination. They will evaluate the feasibility and cost-effectiveness of the program in three PDCs in Dhaka and assess community response by a post-intervention survey.

Addressing Preeclampsia with Nanomedicine and Bioengineering

Marnie WinterUniversity of South AustraliaAdelaide,, South Australia, Australia
Grand Challenges Explorations
EmergingTechnologies
1 Nov 2019

Marnie Winter of the University of South Australia, together with Tina Bianco-Miotto, Claire Roberts, and Clare Whitehead of the University of Adelaide in Australia and the University of Toronto in Canada, will develop and test short-interfering RNAs (siRNA) high-density lipoprotein (HDL) nanocarriers for the treatment of preeclampsia. Globally, ten million women develop preeclampsia during pregnancy each year, which results in the deaths of 76,000 women and 500,000 babies; 99% of these are in developing countries. Most current treatments focus on treating the symptoms (high blood pressure and proteinuria) rather than the molecular causes. Some of the causative molecules, such as the angiogenesis inhibitor sFlt1, can be blocked by specific siRNAs, but the challenge is targeting the siRNAs to the right cells in the body. HDL delivery systems for this purpose are effective and safe, and both siRNAs and HDLs are stable at room temperature, important for therapies in resource-poor areas. They will optimize the formulation of their HDL nanocarrier manufacturing platform, and characterize siRNA loading, carrier stability, size, cellular uptake, and silencing ability in 2D culture. Further, they will bioengineer an ex-vivo placenta model that fully recapitulates the structural and phenotypic complexity of a preeclamptic placenta and use it to evaluate tissue penetration and silencing abilities of the siRNA-nanocarrier complex.

Determining the 'Environmental Typhoid Mary', and Conditions that Favour Perisistence

Andrew GreenhillFederation University AustraliaBallarat, Victoria, Australia
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Andrew Greenhill of Federation University Australia in Australia, along with partners at the Papua New Guinea Institute of Medical Research, will use advanced environmental microbiology methods to study microbial community dynamics associated with survival of the typhoid fever-causing bacterium Salmonella Typhi in aquatic environments in Papua New Guinea. "Typhoid Mary" Mallon was an Irish-American cook, written into infectious disease folklore as the first asymptomatic carrier of S. Typhi. More than eighty years after her death, little is still known about how the bacteria persists in environmental niches such as contaminated water, which is a major route of disease transmission. They will collect and filter water samples from streams in areas where the disease is common over an eight-month period covering both wet and dry seasons and analyze the microbial communities within by qPCR. This will be combined with physiochemical parameters of the water (temperature, stream height, photosynthetic activity) collected using DIMPP - a low-cost, late-stage prototype suitable for use in low-resource environments - to build network models. These models will be used to identify mathematical connections between environmental factors, aquatic populations, and the presence of antibiotic resistance genes. These connections could be used to develop an early warning system for impending outbreaks.

Sediment Biofilm Ecology in High-Typhoid-Incidence Rivers

Aaron JenkinsUniversity of SydneySydney, New South Wales, Australia
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Aaron Jenkins of the University of Sydney in Australia will combine genomics approaches with physical chemistry to identify the organisms and environmental factors in riverbeds that support the survival and spread of the bacterium, Salmonella enterica serovar Typhi, which causes typhoid. Aquatic environments are a major reservoir of typhoid, but how the bacteria survive in these conditions is unclear, making it difficult to prevent the disease spreading to humans. They hypothesize that S. Typhi survive in biofilms associated with sediments in riverbeds, and that the composition of this niche promotes its ability to infect humans. To test this, they will sample aquatic biofilms from areas of high, low, and zero typhoid incidence in Fiji, and identify the microbial communities supporting S. Typhi survival using antibody capture and metagenomics. They will also use fluorescence in situ hybridization to determine the spatial organization of S. Typhi in multispecies biofilms. In addition, they will analyze the composition of the sediments and soil of the riverbeds, and the nutrients being taken up by resident fish and crustaceans. By combining these results with their epidemiological data, they can identify the ecological niches that support high typhoid incidence, which will help develop and guide intervention strategies to block transmission to humans.

Intracellular Survival of S. Typhi in Environmental Acanthamoeba

Dilip AbrahamChristian Medical College, VelloreVellore, Tamil Nadu, India
Grand Challenges Explorations
Salmonella Typhi
1 Nov 2019

Dilip Abraham of Christian Medical College in India will analyze water samples from peri-urban and rural areas in India to study whether and how the typhoid fever-causing bacterium S. Typhi survives by living inside the common amoebae, Acanthamoeba. Acanthamoeba spp. are known to internalize S. Typhi, and may provide an intracellular environmental niche and extend survival of the bacteria. They will collect samples from drinking water sources and sewage lines in peri-urban and rural sites in Southern India. From these samples, they will recover Acanthamoeba and detect any internalized S. Typhi by culture and PCR. Whole genome sequencing will be used to conduct comparative genomic analysis of intracellular S. Typhi to identify any major virulence markers that promote its ability to be internalized by and remain viable within Acanthamoeba. This would help explain why persistence of S. Typhi in the environment can lead to sporadic outbreaks, and allow officials to plan preventative strategies beyond vaccines for the control and elimination of typhoid.

Toward a Permanent Influenza Vaccine: Design of Hemagglutinin Antigen Analogs and Vaccination Protocols by Structural Modeling, Atom-Based Simulations, Machine Learning, and Experiments

Martin KarplusHarvard UniversityCambridge, Massachusetts, United States
Grand Challenges
Influenza Vaccine
29 Aug 2019

Combining Epitope-Based Vaccine Design with Informatics-Based Evaluation to Obtain a Universal Influenza Vaccine

Rebeca SalmeronFoundation for the National Institutes of Health IncNorth Bethesda, Maryland, United States
Grand Challenges
Influenza Vaccine
28 Aug 2019

Turning Influenza into Measles via Mosaic Natural Selective Targeting of Immune Responses (MONSTIR)

Patrick WilsonUniversity of ChicagoChicago, Illinois, United States
Grand Challenges
Influenza Vaccine
28 Aug 2019

An Unconventionally MHC-Restricted T Cell Vaccine for Influenza

Jonah SachaOregon Health and Science UniversityPortland, Oregon, United States
Grand Challenges
Influenza Vaccine
20 Aug 2019

New Safer Contraceptives That Block Ovulation

Darryl RussellUniversity of AdelaideAdelaide, South Australia, Australia
Grand Challenges Explorations
Contraceptive Discovery
18 Aug 2019

Darryl Russell of the University of Adelaide in Australia is seeking safer contraceptives that block ovulation without altering hormone levels and cause fewer side effects using an automated in-vitro screening platform that measures cell adhesion in the cumulus-oocyte complex, which is required to release the oocyte from the ovary. In Phase I, they built the screening platform by isolating cumulus-oocyte complexes from mice, culturing them in fibronectin-coated multi-well plates, and quantifying adhesion in a 96-well plate format using an automated assay. In a first run, they screened a library of 129 FDA-approved chemical compounds over four months and identified seven candidate contraceptives with known protein targets, one of which showed a strong reduction in ovulation when tested in mice. In Phase II, they will study whether one of the main target proteins identified in their first screen is a key target for blocking ovulation. They will also test whether the other candidates from their first screen can block ovulation in mice and screen larger and more diverse libraries to identify new candidate contraceptives and prioritize them for further drug development and testing.

Digital Immune Optimized and Selected Universal Influenza Vaccine Antigens (DIOS-UIVA)

Jonathan HeeneyUniversity of CambridgeCambridge, United Kingdom
Grand Challenges
Influenza Vaccine
13 Aug 2019

Predictive Supply Chain for Vaccines

Benjamin FelsMacro-Eyes, Inc.Fall City, Washington, United States
Grand Challenges Explorations
Health Supply Chains
11 Aug 2019

Drew Arenth, Benjamin Fels, and Suvrit Sra of Macro-Eyes in the U.S. are applying a statistical machine learning approach to the immunization supply chains of health facilities in Tanzania that accurately and continuously predicts demand to ensure the right vaccines and levels are being stocked. Currently, vaccine supply is largely fixed or driven by depleted stocks. This leaves children unable to be vaccinated due to stock outs at clinics, as well as often high levels of waste, which could both be overcome by better forecasting vaccination needs for individual clinics. In Phase I, they worked with an NGO and the Ministry of Health to access routinely-collected daily vaccination data from 710 health facilities spread across Tanzania. These data were then used to train algorithms to identify predictive patterns that were tested on independent datasets. This led to a model that could accurately forecast future vaccine consumption. In Phase II, they will work out how best to integrate their approach as an automated component within the existing supply chain infrastructure in Tanzania and develop tools and train advocates to demonstrate its value and encourage implementation and adoption.

