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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.

Use of Metabolomics for the Identification and Validation of Clinical Biomarkers for Preterm Birth

José Guilherme CecattiUniversidade Estadual de CampinasCampinas, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

José Guilherme Cecatti from the Universidade Estadual de Campinas in Brazil will develop a predictive algorithm to identify early in pregnancy those at increased risk of preterm birth so that if possible they can be treated. There are likely to be many causes of preterm birth, and it is a major cause of both short and long term life-threatening complications for infants. They will use existing data from 6,000 pregnancies that resulted in both term and preterm births, and perform three complementary mass spectrometry-based methods on blood taken early (around 15 weeks) in those pregnancies to identify a panel of biomarkers that can predict preterm birth. This will be combined with sociodemographic and physical data including economic status and age to generate a predictive algorithm. They will then evaluate this algorithm in a cohort of 1,150 low risk pregnant Brazilian women for its ability to identify those that go on to give birth prematurely.

Pessary Plus Progesterone to Prevent Preterm Delivery in Women With Short Cervical Length

Rodolfo de Carvalho PacagnellaUniversidade Estadual de CampinasCampinas, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Rodolfo de Carvalho Pacagnella from the Universidade Estadual de Campinas in Brazil will perform two randomized clinical trials across 15 obstetric clinics in Brazil to evaluate treatment with progesterone in the presence or absence of a cervical pessary for preventing spontaneous preterm birth. Both cervical pessary and progesterone are individually considered to be effective preventative treatments for preterm birth, which is one of the most common complications seen in pregnancy and can cause severe complications for the premature infant. The causes of preterm birth are mostly unknown, although incidence does increase with cervical shortening during the mid stages of pregnancy. They will also analyze the prevalence of a short cervix in Brazilian pregnant women, and determine how well it predicts preterm birth. Their approach to screen for cervix length and then treat high-risk individuals with the combination therapy will also be evaluated for cost-effectiveness.

Influence of the Vaginal Microbiome and Vaginal Metabolites on Cervical Remodeling and Preterm Parturition

Antonio Fernandes MoronUniversidade Federal de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Antonio Fernandes Moron from the Universidade Federal de São Paulo in Brazil will investigate whether the presence of specific bacterial populations in the vagina can predict preterm birth, which could form part of an inexpensive test suitable for low resource settings. Preterm birth leads to major short- and long-term health problems for the child. The causes are largely unknown, making it hard to identify pregnant women at increased risk who need monitoring and might benefit from treatment. They hypothesize that bacterial infections in the vagina during pregnancy can alter the length, elasticity and/or thickness of the cervix, thereby triggering preterm birth. To test this, they will analyze vaginal samples from 400 pregnant women located at four urban care centers throughout Brazil to identify bacteria and selected proteins that associate with specific cervical alterations detectable by ultrasound, and determine their association with preterm birth.

Senses of Birth: Effects of an Interactive Exhibit in Changing the Perception About Labor and Birth With Community Mobilization for Reducing Excessive Caesarean Sections and Iatrogenic Prematurity In Brazil

Bernardo Jefferson de OliveiraUniversidade Federal de Minas GeraisBelo Horizonte, Minas Gerais, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Bernardo Jefferson de Oliveira from the Universidade Federal de Minas Gerais in Brazil will develop an interactive exhibit including images, audio, games, and theatre to encourage natural childbirth and perform a pilot study to evaluate its effect on changing public perception of labor and birth. They aim to reduce unnecessary cesarean sections in Brazil where the incidence of preterm births, which can cause severe disabilities, has been increasing. This is thought to be due in part to the negative perception of normal birth and the assumption that cesarean sections are safer and more convenient. The exhibit will focus on producing sensations and emotions to teach participants about the experience, risks and benefits of both cesarean section and natural childbirth. They will present the exhibit over 12 months in three major cities, which should reach around 30,000 people, and use interviews and questionnaires before and after participants visit the exhibit to measure its effect on knowledge and attitudes.

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