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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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Prevention of Maternal Death by Improving Iron Status of Women Through Iron Fortification of Tea

Levente DiosadyUniversity of TorontoToronto, Ontario, Canada
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

Iron deficiency is a major contributor to maternal death. Improving the health of women through iron fortification of a universally consumed food vehicle will result in significant saving of lives at birth. Tea is universally consumed in South Asia; however, iron forms complexes in tea, reducing bioavailability, and thus thwarting earlier fortification attempts. Our approach will make tea viable as an iron fortification vehicle. We will develop spray-encapsulated iron premix that will be attached to tea leaves, and released into hot water during brewing, without altering the tea's sensory attributes. Iron will be encapsulated in enteric coating to prevent formation of non-bioavailable tannin complex in the stomach, the coating will dissolve in the small intestines to expose a high bioavailability self-emulsifying iron delivery system. Our innovations are: (1) the encapsulation/microemulsion approach which protects iron in the stomach and enhances absorption in the lower GI, and (2) using tea as the fortification vehicle which will ease adoption because no user behavior change will be required.

Augmented Infant Resuscitator (AIR)

Data SantorinoMbarara University of Science and TechnologyMbarara, Uganda
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

Effective resuscitation could reduce intrapartum related neonatal deaths by 30%, and deaths from prematurity by 10%, creating the potential to save 347,200 babies annually. However, one in five trained healthcare professionals (HCPs) fail to perform the resuscitation technique correctly, and those that do, often experience a rapid decline in proficiency. Our Augmented Infant Resuscitator's advanced training capabilities, instant feedback mechanism, and objective self-audit and retraining abilities will maximize and sustain gains from effective resuscitation. The AIR prototype provides instant feedback to users about effective ventilation. This is measured using inexpensive instrumentation that calculates ventilation rate, air volume and air pressure delivered by the bag-valve-mask (BVM) across the resuscitation face-mask. These parameters correlate with the four most common mistakes that result in ineffective resuscitation: 1) Failed seal at the face-mask interface resulting in failure to inflate the lungs; 2) Blocked airways; and 3) Wrong ventilation frequency 4) Insufficient/shallow lung inflation. Each of these mistakes can cause death or brain damage. AIR also records performance on an internal memory card for future feedback, improving HCPs training by identifying persistent gaps in technique.

HIST-BIRTH: Innovative and Rapid Point-of-Care Histone Test Strips for Early Diagnosis of Sepsis in Pregnancy and Childbirth.

Federico Pallardo CalatayudUniversidad de ValenciaValencia, Spain
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

We propose to develop a rapid, low-cost and effective method for detecting sepsis in early stages. We will take advantage of the potential of histones to be sensitive and effective biomarkers for sepsis, and of the versatility, simplicity and low-cost of test strips. The diagnostic test will be simple, comfortable, easy to interpret and low-cost for prognosis/early diagnosis of sepsis based on histone expression. The test can be used by non-technical experts in any hospital or health center worldwide, though it has been designed intentionally for low-resource countries. Proof-of-concept of this diagnostic test will be performed in Uganda, in order to analyze benefits and reduction in mortality of pregnant women and infants in that country. The innovative combination of histones and strips make this diagnostic test a significant improvement over the inefficient methods currently used for sepsis diagnosis, such serum lactate measurement, microbiological sampling, etc.

JustMilk - Development of an Infant Nipple Shield Drug Delivery System Used During Breastfeeding

Nigel SlaterUniversity of CambridgeCambridge, United Kingdom
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

We propose to develop a low-cost Nipple Shield Delivery System (NSDS) to administer drugs or nutrients to breastfeeding infants via easily disintegrating tablets within a modified nipple shield. A wide-range of active pharmaceutical ingredients (APIs) could be delivered to infants using the NSDS such as antibiotics, antimalarials, antiretrovirals, vitamins, nutrients, and probiotics. Use of the NSDS would empower a breastfeeding mother during the early postnatal period by allowing her to personally administer medicines in a natural setting. This system can provide a novel method for accurately administering drugs and nutrients to breastfeeding infants.

A Low-Cost, Electricity-Free Oxygen Concentrator

Bryn SobottUniversity of MelbourneMelbourne, Victoria, Australia
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

Our proposal will provide this life-saving treatment to isolated, extremely resource poor people by obviating the need for electricity. This will be achieved by applying recently developed hydrological engineering approaches to extract the pressure differential required for the adsorption process exploited by Oxygen concentrators. This project aims to develop and test an electricity free Oxygen concentrator suitable for a developing world health facility. This represents a major paradigm shift, as to-date the problem has been interpreted as how to supply electricity to an Oxygen concentrator. In comparison with solar and generator based approaches the prototype will require significantly less capital cost and maintenance. Further, construction out of locally available components will empower the community to independently and sustainably access this life-saving treatment.