Rational Design of a Universal Flu Vaccine Using Recombinant Neuraminidase

Alice McHardyThe Helmholtz Centre for Infection ResearchBraunschweig, Germany
Grand Challenges
Influenza Vaccine
23 Jul 2019

DEtection Technology for Evaluating Crop Threats (DETECT)

Peter WagstaffSelf Help AfricaDublin, Ireland
Grand Challenges Explorations
Crop Disease Surveillance
1 Jul 2019

Peter Wagstaff of Self Help Africa in Ireland will build an advanced machine learning algorithm that automatically analyzes high-resolution satellite images for near real-time, low-cost detection of crop pests and diseases across wide, varied landscapes. Current detection methods are either resource- or cost-intensive and limited in their ability to provide up-to-date information across large and complex geographic areas. Crop pests and diseases can alter leaf color and expose soil, which can be detected by very high-resolution satellite imaging. They will combine satellite images provided by their partner with field data on the fall armyworm crop pest collected by their project team over 18 months on smallholder plots in the Balaka district in Malawi. These data will be used to train an algorithm to detect pests and diseases. They will use cloud-based workflows to enable computationally intensive processing of large quantities of high-resolution images in near real-time. The accuracy of the algorithm will be evaluated by an independent field survey. Note: This grant is funded by the Foundation for Food and Agriculture Research (FFAR).

Low-Cost Real-Time Sensor Network for Large-Area Pest and Disease Surveillance of Crop Plants

Hanseup KimUniversity of UtahSalt Lake City, Utah, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 Jun 2019

Hanseup Kim of the University of Utah in the U.S. will develop small, ultra-low power, chemical sensors that can be distributed around farms to help detect crop diseases in low-resource settings. Plants under attack from pests and diseases release low levels of volatile organic compounds that could be used as an early warning system to reduce crop losses, which can be substantial. They will design chemical sensors that trigger a change in electrical conductivity when they bind a target compound to minimize energy consumption so that they can be operated over the eight-month farming season in low-resource settings. The sensors will first be developed to bind trace levels of hexenol, hexenal, or indole, which are released from damaged maize and sorghum. They will optimize sensitivity by testing different sensor materials and correlate compound detection with different types and stages of crop damage. They will also evaluate wireless monitoring of multiple sensors distributed around a small plot of crops ready for scaling up to future in-field testing on these and other crops. Note: This grant is funded by the Foundation for Food and Agriculture Research (FFAR).

Real-Time Genomic Epidemiology and Improved Data Sharing to Control Middle East Respiratory Syndrome (MERS-CoV)

David AanensenUniversity of OxfordOxford, United Kingdom
Grand Challenges
Annual Meeting Call-to-Action
23 May 2019

David Aanensen from the University of Oxford and the Wellcome Sanger Institute in the United Kingdom and Maria van Kerkhove of the World Health Organization in Switzerland will combine next generation DNA sequencing technology with a simple, web-based data collection, processing, and distribution platform to better track the global spread of deadly infectious diseases including Middle East Respiratory Syndrome (MERS-CoV). MERS - also known as camel flu - is a viral disease that causes fever, cough, diarrhea, and shortness of breath, and is transmitted from camels to humans. One third of people diagnosed with the disease die. Next generation sequencing (NGS) technology allows rapid, inexpensive detection of pathogens as they spread. However, laboratories in different member states use different formats for sequencing data, and there is no mechanism for sharing it in real time. This limits the value of the technology for stopping outbreaks. To address this, they will establish routine sequencing protocols for both human and camel samples, and develop an interactive web platform on which the sequencing and epidemiological data can be shared. This will help develop more effective, real-time medical and non-medical interventions at local, national, and international levels. Once established, the protocols developed here may be applied to outbreaks of other diseases.

A Systems Level Approach to Crop Health

David HughesPennsylvania State UniversityUniversity Park, Pennsylvania, United States
Grand Challenges
Annual Meeting Call-to-Action
23 May 2019

David Hughes of Pennsylvania State University, John Corbett of aWhere, and Rhiannan Price of DigitalGlobe, in the U.S. will develop a software platform comprising prediction algorithms that leverage artificial intelligence to predict where and when plant diseases and pests will occur from weather and satellite data to alert farmers to check their crops. Pests and diseases are moving targets, however most current surveillance methods monitor only their presence or absence. Predicting when and where they are likely to occur would be more valuable for preventing them. This has recently been made possible by studies on how environmental factors influence the emergence and behaviour of crop pests and diseases. They will use a systems approach that incorporates these new predictors along with historical data and couples them with an artificial intelligence component that learns from ground observations recorded using smartphones to improve accuracy. They will combine their existing agricultural intelligence platform and smartphone application with their prototype predictive model and test their approach with maize and cassava crops on farms across seven different counties in Kenya. The platform will produce location-specific forecasts that can be acted upon immediately by farmers.

Medicinal Chemistry Progression of Hits Identified from the MMV Pathogen Box for Malaria and Tuberculosis

Richard AmewuUniversity of GhanaAccra, Ghana
Grand Challenges Africa
Drug Discovery
20 May 2019

The emergence of drug resistance has rendered most clinically used drugs ineffective. There is, therefore, the need to discover new, safe, effective and novel chemo types with new modes of action. This project seeks to continue medicinal chemistry efforts on a chemical class identified from the MMV Pathogen box to develop an early lead with in vivo antitubercular/antimalarial activity as a proof-of-concept

Targeting Protein Kinases for the Development of Novel Drugs for Trematode Infections

Edwin MurungiKisii UniversityKisii, Kenya
Grand Challenges Africa
Drug Discovery
20 May 2019

There is a compelling need for the development of new drugs for trematode infections since current drugs are often ineffective and/or have widespread resistance. Drug repurposing which is advantageous in fast-tracking compounds into clinical studies is a promising drug discovery approach. Edwin’s research involves the application of computational biology in the drug repurposing of kinase inhibitors as new therapies for trematode infections

Discovery of New Drug Candidates Against Malaria, Leishmaniasis and Trypanosomiasis Through Screening of Chemical Libraries

Fabrice BoyomUniversity of YaoundéYaoundé, Cameroon
Grand Challenges Africa
Drug Discovery
20 May 2019

This project builds on intra-African and international (pharmaceutical companies, academic institutions) collaborations to identify medicinal chemistry starting points from the screening of target-based chemical libraries against the causative agents of malaria, leishmaniasis and Human African Trypanosomiasis (HAT), also known as sleeping sickness.

Anti-Adhesins With Therapeutic Potential for Enteroaggregative Escherichia Coli Diarrhoea

Iruka OkekeUniversity of IbadanIbadan, Nigeria
Grand Challenges Africa
Drug Discovery
20 May 2019

The project aims to discover molecular scaffolds that could be forerunners of EAEC therapeutics. Following a small molecule library screen, the team is evaluating hits, determining their mechanisms of action and their potential to be progressed as drug candidates. The group will also apply their anti-biofilm screen to other small libraries with a view to increasing the repertoire of promising leads against EAEC and other neglected enteric pathogens.

SNPs, Allosteric Modulations, Dynamic Residue Networks: Combined Approaches Towards Modern Computational Drug Discovery

Ozlem BishopRhodes UniversityGrahamstown, South Africa
Grand Challenges Africa
Drug Discovery
20 May 2019

This research proposes to apply new protocols that have been developed at RUBi combined with traditional computational drug discovery approaches to further improve our understanding of rational drug discovery in the context of tuberculosis and malaria. Additionally, where applicable, it aims to identify novel hits from African natural products against these diseases as screening of them may lead to the development of novel pharmaceutics in Africa

Identification of Plasmodium Falciparum Transmission Blocking Compounds

Dinkorma OuologuemUniversity of Sciences, Techniques and Technologies of BamakoBamako, Mali
Grand Challenges Africa
Drug Discovery
20 May 2019

The project aims to develop an assay/test to measure the activity of antimalarial drugs on the transmission of the malaria parasite. This innovative work is anticipated to be a useful addition to the current tools for drug discovery and to support the malaria eradication agenda

Novel Arf GTPase Assays for Antimalarial Drug Discovery

Heinrich HoppeRhodes UniversityGrahamstown, South Africa
Grand Challenges Africa
Drug Discovery
20 May 2019

The propensity of malaria parasites to develop resistance motivates the ongoing discovery and development of antimalarials with new modes of action. Heinrich Hoppe’s research focuses on employing novel bioassays to find inhibitors of Arf1, a GTPase that regulates protein secretion, in order to validate it as an antimalarial drug target

The DnaJ-DnaK-GrpE Complex as a Selective Drug Target in Mycobacterium Tuberculosis

Adrienne EdkinsRhodes UniversityGrahamstown, South Africa
Grand Challenges Africa
Drug Discovery
20 May 2019

The aim of the research is to identify selective modulators of the TB bacteria, Mycobacterium tuberculosis (Mtb), to support development of newer, more effective therapies.

Deep Learning (AI) for Histology of Onchocerciasis

Achim HoeraufUniversity Hospital BonnBonn, Germany
Grand Challenges
Annual Meeting Call-to-Action
3 May 2019

Achim Hoerauf of IMMP in Germany will apply artificial intelligence (AI) to speed the development of treatments for onchocerciasis, which is an infectious disease commonly known as River Blindness caused by a parasitic worm. The parasites are spread by affected blackflies, and the worm larvae accumulate in the skin and eyes, causing irritation and sometimes blindness. Nearly 21 million cases occur each year, and 99% of affected people live in Africa. The drug currently used for treatment kills only worm larvae, and studies are ongoing to identify more effective drugs that target adult worms. However, evaluating these drug candidates requires manual analysis using microscopy of samples of irritated skin from patients after treatment. This process is time consuming and slows drug development. To address this, they will use samples that have already been manually annotated to train an AI system to automatically analyze future samples to recognize worm body parts, gender, vitality, and stage of development. Once established, the AI system will be tested with samples from a new clinical trial - tissues from patients treated with the new drug will be analyzed in parallel by human and computer. Once optimized, the AI system will take over the analysis, and the much slower human analysis will only be needed as a quality control system.

PET/CT Signatures to Optimize Tuberculosis Host-Directed Therapy (HDT) Development

Yingda XieRutgers, The State University of NJNewark, New Jersey, United States
Grand Challenges
Annual Meeting Call-to-Action
3 May 2019

Yingda Xie of Rutgers, The State University of NJ and JoAnne Flynn of the University of Pittsburgh, both in the U.S., will develop a non-invasive approach for testing candidate anti-tuberculosis compounds in animal models and patients using positron emission tomography-x-ray computed tomography (PET/CT). Tuberculosis (TB) is a leading cause of death in developing countries, and rates are sustained by the causative bacterium, Mycobacterium tuberculosis, developing resistance to current drugs. To circumvent this, new drugs are being designed to target human cells and proteins rather than those of the bacteria. To test these drugs, new tools are also needed to monitor TB in patients. 18 Fluorodeoxyglucose (FDG)-PET/CT is a non-invasive imaging tool that uses radioactively-labelled glucose to light up areas of metabolic activity in the body such as the lesions formed by M. tuberculosis and immune cells that play a critical role in infection. They have histopathological sections and cell and chemical data of TB lesions from non-human primate models and will use them to quantify the different lesions. Then, by using the available PET-CT scans of the lesions, they will search for quantitative signatures that can predict a specific type of lesion. The accuracy of these PET/CT signatures will be tested in a separate group of animals. Their study will reveal details of the TB immune response across different lesions, which could help design new treatments, and the signatures can be used to test the activity of new drug candidates in animal models and humans.

Metagenomics and the Etiology of Zoonotic Disease: Deciphering Bat-to-Human Viral Transmission in Madagascar

Cara BrookThe Pasteur Institute of MadagascarAntananarivo, Madagascar
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Cara Brook, Jean-Michel Héraud, and Soa Fy Andriamandimby of the Pasteur Institute in Madagascar, and Jessica Metcalf of Princeton University in the U.S. will establish metagenomic next generation sequencing (NGS) in Madagascar to analyze samples from undiagnosed fever patients and from bats to identify bat-derived viruses that cause human infectious diseases and help develop new diagnostics. It is estimated that up to 75% of emerging human diseases are derived from an animal reservoir. The majority of these zoonoses emerge in low-resource settings in equatorial regions likely due to living conditions and limited access to healthcare. Madagascar has long been geographically isolated, and Madagascan fruit bats are considered potential major sources of several different zoonotic diseases such as Ebola. However, identifying disease-causing viruses using traditional diagnostic methods requires the development of targeted assays and is laborious and inefficient. In contrast, metagenomic NGS is a powerful diagnostic tool that can simultaneously assay many viruses and identify new ones. Their institution serves as a national reference laboratory for several diseases in Madagascar, and to help develop local next generation sequencing and data analysis capacity, they will pilot the approach with a subset of 380 human clinical samples already collected. They will then process an additional 410 human samples for NGS library preparation, sequencing, and pathogen analysis in Madagascar.

An Enzyme-Embedded Hydrogel Bioreactor System

Paul de FigueiredoTexas A&M University Health Science CenterCollege Station, Texas, United States
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Paul de Figueiredo and Daniel Alge of Texas A&M University in the U.S. will develop a portable, disposable bioreactor for the low-cost production of gut microbial biotherapeutics at an estimated $0.09 per dose in low-resource settings. Dysfunction of the human gut microbiome is a common consequence of malnutrition in poor countries. It may be effectively treated with live biotherapeutics, yet current production methods are complicated and expensive. Glucose oxidase consumes oxygen as a co-substrate in glucose oxidation and has been shown to create hypoxic microenvironments in vitro, similar to that in the human gastrointestinal tract. They will engineer an inexpensive bioreactor by immobilizing glucose oxidase in a hydrogel placed in dialysis tubing and incubated in liquid media; the glucose oxidation reaction will deplete the bioreactor of oxygen and create an oxygen gradient to mimic the intestinal lumen. This will enable growth of a consortium of anaerobic bacteria, after which the microparticles will be removed by filtration. They will optimize the system using an artificial consortium of at least ten strains of common gut bacteria.

Novel Radial Gradient in Fibrous-Bed Bioreactors with Cellulose Hydrogel

Carol Sze Ki LinCity University of Hong KongHong Kong, Hong Kong S.A.R., China
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Carol Sze Ki Lin of the City University of Hong Kong and Srinivas Mettu of the University of Melbourne in Australia will develop a new, low-cost bioreactor system to mimic the human gut and facilitate simultaneous growth of multiple bacterial strains with diverse growth requirements. A healthy mixture of bacteria in the human gut is essential to overall health, and live biotherapeutics could be used to restore this population in infants whose gut microbiota has been damaged by malnutrition. Manufacture of these therapeutics is difficult and expensive: the human gut contains multiple strains of bacteria with diverse environmental and nutritional growth requirements, and designing a bioreactor to accommodate such variation is difficult. They will create stratified growth zones within one reactor based on immobilization of the bacteria on a low-cost, biodegradable plant-based cellulose hydrogel. They will alter the porosity and surface chemistry of the hydrogel to create variations in pH and oxygen and nutrient levels within the reactor to simulate the human gut from stomach to rectum. This will facilitate the simultaneous growth of ten bacterial strains with diverse growth requirements, first in a lab setting and later on a commercial scale.

Identification and Characterization of Vector-Borne Pathogens and Vector Exposures to Define Regional Biomonitoring Strategies and Vector Control Efforts in Cambodia

Jessica ManningNational Institute of Allergy and Infectious DiseasesBethesda, Maryland, United States
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Jessica Manning and Fabiano Oliveira of the National Institute of Allergy and Infectious Diseases along with Daniel Parker of the University of California Irvine, all in the U.S., will develop a combinatorial approach to better define the incidence of vector-borne diseases in Cambodia in order to limit their transmission. The global incidence of vector-borne diseases such as malaria and dengue are increasing globally. However, accurately defining the disease-burden is challenging, particularly in resource-poor settings where diagnostics and expertise are limited. They will perform an exploratory clinical study in a peri-urban referral hospital with a catchment area of over 60,000 people in Kampong Speu Province, Cambodia, using a combination of approaches to define the high-resolution landscape of vector-borne diseases in the heart of the Greater Mekong Subregion. The study will involve next generation sequencing to identify pathogens in prospectively collected samples from infants with fever in their existing pediatric cohort as well as in new samples to be collected from febrile individuals aged between 0 and 45 arriving at the hospital; ELISA to generate antibody reactivity profiles of vector saliva, which plays a critical but often overlooked role in disease transmission; and geolocating cases using open-source (Quantum GIS) software. These data will be used to model transmission risk and identify target areas for interventions.

The Study of Encephalitis in Children Using Next Generation Sequencing

Nguyen Thanh HungChildren's Hospital 1Ho Chi Minh City, Vietnam
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Nguyen Thanh Hung and colleagues in Children’s Hospital 1 in Vietnam will implement next generation sequencing to identify the diverse viral causes of encephalitis in children in Vietnam and develop more accurate and rapid diagnostics to improve clinical outcomes. Encephalitis is an inflammation of the brain commonly caused by viral infection and is a major contributor to childhood morbidity and mortality worldwide. Treatment requires rapid diagnosis so that the appropriate antimicrobial therapy can be administered. However, traditional diagnostics are inadequate, and identify less than half of cases. Further confounding accurate diagnosis is the emergence of new and diverse pathogens that cause encephalitis. Next generation sequencing could overcome these challenges by more rapidly sequencing viral nucleic acids than previous methods and at lower costs. They will test this at their 1,600-bed hospital located in Ho Chi Minh City in Vietnam with samples from around 150 children presenting with encephalitis and compare the results with routine diagnostics. Overall, they aim to identify the major causes of encephalitis across Vietnam, map them temporally and spatially, and characterize disease outcomes.

Using Radio and Image Data for Surveillance

Joyce Nakatumba-NabendeMakerere UniversityKampala, Uganda
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

Joyce Nakatumba-Nabende of Makerere University in Uganda will use artificial intelligence to mine data from local village radio stations to generate timely data on crop pests and disease in sub-Saharan Africa. Crop loss due to pests and disease threatens the economic survival of smallholder farmers, and access to surveillance data is critically important yet often unaffordable. Local radio shows are a powerful source of information flow in rural African villages: they cover topics including politics, policy, climate, and social circumstances, in addition to crop concerns. Collectively, this information provides a holistic representation of current events in these communities. They will analyze local broadcasts to generate crop surveillance data that is linked to the local community situation. Radio content will be collected at low cost through a collaboration with Pulse Labs Kampala, and they will build artificial intelligence models based on deep neural networks and keyword identification to mine the data. The results will be combined with photographs of diseased crops provided by local farmers and used to train machine learning models to ultimately extract radio information in multiple languages and with diverse accents. This project will provide near real-time crop surveillance data and allow for timely responses to threats.