Que Vivan Las Madres: Scaling Up an Integrated Approach to Reduce Maternal and Perinatal Mortality in Northern Guatemala

Edgar KestlerCentro de Investigación Epidemiológica en Salud Sexual y Reproductiva (CIESAR)Guatemala City, Guatemala
Grand Challenges for Development
Saving Lives at Birth
16 Dec 2013

Guatemala has one of the highest national maternal mortality ratios in Latin America at 149 per 100,000 live births, and up to 260 per 100,000 in some northern departments. Only 31% of deliveries are attended by a skilled birth attendant. We propose to scale up an already tested innovative strategy, combining technology, service delivery, and demand creation approaches. Our collaborative effort integrates: 1) a low cost, simulation-based training program (PRONTO) using a low-tech birth simulator (PartoPants) to teach provider teams emergency management during childbirth, 2) a research-driven social marketing campaign encouraging women in the target communities to give birth in clinics rather than at home, and 3) professional midwife liaisons charged with connecting traditional birth attendants to the formal health care system. We expect that this effort will catalyze critical practice changes in maternity care, increase the proportion of births attended in clinics, improve maternal outcomes, and decrease perinatal death in indigenous Guatemalan communities.

Development of a Rectal Antibiotic Formulation for Community-Based Management of Neonatal Sepsis

Nicholas WhiteUniversity of OxfordOxford, United Kingdom
Grand Challenges for Development
Saving Lives at Birth
2 Jul 2013

This project proposes to develop a rectal formulation of a third-generation cephalosporin antibiotic for reducing mortality through early community-based management of neonatal sepsis. It will carry out pharmaceutical and preclinical studies with the aim of developing a stable rectal formulation of a candidate antibiotic with adequate bioavailability. Selection will depend on activity against causative pathogens, a good safety profile, and central nervous system penetration. Rectal administration is a simple, safe, and acceptable method of treating sick children. It would be suitable for the community-based management of neonatal sepsis if an appropriate antibiotic could be provided in a stable and adequately bioavailable formulation which could save millions of infants' lives each year.

Building and Sustaining Capacity of Frontline Health Workers in Prevention and Management of Postpartum Hemorrhage and Neonatal Asphyxia on the Day of Birth

Cherrie EvansJhpiego CorporationBaltimore, Maryland, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

Jhpiego proposes a capacity building and sustaining "Day of Birth" approach to bring lifesaving services to remote health facilities where complications must be prevented and managed simultaneously and swiftly, often by a single provider. This approach uses evidence-based practices in prevention and treatment of the two biggest killers of women and newborns in the hours after birth -PPH and neonatal asphyxia. Our approach will increase the knowledge and skills of frontline health workers, and therefore reduce newborn mortality and PPH in the areas where the intervention is applied through: 1) capacity building of facility teams through targeted training in "Helping Babies Breathe" and "Bleeding After Birth," 2) use of a low-cost, easy to use and durable simulator during training and low-dose high-frequency routine practice sessions carried out at the facilities after training, 3) further reinforcement through supportive supervision via phone and text messages, and 4) awareness creation within the community of improved services at the health facilities to boost desire for facility birth.

Increasing Healthy Behaviors and Use of Reproductive Health Services Through Improved Quality of Care, Novel Incentives, Information Technology, and Enhanced Demand for Health Products

Jill LuotoRAND CorporationSanta Monica, California, United States
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

We propose a comprehensive integrated program to address the comprehensive interrelated factors leading to poor maternal and child health. We combine service delivery improvements with demand-side innovations and multiple mobile phone applications. These include safe delivery kits, insurance for transport and treatment of obstetric emergencies, safe water and hygiene products, and small incentives for women to start antenatal care (ANC) early.

Development and Application of a Point-of-Care Assay for Plasma Bilirubin

Claudio TiribelliBILIMETRIX SRLTrieste, Italy
Grand Challenges for Development
Saving Lives at Birth
1 Jan 2013

Devastating brain injury and neonatal death caused by hyperbilirubinemia (kernicterus) is very common in low resource settings (LRS) but can be prevented by early detection and treatment with light therapy. A major roadblock to the global effort to eliminate kernicterus is the inability to measure total plasma bilirubin (TB) in most LRS, including many referral hospital centers. To meet this need, we are developing an inexpensive Point-of-Care system that rapidly measures TB.

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