Broad-Scale Agricultural Pest Monitoring in Africa Using Dual-Polarization Weather Radar

William KuninUniversity of LeedsLeeds, United Kingdom
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

William Kunin of the University of Leeds in the United Kingdom will develop methods to monitor agricultural pest outbreaks in Africa using data from dual-polarization weather radar. Pest infestation is responsible for up to 50% of pre-harvest crop loss in Central Africa, and control depends on the ability to monitor local pest outbreaks and movement over large areas – a difficult and expensive task. Sophisticated dual polarization Doppler weather radar is designed to detect airborne objects like rain and hail. However, because it is sensitive to size and shape, it can also be used to detect specific types of insects, including crop pests, and algorithms exist to separate the different signals. They will use micro-CT scans to create three-dimensional models of pests common to Rwandan crops and conduct simulations to predict radar data patterns for swarms of particular pests at varying densities. Through collaboration with the Rwandan meteorological service, they will analyze radar data to identify pest outbreaks and their movements across the country. Once established, the methods will be applied across Africa to provide a low-cost, advanced warning system for crop protection.

Optimizing Bacterial Co-Cultures Using Metabolomics Data

Gregory MedlockUniversity of VirginiaCharlottesville, Virginia, United States
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Gregory Medlock of the University of Virginia in the U.S. will develop a method to predict the optimal combinations of different strains of human gut microbes with health-promoting (probiotic) properties to maximize their yield by fermentation and minimize production costs. Microbes tend to grow better when they are in a mixed population (co-culture) because they can share resources and are more resistant to pathogens. Co-culturing can also lower production costs. However, identifying the right mix is challenging as it depends on the properties of each strain and how they interact with other strains. To simplify this, they will build an algorithm that can be applied to any strain of interest. Metabolic and growth profiles will be collected from 10 probiotic strains grown under different conditions to determine their nutrient preferences. These profiles will be used to model the metabolic space occupied by each strain for identifying the combinations that maximize the potential for cross-feeding and minimize resource competition when grown under specified culture conditions. They will test their predictions by comparing biomass produced using the predicted combinations with random combinations and with strains grown on their own.

PERSO-MAP: Persona Map for Community Worker Decision Support

Nico VandaeleKatholieke Universiteit LeuvenLeuven, Belgium
Grand Challenges Explorations
Immunization Demand
1 May 2019

Nico Vandaele and Catherine Decouttere from the Katholieke Universiteit Leuven in Belgium along with workers at the St. Francis of Assissi Community Dispensary in Kenya will develop a decision support tool for community workers who vaccinate children that incorporates the diverse characteristics and needs of the local parents and caregivers to help them improve vaccination uptake. The diverse characteristics of caregivers in a specific catchment area, such as their profession and household situation, affect the challenges they face when seeking health care and the solutions needed to overcome them. They plan to develop a tool for community workers to map these characteristics so that they can exploit them to provide a better health service, such as by tailoring appointment times, arranging transport, and sending reminders. This will enable them to work more efficiently. They will build a paper-based prototype in collaboration with community workers and pilot test the tool and validate maps of selected communities.

Exploring the Potential Use of Next Generation Sequencing for Molecular Characterization of Infectious Causes of Stillbirths and Neonatal Death

Shabir MadhiWits Health ConsortiumJohannesburg, South Africa
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Shabir Madhi, Vicky Lynne Baillie, and Courtney Paige Olwagen of Wits Health Consortium in South Africa will use next generation sequencing to identify pathogenic causes of neonatal deaths and stillbirths to help develop new treatments such as vaccines and better prevent disease spread. There are around 2.5 million neonatal deaths annually, and an estimated 2.6 million stillbirths, the vast majority of which occur in low- to middle-income countries. Conventional assays have recently indicated that infectious diseases cause far more of these neonatal deaths and stillbirths than previously thought. They also revealed a worryingly high proportion caused by multi-drug resistant, hospital-acquired infections. They will apply a next generation sequencing approach to 80 archived blood samples from stillbirths obtained in an earlier study and analyze the results using the Global IDseq software platform to identify any novel or unculturable or untargeted pathogens that were not identified using the more traditional microbiological methods. They will also use in silico approaches to analyze virulence factors and antimicrobial resistance profiles of identified pathogens.

Metagenomics for Discovery of Novel Pathogens in Infectious Childhood Illnesses

Muhammad Imran NisarAga Khan University - PakistanKarachi, Pakistan
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Muhammad Imran Nisar, Furqan Kabir, Fyezah Jehan, and Syed Asad Ali of Aga Khan University in Pakistan will employ a metagenomic sequencing approach to better identify bacterial and viral infections, including those caused by novel pathogens, in newborns and infants in Pakistan. Pakistan has the highest neonatal mortality rate in the world. Almost one third of neonatal deaths are thought to be caused by an infectious disease, but accurate diagnosis is challenging in low-resource settings. In a recent study, despite using elaborate detection methods, only 28% of suspected infectious cases could be confirmed. In addition, novel pathogens escape detection because conventional microbiological methods are limited to detecting a predetermined selection. To overcome these limitations, they will establish a metagenomics approach for next generation sequencing with the cloud computing IDseq software to identify the infectious pathogens. They will sequence and analyze 150 archived blood and nasopharyngeal specimens from a previous study and additionally analyze blood and swab samples to be collected from sick newborns and infants with suspected infections over a six-month period at a primary healthcare center in a peri-urban community in Karachi, Pakistan.

Micro-Beads Building Trophic Networks for Gut Microbial Biotherapeutic Production

Christophe LacroixETH ZürichZürich, Switzerland
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Christophe Lacroix of ETH Zürich in Switzerland will develop a new method to grow mixed strains of bacteria in bioreactors more efficiently and at lower cost for producing microbial-based biotherapeutics by immobilizing the bacteria on porous polysaccharide gel beads. Damage to the naturally-occurring bacterial populations in the human gut often occurs as a result of malnutrition and can cause serious illness. Healthy populations may be restored by gut microbial biotherapeutics - the ingestion of mixtures of naturally-occurring gut bacteria. Traditional processes to manufacture these mixtures is complex and expensive because many strains have strict growth requirements and do not grow well in mixed culture. They will immobilize bacteria on microbeads to allow multiple strains of bacteria to grow in the same culture: antagonistic strains will be spatially separated, less competitive strains will be maintained, and diversity will be preserved. Using inoculums from healthy human adults, they will optimize individual components of the system including the composition of the bacterial mixture, method of immobilization, and fermentation conditions within a continuous-culture stirred-tank reactor. The result will be the controlled, reproducible and efficient production of gut microbial biotherapeutics.

Brewery-Based Bacterial Consortia Fermentation for Manufacturing Microbial Therapeutics

Ricardo ValladaresSiolta TherapeuticsSan Francisco, California, United States
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Ricardo Valladares of Siolta Therapeutics in the U.S. will develop a low-cost method to manufacture large quantities of mixed populations of bacteria for use as biotherapeutics to restore a healthy population of gut microbes in infants. A diverse population of bacteria in the infant gut is essential for health, but malnourishment and antibiotics can destroy microbial diversity and cause metabolic and immune problems. Gut health may be restored by treatment with a consortium of bacterial strains. However, mass production of these strains is challenging as many have complex nutritional and environmental growth requirements. To date consortium microbes have been cultured individually, resulting in a costly, small-scale process. They will first study bacterial populations in healthy infant guts to determine what species are required and the combinations that co-exist naturally. To support their growth in vitro, they will optimize a vegetable-based culture media composed of low-cost, widely available food staples, and then apply bioreactor technology used by commercial breweries to manufacture large quantities of the microbial mixture at low cost. Together, these approaches could help make microbiota-based biotherapeutics accessible in low- and middle-income countries.

A Low-Cost, Highly Scalable Continuous Culture System for Rapid Optimization and Precise Tuning of Gut Microbial Formulations

Ahmad KhalilBoston UniversityBoston, Massachusetts, United States
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Ahmad Khalil of Boston University in the U.S. will develop a low-cost bioreactor platform to simultaneously optimize growth conditions of multiple bacterial species for large scale production of biotherapeutics. The human gut microbiome plays an essential role in health and development and living microbial biotherapeutics could be an effective treatment in the case of damage by illness or malnutrition. Commercial production is limited by the capacity of bioreactors, which are costly and challenging to scale and relatively inflexible. Using their eVOLVER continuous culture system, which is modular, inexpensive, and highly scalable, they will adapt the set-up and optimize protocols to allow for the management of unique growth conditions for individual species in parallel, and dynamic mixing of cultures from individual pools to precisely tune multi-species formulations. They will conduct full-scale tests to evaluate their approach for optimizing production of human gut microbiota.

Resolving the Agricultural Policy Impasse in Tanzania

Benedict MongulaUniversity of Dar es SalaamDar es Salaam, Tanzania
Grand Challenges Explorations
Agricultural Policies
1 May 2019

Benedict Mongula of the University of Dar es Salaam in Tanzania will analyze two apparently conflicting national agricultural policies centered on either large-scale agriculture or smallholder farmers and determine how to combine them to benefit all stakeholders for inclusive agricultural transformation. Agriculture is central to the Tanzanian economy, yet its impact is limited by a lack of infrastructure, education, and market access. Current agricultural policy is shaped by two conflicting approaches: large-scale agriculture under the Southern Agricultural Growth Corridor (SAGCOT), driven by wealthy foreign investors; and smallholder farming under the government-led Agricultural Sector Development Programme (ASDP). SAGCOT has been criticized for removing land from rural farmers and increasing poverty, while ASDP has many projects in place but has not demonstrated significant impact on the industry. They will investigate how to link the two approaches for inclusive agricultural transformation – improvements to the industry that protect all stakeholders, regardless of social class, culture, gender or age. Through consultation with participants, including government officials, investors and ordinary citizens, they will analyze the two approaches, identify which of the large-scale agricultural investments are most consistent with inclusive transformation, and determine to what extent both SAGCOT and ASDP address the needs of the diverse population. The new policy framework will be presented in the form of a journal article, stakeholder meetings, and workshops.

Application of Metagenomic NextGen Sequencing Technology to Identify Etiology of Fatal Acute Encephalitis Syndrome (AES) in Nepal

Rajeev ShresthaDhulikhel Hospital Kathmandu University HospitalDhulikhel, Nepal
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Rajeev Shrestha and colleagues at Dhulikhel Hospital, Kathmandu University in Nepal will apply metagenomic, next generation sequencing technology to identify causative pathogens of fatal acute encephalitis to improve diagnosis and treatment. Acute encephalitis syndrome (AES) annually affects over 100,000 individuals in low- and middle-income countries, causing substantial morbidity and mortality. It is a diverse disease caused by over 100 different pathogens, including viruses and parasites, making accurate diagnosis difficult, even in high-resource settings. This hinders prevention and treatment efforts, even though several effective vaccines exist. To better characterize the pathogens causing AES, particularly treatable and emerging ones, they will apply metagenomic, next generation sequencing technology to 60 banked cerebral spinal fluid samples collected from fatal acute encephalitis cases in Nepal as part of a nationwide AES surveillance program that covered 189 hospitals. They will validate and refine their technique using previously validated samples.

Surveillance as a Side Effect of Service

Melanie Bannister-TyrrellAusvetBruce, Australian Capital Territory, Australia
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

Melanie Bannister-Tyrrell of Ausvet in Australia will create an SMS-based communication system for farmers in Kenya to anonymously report crop disease and pest infestations and generate surveillance data to minimize crop loss. Pest infestation and disease cause substantial crop losses each year. In many low-income countries, farmers do not report disease to local agricultural authorities because they fear their crops will be destroyed without compensation. Yet information on the presence and spread of pests is needed to inform decisions on planting and control measures. They will optimize the design of an SMS interface for anonymous reporting using SMS codes for diseases and pests. The system will be piloted in one county, leveraging existing users and community volunteers to recruit new users. Reports will be used to estimate the local prevalence of pests and disease using modified small-area statistics. If a credible threat is detected, all users will be alerted. The system will improve connection and trust between farmers and agricultural extension workers and improve surveillance.

Beyond Data Collection: Actionable Insights to Vaccinator Supervisors

Mustafa NaseemUniversity of MichiganAnn Arbor, Michigan, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2019

Mustafa Naseem of the University of Michigan in the U.S. will create an android application to present digital immunization and performance data from front-line health workers to their medical supervisors to improve vaccination coverage in Pakistan. Polio is a vaccine-preventable disease, eradicated in much of the world yet endemic in Pakistan due to poor compliance with immunization schedules. Vaccine administration in rural provinces is challenging because of understaffed, understocked, and sparsely-located healthcare centers. To improve this, the government introduced eVaccs – a smartphone-based monitoring system to track the movements and vaccinations administered by each vaccinator. However, these data remain largely inaccessible to their direct supervisors. To address this, they will develop an application to present them with relevant data in a useful format in real time. This will enable supervisors to better monitor performance, identify key challenges to comprehensive vaccination coverage, and help them better manage vaccine supplies. They will perform behavioral experiments in the field to test whether their approach positively influences vaccination coverage.

Application of Agent-Based Modeling for Policy Prioritization in Sub-Saharan Africa

Kindie Tesfaye FantayeInternational Maize and Wheat Improvement Center (CIMMYT)El Batan Texcoco Edo de Mexico, Mexico
Grand Challenges Explorations
Agricultural Policies
1 May 2019

Kindie Tesfaye-Fantaye of the International Maize and Wheat Improvement Center in Mexico will develop a computational model that incorporates the variable characteristics of households and farms to better predict the outcomes of agricultural interventions in Ethiopia in order to inform policy choices. Agriculture is central to the Ethiopian economy; it accounts for almost 50% of the gross domestic product and 80% of total employment, yet the industry struggles with limited infrastructure and environmental challenges. Prioritization of agricultural policies has generally relied on analysis of past observations, which are static and tend to ignore variability. They will build and validate an agent-based model that uses current data to model future outcomes, and input biophysical (e.g., soil, climate) and socioeconomic (e.g., household characteristics, land use, access to market and financing) data. They will test their model by comparing five candidate policy options under consideration by the government in terms of impact, effectiveness, efficiency, and inclusiveness. Once established, the model will be scaled up for policy intervention in other Sub-Saharan countries including Tanzania and Nigeria.

Use of Novel Oligosaccharides For Simultaneous Growth of Keystone Bacteria

David MillsUniversity of California, DavisDavis, California, United States
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

David Mills of the University of California, Davis in the U.S. will determine whether specific plant-based oligosaccharide formulations can drive mixed-culture growth of selected strains of intestinal bacteria for the low-cost and efficient production of live biotherapeutics. Microbial colonization in the human gut is important for overall health. It has been shown that oligosaccharides can provide a food niche to specifically enrich key colonizing bacteria, even in the competitive environment of the human gut. They will exploit this to grow multiple strains simultaneously in a controllable, scalable manner. They have recently developed analytical tools to characterize over 1,000 plant polysaccharides. These will be screened using bioinformatics methods and then in vitro to identify optimal oligosaccharide-therapeutic bacteria combinations that can support mixed-culture growth. They will then progress to bioreactor screening of the top candidate combinations. Once established, the live biotherapeutics will be formulated with their paired oligosaccharides for synbiotic application that may enable them to more readily colonize the human gut.

Massively Deployed GHz Ultrasonic Imagers for Pest Detection

Amit LalGeegah LlcIthaca, New York, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

Amit Lal of Geegah LLC in the U.S. will develop battery-powered ultrasonic imagers to collect and wirelessly transmit high-resolution images of soil and airborne pests for the early detection of crop threats across large farming areas in rural Africa. Crop losses due to pest infestation negatively impact both food security and local economies. Damage caused by nematodes is particularly difficult to detect because the symptoms visible above ground are not unique and are often incorrectly attributed to deficiencies in soil nutrients or moisture. Currently the only way to test for nematodes is through root and soil samples taken after harvest, when it is too late to respond to an infestation. They will integrate complementary metal-oxide semiconductors (CMOS) with GHz ultrasonic imagers to detect nematodes and survey soil properties over large areas to detect infestations before crop damage occurs and transmit the data in real time. They will optimize the sensor technology in a controlled laboratory setting to maximize sensitivity and specificity and minimize power consumption and then transition to a farm setting for incorporating data transmission via the radio frequency wireless network.

Using GIS for Reducing Inequities in Immunization in Urban Settings in Nairobi and Kisumu Counties

Caroline KabariaAfrican Population and Research CenterKitsuru, Kenya
Grand Challenges Explorations
Immunization Delivery
1 May 2019

Caroline Kabaria of the African Population & Health Research Center in Kenya will use geographic information systems (GIS) to map the location of health facilities and community health volunteers in Kenya to identify particularly marginalized slum populations that need better access to health services such as vaccinations. Nairobi and Kisumu contain over 100 slums where residents live in dense and unsanitary conditions. The specific health needs of these residents are difficult to assess from national statistics that often exclude them. To address this, they will conduct an in-depth assessment to identify equity gaps specifically in childhood immunizations. Community health volunteers will be trained to use GIS mapping techniques and to register households, and the data will be integrated with the existing district health information system (DHIS 2). This will be used to produce an interactive map of the two cities that includes the spatial and social structures of informal settlements and the location of health facilities. They will also provide training and guidance to local stakeholders on how to utilize the map to improve vaccination coverage.

Safi Sana: Tracking Waste for Social and Economic Value

Aart Van den BeukelSafi SanaWeesp, Netherlands
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Aart Van den Beukel of Safi Sana in the Netherlands will enable digital monitoring of the entire waste and sanitation supply chain to improve quality control, reduce costs, and help communities transform waste into resources such as agricultural and energy products. Poor sanitation and waste management can drive poverty and disease, but it is difficult to monitor in low-resource settings. The sanitation and waste industry can also provide unique opportunities for social and economic benefit when communities are given access and support. They will install data collection systems to monitor all elements of waste processing such as GPS data from waste truck drivers to help improve efficiency and reduce contamination and costs. These data will be provided on a tailored, computer-based platform to relevant stakeholders and local communities, along with education and awareness training to encourage new waste-converting enterprises.

Transforming the Fecal Sludge Emptying Business

Hidenori HaradaKyoto UniversityKyoto, Japan
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Hidenori Harada of Kyoto University in Japan will develop and test a largely automated system for the regular removal and safe disposal of fecal sludge from septic tanks in Asia. Billions of people rely on septic systems to collect human waste. Regular emptying and proper disposal of fecal sludge are critical to avoid potential contamination of clean water by backups, leaks and illegal dumping of waste. Hazardous sanitation problems occur when customers are unaware of the need to have their system emptied or when truck operators hired to empty sludge illegally dump the waste outside of a proper treatment site. They will institute a program by which tanks are – at no charge to the customer - equipped with tagged covers that provide access for safe emptying and enables them to be registered with a centrally-monitored system that will automatically notify customers when their tank needs to be emptied. Payment by households for emptying the tanks will be collected electronically, and the sludge will be removed and transported via trucks equipped with GPS to ensure proper disposal of the waste at a treatment center. The system will be tested in cooperation with a public emptier in Mandalay, Myanmar.

REAP: Risk-Explicit Agricultural Policy Prioritization

Christine LamannaWorld Agroforestry CentreNairobi, Kenya
Grand Challenges Explorations
Agricultural Policies
1 May 2019

Christine Lamanna and Todd Rosenstock of the World Agroforestry Centre in Kenya will develop a strategy that combines local knowledge and a Bayesian network model to prioritize agricultural policy using Tanzania’s Agriculture and Food Security Investment Plan as a case study. Agriculture is responsible for nearly one third of Africa’s gross domestic product, yet productivity suffers from limited infrastructure and lack of access to markets and financing. Many policy options exist to stimulate agricultural transformation, however countries struggle to prioritize them and progress is limited. They will develop a Bayesian network to model the cost and risks of implementing specific agricultural policies as well as the economic, social and environmental benefits. Using the Tanzanian plan as a case study, they will develop a data-driven model for policy prioritization that incorporates risk (financial, climate, logistical, political) and reflects stakeholder perspectives to create a sense of ownership over the process. This strategy will allow for direct and transparent comparison of diverse policy options and provide decision-makers with clear prioritization information.

Mobile Technology and Boat Taxis to Enhance Vaccine Coverage

Paul NamwanjaCommunity Health Centre BusabalaKampala, Uganda
Grand Challenges Explorations
Immunization Demand
1 May 2019

Paul Namwanja of the Community Health Centre, Busabala in Uganda will implement mobile technology for village health teams to monitor households and childhood vaccinations on remote islands in Uganda and to establish public-private partnerships with community health workers and boat owners to improve vaccine coverage. Vaccination rates on Ugandan islands are significantly lower than the national level because of unreliable transportation to access mainland healthcare centers; island residents rely on commercial fishing boats to travel and face long wait times for healthcare service. They will modify an existing mobile application for village health teams to create a registry of new and expectant mothers by recording household location and required vaccines. These data can then be shared with mainland health workers and used to facilitate access to a subsidized boat taxi service for travel to medical appointments. They will test their approach on six trial islands by providing the mobile phones and application along with training to health workers and recruiting boat drivers and evaluate its effect on vaccination coverage.

Vaccination Calendar Baby-Wrap: Carrying Infants to Vaccines

Anne De GrootGAIA Vaccine FoundationProvidence, Rhode Island, United States
Grand Challenges Explorations
Immunization Demand
1 May 2019

Anne De Groot of the GAIA Vaccine Foundation in the U.S., along with Mika Kunieda of Keio University in Japan and Eliza Squibb and Julia Shivers of ZTwist Design in Boston, will design and distribute printed fabric baby-wraps that use West African iconography to represent the infant vaccination schedule to new mothers in Niger to encourage vaccine completion and reduce child mortality in West Africa. Due to low literacy rates among women in Niger and lack of adapted vaccination information, there are high dropout rates for pediatric vaccination and 40% of Nigerien children are unprotected from measles. In partnership with the Niger Ministry of Health's Social Mobilisation team, the Vaccine Calendar Baby-Wrap addresses key barriers to vaccination coverage in Niger by leveraging local textile traditions to bridge the information gap between the Ministry of Health's efforts to promote free vaccination and mothers’ understanding of the schedule. This visual tool provides mothers with a personal understanding of the vaccination series while enabling them to become health advocates who can educate their peers. As a practical educational intervention for children's health, the Baby-Wrap serves as a strategy for improving information equity in populations with low literacy.

Smart Immunization Targeting by Combining Artificial Intelligence and Mobile Tools

Rumi ChunaraNew York UniversityNew York, New York, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2019

Rumi Chunara of New York University in the U.S. will collect data from mobile phones of healthcare workers to develop algorithms that will help prioritize healthcare resources to increase vaccine coverage in Punjab, Pakistan. Immunization is one of the most cost-effective and successful public health strategies and is estimated to prevent up to three million deaths each year. Still, many rural areas of low- and middle-income countries have an under-vaccinated population due to a lack of formal education and awareness of the importance of vaccinations. They will collect data on disease incidence and vaccine resources and coverage from the mobile phones of 3,800 rural healthcare workers. These data will be used to train an artificial intelligence model to identify the ideal times and locations to target vaccine efforts. The model will also address accessibility and awareness issues by incorporating distance to healthcare centers and frequency of visits. Their approach will be evaluated by analyzing coverage before and after implementation. Once proven, it can be scaled to other areas in Pakistan.

Vaccination on Wheels - VOW

Jignesh PatelIndian Institute of Technology HyderabadHyderabad, Andhra Pradesh, India
Grand Challenges Explorations
Immunization Demand
1 May 2019

Jignesh Patel of the Indian Institute of Technology Hyderabad in India will increase vaccination coverage among low-income urban populations in India by designing a mobile vaccine service including a smartphone-based management application that provides customized vaccinations at homes and schools and at lower cost. Vaccination offers excellent protection against many diseases, however coverage is low among low-income populations in urban centers: immunization at private clinics is unaffordable, and public clinics have longer wait times leading to lost wages. They will develop an affordable, convenient, in-home vaccination service and a smartphone-based management application to schedule appointments, automate routes, record vaccination data and collect customer feedback. They will pilot test their approach among low-income populations in three cities by recruiting and training healthcare workers and drivers and evaluating its effect on vaccination coverage.

Testing a Geo-Fencing Community Sanitation Support System

Muhamed BizimanaCAREAtlanta, Georgia, United States
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Muhamed Bizimana of CARE in the U.S. will establish an electronic system to group urban slum households and connect them with sanitation services and financing options to reduce unsafe dumping of human waste in urban Cote D’Ivoire cities. Sixty percent of urban households in Cote D’Ivoire have unsafe sanitation systems – septic tanks improperly emptied, public dumping of human waste, and open defecation – which causes a serious health threat and limits economic development. A goal has been set for all households to have access to clean drinking water and sanitation by 2030. To achieve this requires behavior change. They will set up an electronic community sanitation support system in the trial cities of Bouake and Katiola that facilitates pooling of households’ resources to acquire better toilets and more affordable waste disposal. The system will group households geographically, establish a financial scheme for sanitation equipment and services, and link groups with waste removal service providers. They hope to cause a domino effect on behavior change towards safe sanitation habits, with plans to expand across the country by collaboration with the national office of sanitation and local municipalities.

Building Vaccination Infrastructure on the BabyOnTrack System

Suparna KalghatgiBempu Health Private LimitedBangalore, Karnataka, India
Grand Challenges Explorations
Immunization Demand
1 May 2019

Suparna Kalghatgi of Bempu Health Private Limited in India will introduce an online, personalized messaging platform to educate parents and caregivers on immunization and address their concerns to increase vaccine compliance and decrease childhood morbidity in India. Despite the existence of a universal immunization program, there are 7.4 million unvaccinated children in India, and only 65% of infants are fully vaccinated by age one. Limited caregiver knowledge is a key barrier to vaccination: parents must understand why vaccination is important and know the prescribed immunization schedule and where vaccine services are available. They will develop BabyOnTrack - an online support system that runs through WhatsApp, a free online messaging application widely used across India, to provide daily communications including practical infant health education, personalized counseling, and vaccination reminders, to new parents. They will test their approach by running small pilots in private and government hospitals where babies will be enrolled as they are discharged after birth and evaluate its effect on parent engagement and vaccination compliance. The program will also help health centers better manage vaccine supplies to reduce waiting times, which will further improve the vaccination experience for caregivers.

Rejoice Architecture Meets Social Norms to Accelerate Vaccinations in Nepal

Rajiv RimalGeorge Washington UniversityWashington, District of Columbia, United States
Grand Challenges Explorations
Immunization Demand
1 May 2019

Rajiv Rimal of George Washington University in the U.S. will increase vaccination uptake in Nepal by improving the state of health centers to make them more enjoyable and practical places for mothers to bring their children and to motivate health workers to provide better care. In Nepal and many other low-resource settings, essential health services such as vaccinations are often provided in settings with long waiting times and limited facilities, which is also demotivating for the staff. To address this, they will interview recent mothers and service providers to understand the challenges around receiving and providing vaccinations. These will be used to design an intervention that involves improving the relationship between service providers and those giving the vaccinations as well as cleaning up the health centers by painting and providing seating. They will test the ability of their approach to increase vaccination uptake by conducting a two-arm cluster randomized study using 10 clinics in the Makwanpur district.

Voice-Based Platform to Enhance Service Delivery and Improve Caregiver-Community Health Worker Interactions Around Immunization

Sumeet SinghOneKeyCare Ventures Private LimitedNew Delhi, Delhi, India
Grand Challenges Explorations
Immunization Delivery
1 May 2019

Sumeet Singh of Onekeycare Ventures Private Limited in India will develop a voice-based platform to store immunization records and improve caregiver attitudes toward vaccination in rural India. Adherence to a standard immunization schedule is essential to reduce childhood death from vaccine-preventable diseases. However, many mothers in rural and remote India are unaware of the recommended childhood immunization schedule and how crucial it is to follow it. They will develop a voice-based platform for health workers to easily update immunization records and to provide automated reminder calls to caregivers when vaccinations are due. They will also develop voice-based games to educate caregivers on hygiene best practices and the importance of immunization for health and provide the opportunity to earn points that can be redeemed for rewards. Importantly, these systems are independent of internet or smartphone access, which are largely absent in remote areas. They will test their platform in a target area by training a group of health workers and influencer caregivers and evaluating its effect on awareness and behavior.

Near-Field Communication-Enabled Precision Molecular Diagnostics for Smartphones

Firat GuderImperial College LondonLondon, United Kingdom
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

Firat Guder and Tony Cass of Imperial College London in the United Kingdom along with George Mahuku and James Legg at the International Institute of Tropical Agriculture in Tanzania will develop a smartphone-based electrochemical lateral flow assay to rapidly diagnose crop viruses in the field and relay the results. Viral crop diseases like maize lethal necrosis and cassava brown streak disease can destroy up to 30% of crops and are the main threat to food security in East Africa. Most diagnostic tests are laboratory-based and slow, hampering efforts to stop the diseases from spreading. They will develop a system that combines cutting edge chemistry and widely-used smartphone technology to quickly test field samples and upload the results to the cloud for immediate sharing with farmers and agricultural partners. Their approach is based on chemical amplification and detection of nucleic acid aptamers: as few as a hundred virus particles can be detected without the need for complex genetics or fragile and expensive antibodies. They will identify aptamers that selectively recognize the viruses, optimize the lateral flow assay in the lab, and then field-test it in Tanzania and the Democratic Republic of Congo. Once validated, they plan to develop a simpler, disposable version and scale-up the technology to other crops and countries.

Demand-Responsive Cluster Generation for Pit Emptying

Rachel SklarPit Pumpers Ltd.Kigali, Rwanda
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Rachel Sklar of Pit Pumpers Ltd. in Rwanda will develop an interactive SMS messaging platform to increase community use of companies to safely empty pit latrines in Rwanda by using communication to increase demand and thereby decrease cost and wait-times for service calls. Pit latrines, used by nearly two billion people worldwide, must be emptied regularly to avoid public health risks associated with fecal contamination of groundwater. Companies in Rwanda provide an emptying service with cost-saving opportunities when several households book together. However, this is more difficult to arrange for users in remote areas, and households may resort to unsafe dumping. They will improve coordination of service requests among remote communities by using local shop owners (duka agents) to identify households needing an emptying service. These leads will be followed up with targeted SMS marketing, and the agents paid a commission for those converted to customers. The interactive SMS messaging platform will provide households with a referral code to invite neighbors to join the service call, and the resulting cluster of customers pay a reduced rate for emptying. It will further include educational messages explaining the negative impacts of manual dumping of fecal sludge to promote behavior change. They will develop the platform and test their approach by training agents in Kigali, Rwanda.

Structured Speech Recognition Platform

Noshad AliPrecision Health Consultants Pvt LtdKarachi, Pakistan
Grand Challenges Explorations
Immunization Delivery
1 May 2019

Noshad Ali of Precision Health Consultants Pvt Ltd in Pakistan will develop a speech recognition platform to record child vaccination data and increase efficiency at vaccination clinics. Adherence to the recommended vaccination schedule is critical for reducing vaccine-preventable disease in developing countries and is increased when caregivers have positive interactions with healthcare workers. They will implement a system that will allow caregivers to dictate and record child vaccination information via speech recognition. This will decrease the amount of time spent recording data, allowing vaccinators more time with caregivers to address any concerns. This should help strengthen the relationship between healthcare workers and caregivers and thereby promote vaccination adherence. Software developers will shadow vaccinators in clinics during the design phase, noting the main discussion topics and questions asked. Once functioning, the success of the platform will be measured by software precision and satisfaction of vaccinators using the technology.

Disease and Pest Data Collection and Early Warning System

Molly BrownSyngenta Foundation for Sustainable AgricultureBasel, Switzerland
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

Molly Brown of Syngenta Foundation for Sustainable Agriculture in the U.S. will develop an early warning system for crop diseases for rural farmers in Africa by gathering data using existing infrastructure and mobile tools from commercial partners and applying machine learning pest models. Insect pests cause almost half of crop losses in Africa each year, which impacts both food supply and the economy. An effective disease and pest surveillance system provides early warning to minimize crop loss but is often unavailable to rural farmers in poor countries who lack tools for sufficient pest data collection. To address this, they propose to leverage the existing infrastructure, including demonstration farms, retailers, and mobile tools, of a commercial partner to gather the required data, such as field photographs, data on pest prevalence, and satellite weather data. Mobile tools will be available on computer and Android devices with off-line modes. They will pilot test their approach in Zambia focusing on damage to maize crops caused by the fall armyworm. Real-time data will be uploaded to a freely available, public portal with information on geography, pest populations, and affected crops.

Leveraging Enablers of Positive Deviancy to Increase Demand for Vaccination: A Community-Driven Intervention in Nigeria

Bolanle OyeledunCentre for Integrated Health ProgramsAbuja, Nigeria
Grand Challenges Explorations
Immunization Demand
1 May 2019

Bolanle Oyeledun of the Center for Integrated Health Programs in Nigeria will develop a new approach that involves teaching Nigerian parents to leverage their motivations for ensuring their children were fully immunized so that they can persuade other parents in low-income settings to do the same. They will hold interviews and group discussions with around 250 parents and grandparents of children who are fully immunized across four regions of Nigeria. These will be used to identify their positive and negative experiences during the vaccination process and why they ultimately ensured their children were fully immunized. From this group, around 40 will be selected to act as mentors who will be trained to deliver some of the key lessons learned from the interviews via group discussions. The ability of their approach to increase knowledge and demand for vaccinations will be tested with the 40 mentors along with 400 caregivers of infants younger than five months who have already missed at least one vaccination.

Household-Level Approach for Prioritization of National Agricultural Investment Plans (NAIPS)

William MartinInternational Food Policy Research InstituteWashington, District of Columbia, United States
Grand Challenges Explorations
Agricultural Policies
1 May 2019

William Martin of the International Food Policy Research Institute in the U.S. will combine existing, high-quality survey data collected from individual households in rural Ethiopia and Nigeria with agricultural information from the Global Agro-Ecological Zone (GAEZ) database to model the impact of specific investments on poor communities to better inform policy decisions. National Agricultural Investment Plans (NAIPS) shape policy development by outlining investments required to stimulate growth in Africa through transformation of the agricultural sector. However, they rarely consider the impact on individual households. To address this, they will use existing household survey data from the Living Standards Measurement Study – Integrated Services on Agriculture (LSMS-ISA), which was designed to dissect the relationship between agriculture and poverty. These data will be combined with the publicly available GAEZ database, which assesses agricultural resources and potential, to model the direct impact of policy decisions, such as investments in research and rural infrastructure (irrigation, electrification), on households. Results of the analysis will help prioritize future agricultural investments for maximum impact on the poorest families.

Human-Centered Design Approach to Improve Efficiency of Routine Immunization

Shola Dele-OlowuClinton Health Access InitiativeBoston, Massachusetts, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2019

Shola Dele-Olowu of the Clinton Health Access Initiative in Nigeria will consult with a team of community members and health professionals to improve the efficiency of routine immunizations in primary health centers in Nigeria. The vaccination rate in Nigeria varies: while the overall average is 33%, in some areas only 3% of the population is vaccinated. Historical issues with service delivery including long wait times and lack of information have caused fear and mistrust of the healthcare system among caregivers. Although the government is working to improve vaccine coverage, the focus on increased efficiency without consideration of consumer perspective does not address this fear. They will apply a human-centered design (HCD) approach, increasingly applied in healthcare, to identify deficiencies and implement a workflow redesign to meet both caregiver expectations and the needs of overworked healthcare workers. They will consult with caregivers, healthcare workers, and community members to work through the core HCD phases of inspiration, ideation, and implementation, and develop two solutions. These will be tested in a randomized-control trial in healthcare facilities in Katsina state and evaluated for their impact on wait times, caregiver satisfaction, and efficient use of resources.

Advanced Pathogen Detection in an Urban 'Hot Spot' for Global Emergence

Federico CostaFiocruzRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Federico Costa of the Federal University of Bahia, Brazil, Mitermayer Galvão dos Reis of Fiocruz, Brazil, and Nathan Grubaugh and Albert I Ko of Yale University in the U.S. will establish metagenomic next generation sequencing in clinical settings in an urban region of Brazil classified as an infectious disease ‘hot spot’ to help develop new diagnostics and identify emerging pathogens. Rapid urbanization in Salvador, a metropolitan of 2.9 million inhabitants in Northeast Brazil, has produced a favorable environment for the emergence and spread of infectious diseases, and was the founding site for the recent Zika epidemic. Early detection is critical for preventing disease spread, particularly in Salvador, which is a transport hub and popular holiday destination. However, diagnosis can be challenging in low-resource settings, especially when the causative pathogen is unknown, the disease has diverse symptoms, or a known pathogen starts causing new symptoms. They will collect around 160 clinical samples from patients with suspected infections at a local infectious disease reference hospital and a maternity unit and apply a next generation sequencing approach together with the IDseq analysis platform to identify pathogens from the sequencing data.

Leveraging Rotating Savings and Credit Associations (ROSCAs) for Innovation in Demand Generation

Erika LinnanderYale UniversityNew Haven, Connecticut, United States
Grand Challenges Explorations
Immunization Demand
1 May 2019

Erika Linnander of Yale University in the U.S. will use the social influence of rotating savings and credit associations (ROSCAs) – groups who save and borrow together– to increase demand for routine immunizations in Cameroon and Ethiopia. Both these countries have lower than average vaccination coverage and high levels of ROSCA participation. ROSCAs, associations whose members contribute to a fund that can be paid out in whole or in part to each member in rotation, are a savings vehicle for those who may not have access to formal financial institutions. They are also an important part of community structure; it is estimated that 50-95% of adults in parts of Africa belong to at least one. Invitation to join is a signal of belonging and the associations yield powerful social influence also on health behavior. They will develop a program to leverage this influence to increase routine immunization coverage for children. They will locate three ROSCAs in each country in areas with poor coverage and work with local innovators using a human-centered design approach to develop and test ways to increase demand for immunization. Success will be evaluated by changes to member knowledge of and attitudes toward immunization and increased demand.

Pathogen Discovery in the Context of Childhood Mortality and Encephalopathy

James BerkleyUniversity of OxfordOxford, United Kingdom
Grand Challenges Explorations
Pathogen Identification
1 May 2019

James Berkley and Abdi Abdirahman of the University of Oxford in the United Kingdom will test whether metagenomic analysis of clinical samples from patients with suspected infectious diseases can better identify the causative pathogens than current diagnostic methods, to help improve treatment. In Africa and Asia, many severely malnourished infants die after being discharged from a hospital likely due to infectious disease syndromes such as pneumonia, diarrhea, and sepsis. However, the causative pathogen remains unidentified in the vast majority of cases due to the limited sensitivity of current diagnostic methods. Another group highly vulnerable to the limitations of diagnostics currently available in low-resource settings are those with suspected viral encephalitis, which can cause acute seizures and coma. If diagnosed correctly, some of these diseases are treatable. They will use next generation sequencing to perform metagenomic analyses of samples from patients in both groups to identify the causative pathogens, and test whether first isolating extracellular vesicles that may concentrate viral nucleic acids from the samples can improve sensitivity.

Eyes in the Sky: National-Scale Monitoring of Crop Threats

Ritvik SahajpalUniversity of MarylandCollege Park, Maryland, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 May 2019

Ritvik Sahajpal of the University of Maryland College Park in the U.S. will develop an early warning system for low-income countries that predicts the threat to crops from pests and diseases by combining machine learning and crop pest modelling with freely available earth observation data. Existing monitoring systems allow farmers to share data on pest incidence to ensure the timely and limited use of treatments. This maximizes crop yield while minimizing cost and environmental damage. While effective, these systems are expensive and logistically challenging in low-resource settings, particularly as they require widespread coverage and monitoring of a range of pests and diseases. They have designed a new, low-cost early warning system to automatically predict a variety of different crop threats using freely available data and will first test it on maize and sorghum crops in Tanzania. They will use an ensemble-based machine learning model to estimate crop losses two to three months before harvest using earth observation datasets including vegetation indices, temperature, and soil moisture. They will then determine how much of these pre-harvest losses are caused by crop pests such as fungi and insects using the Environmental Policy Integrated Climate Model, which simulates their impact on plant health including growth. They plan to integrate their warning system with existing agricultural monitoring networks to improve accuracy. Note: This grant is funded by the Foundation for Food and Agriculture Research (FFAR).

Developing Metagenomic Approaches to Identify the Causes of Neonatal Sepsis and Acquisition of Antimicrobial Resistance in The Gambia

Thushan de SilvaMedical Research CouncilSwindon, United Kingdom
Grand Challenges Explorations
Pathogen Identification
1 May 2019

Thushan de Silva, Abdul Karim Sesay, Helen Brotherton, and Beate Kampmann of the Medical Research Council in the United Kingdom will locally implement equipment and methods for next generation sequencing of a range of clinical sample types to detect infectious pathogens in hospitalized neonates in low-resource settings. Almost three million children under five years old die each year in sub-Saharan Africa, which is the highest rate globally. A substantial proportion is likely to be caused by pathogenic infections, including multi-drug resistant organisms. However, defining the etiology of neonatal infections, which is crucial for timely and effective treatment and to block disease spread, remains challenging in countries with limited resources. They will test the potential for next generation sequencing to overcome this challenge by conducting a pilot study using clinical samples from around 30 hospitalized neonates within an ongoing clinical trial in a low-resource setting in West Africa. They will optimize protocols on site for detecting pathogens from a range of sample types and develop methods to specifically detect relevant anti-microbial resistant strains. They plan to use the study to install a network of sites across the region that can perform next generation sequencing and share the resulting large datasets with other sites.

Safe Drinking Water for Poor Households via Data-Driven Vehicular Water Delivery

Casey BrownUniversity of Massachusetts AmherstAmherst, Massachusetts, United States
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Casey Brown of the University of Massachusetts in the U.S. will design and test a water supply platform that uses digital technology to integrate vehicular water delivery with existing water infrastructure to provide affordable access to safe drinking water for poor and vulnerable households. Existing public water infrastructure in low- and middle-income areas provides water at lower costs but are often poorly maintained and unable to meet the quality and quantity of water needed by rapidly growing cities. This has led to additional water being supplied directly to households in need by tankers owned by private companies. This is a valuable service but expensive, and water quality is often poor. They have a fully integrated digital simulation model of the water system in Mexico City, a system maintenance cost model, road network data, household water use data, and surveys of water vendor cost and pricing data. Using these data, they will perform advanced analytics to design an integrated water delivery system that identifies priority delivery locations and cost-effective suppliers and supply routes for safe water. This prototype will be evaluated for financial viability, scalability to other regions, and cost effectiveness compared to extending the existing infrastructure.

Modeling of Microbial Community Dynamics to Enhance Ecological Stability and Growth

Ophelia VenturelliUniversity of WisconsinMadison, Wisconsin, United States
Grand Challenges Explorations
Microbial Biotherapeutics
1 May 2019

Ophelia Venturelli of the University of Wisconsin-Madison in the U.S. will study the growth kinetics and microbial interactions of a synthetic bacterial community in order to optimize bioreactor design and produce large quantities of mixed cultures at low cost. Mixed microbial populations are used to reconstitute the healthy gut microbiota in infants and children who have suffered malnutrition. However, affordable, large-scale production of microbial communities for biotherapeutics is challenging, in part because of poor understanding of how the growth and viability of individual strains are impacted by environmental factors and the presence of other microbes. To address this, they will build a dynamic model of a synthetic 12-member community that mimics the functional and phylogenetic diversity of the human gut microbiome and monitor its stability and growth over time and in response to variations in culturing parameters. This information will be used to predict community growth and stability in bioreactors, which will then be tested. Their approach is low cost, scalable to industrial-sized bioreactors, and can be generalized to other microbial communities relevant for human health.

Strengthening Solid Waste Management Systems in Nepal

Shivani MallaOxfam in NepalLalitpur, Nepal
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Shivani Malla of Oxfam in Nepal will improve the management of solid waste in Nepal using technology including geographic information systems (GIS) to map populations and optimize collection routes, mobile phone-based customer services, and digital monitoring for the public and private sectors. Solid waste management in the Birendranagar municipality in Nepal is becoming increasingly challenging as the population increases, and the private sector tasked with handling it has quite basic resources. Effective waste management is crucial for the health of the population and the planet and provides opportunities to generate value by recycling waste to produce sellable resources. They will work with the municipality, private sector, local communities, and existing waste management companies to develop an implementation plan for the different technologies and also provide support to encourage the start-up of businesses for example to convert waste into organic manure. They will also launch a digital awareness campaign to change public attitudes.

Community-Scale Solar-Powered Drinking Water Ozonation

Samuel DorevitchUniversity of Illinois at ChicagoChicago, Illinois, United States
Grand Challenges Explorations
Water Sanitation Hygiene
1 May 2019

Samuel Dorevitch of the University of Illinois at Chicago in the U.S. will build solar-powered ozonation systems to supply purified water to families living in Kenyan slums. Many peri-urban informal settlements (slums) around the world lack safe, affordable drinking water. In the absence of centralized water purification, methods like chlorination, solar disinfection, and filtration can be used. However, these are time-consuming and expensive, and are generally not monitored for water quality. They have developed microplasma technology for a solar-powered system that can purify surface water by ozonation without the need for electricity. They will increase the scale of this system to produce 2,000 litres of clean water each day and add sensing and reporting technology for sending information on water quality to local health officials. To test their approach, a purification system run by an array of solar panels will be installed in each of two slums in Kisumu city to provide water for 50 families and be run by local clean water teams. Two frameworks for managing and sustaining the clean water system - a membership-based cooperative and a for-profit vendor charging a nominal fee – will also be tested. The results will be used to inform the next stage of expansion to systems with a 10,000 litre/day capacity in cities in two African and two South Asian countries.

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