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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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Point-of-Care Diagnosis of Active Syphilis for the Elimination of Congenital Syphilis

David AndersonBurnet InstituteMelbourne, Victoria, Australia
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

We propose to optimize and pilot-test a finger-stick based rapid syphilis point-of-care test, featuring a novel IgM antibody test (developed by Burnet Institute) that offers specificity for active infection, in combination with a total antibody test (developed by Omega Diagnostics) that offers optimal sensitivity, in one single test-strip. This test will be optimized against "gold standard" reference tests, using approximately 60 plasma samples representing active syphilis, past syphilis and healthy controls.

Point-of-Care Nucleic Acid Diagnostic for Early Infant Diagnosis of HIV

Patrick BeattieDiagnostics For AllCambridge, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

Diagnostics For All is developing a nucleic acid amplification tests (NAATs) platform that can perform sample preparation, amplification, and detection in a disposable, self-contained, cartridge without any additional instrumentation. We propose adapting this platform to deliver a qualitative HIV early infant diagnosis (EID) test that can truly be used at the point-of-care, reducing the turnaround time from over a month to under an hour. Since it can be performed before the mother and child leave the clinic, the proposed technology can result in immediate initiation of antiretroviral therapy (ART) and eliminate loss to follow-up. Through this 2-year seed grant, we will produce a completely equipment-free, fully-integrated device that can receive and process a whole blood sample, perform isothermal amplification, and provide visual result readout with a clinically appropriate sensitivity for HIV EID.

Bili-Hut: Saving Newborn Lives with Rapid Deployment of Phototherapy in Rural India

Donna BrezinskiLittle Sparrows TechnologiesWinchester, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

The Bili-Hut is a novel phototherapy device designed to improve access to jaundice treatment in low resource areas. It is extremely light-weight, portable, and capable of prolonged operation with a battery. The working prototype complies with recommendations of the American Academy of Pediatrics for high intensity phototherapy, delivering treatment in the optimal therapeutic light bandwidth equivalent or superior to existing commercial devices. Most initiatives to improve access to neonatal phototherapy center on equipment donation or designing cheaper devices for urban hospitals that have electricity. The Bili-Hut will meet the specific needs of the previously unreachable, low resource areas without reliable electricity that have the highest mortality from jaundice.

Inhaled Oxytocin - Landscape and Stakeholder Analysis in Regions with High Maternal Mortality

Halina OswaldMonash UniversityClayton, Victoria, Australia
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

Monash is seeking to develop an affordable heat-stable, self-contained, simple to administer inhaled delivery system for oxytocin. Such a product removes the challenges associated with access and use of the current oxytocin product and has the potential to ensure that a high-quality oxytocin product is accessible to women with greatest need. The project is innovative as it would, for the first time, provide an effective oxytocin product that does not rely on cold chain supply and storage to maintain quality or the presence of healthcare workers trained to safely administer injections. Current uterotonic products are presented either as injections susceptible to degradation in ambient conditions or, in the case of misoprostol tablets, do not provide the level of efficacy possible with oxytocin. The proposed inhaled oxytocin product presents the potential of delivering the gold standard therapy in a robust form that simplifies administration at a cost equivalent to current products. As such, this innovative product has the potential to significantly expand access to oxytocin across low- and middle-income countries by creating efficiencies within busy facilities, administration to lower tier healthcare workers and birth attendants.

Validation and Introduction of a Low-Cost Bubble Continuous Positive Airway Pressure Kit and Oxygen Blender for Neonates

Sara WatsonProgram for Appropriate Technology in Health (PATH)Seattle, Washington, United States
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

Continuous positive airway pressure (CPAP) therapy is the standard of care for treatment of neonatal respiratory distress, but the availability of CPAP devices is limited by cost and facility infrastructure such as electricity and pressurized air. The bubble CPAP (bCPAP) kit and oxygen blender address the lack of electricity and pressurized air, common in rural health clinics, and have been demonstrated to provide a stable supply of blended gas. Our proposed work will further address this gap by collaborating with local distributors of hospital supplies to sell inexpensive, preassembled kits to hospitals, clinics, and pharmacies.

Breathalert: High-Performance, Low-Cost Method to Reduce Death Due to Apnea of Prematurity

Maria OdenRice UniversityHouston, Texas, United States
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

Our idea is to develop BreathAlert, a $25 battery-powered monitor that detects and automatically corrects apnea. BreathAlert is a stretchy band placed around a baby's chest to detect if breathing has stopped; if apnea occurs, coin-sized vibrating motors in the strap are activated and the vibration automatically stimulates the baby to resume breathing.

A Simple Tool and Mobile Phone Application to Improve Community-Based Case Management of Premature and Jaundiced Newborns

Anne LeeBrigham and Women's HospitalBoston, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
1 Oct 2014

We aim to develop and validate simple, low-cost, low-technology tools to improve community-based identification, referral, and care of premature and jaundiced newborns by frontline health workers.

Thermal Images on Smartphones to Diagnose Bacterial Neonatal Pneumonia in Pakistan

Patricia HibberdMassachusetts General HospitalBoston, Massachusetts, United States
Grand Challenges for Development
Saving Lives at Birth
30 Sep 2014

Our objective is to develop a low-cost Smartphone attachment and application to diagnose and treat bacterial neonatal pneumonia in Pakistan. Currently, serious bacterial infection - pneumonia, sepsis and meningitis - results in preventable deaths of 700,000 neonates every year, 99% dying in resource limited settings such as Pakistan. Signs of serious infection in young babies are difficult to recognize. Diagnostic tests and chest X-rays are rarely available outside tertiary care hospitals. The proposed device has the potential to identify and treat bacterial pneumonia quickly and decrease mortality. Our technology is an attachment that snaps on to a Smartphone and acquires, then displays a thermal image of a neonate's lungs. An application (app) will calculate the chance a neonate has bacterial pneumonia, based on the presence of "hot spots" or temperature differences which represent the increased blood flow/inflammation that occurs with bacterial pneumonia. The app will produce a read-out recommending treatment with antibiotics if the thermal image is consistent with bacterial pneumonia. The attachment and app will work with most Smartphones that are increasingly available globally and will be powered by the Smartphone's battery. It will take minutes to acquire and process the images. No specialized equipment or technical expertise by the user will be needed. The device is non-invasive, low risk, easy to use and incurs a one-time (not per test) expense which is minimal compared to X-rays.

Design and Prototype Development of a Low-Cost, Smart Pill Dispenser for Continuous Monitoring of TB

Lazar MathewDevi Electronics LLPCoimbatore, Tamil Nadu, India
Grand Challenges India
Tuberculosis Treatment
25 Sep 2014

Lazar Mathew and team are working on a smart pill box that tracks exactly the time through radio frequency identification (RFID) of the dose coupled with SMS trigger systems. The pill box can dispense blister packs rather than tablets, and incorporates a timer which can only be programmed by the medicine provider. Medication cannot be taken out before or after certain times, preventing double dosage. SMS reminders will be sent to family members as well. Monitoring of up to 90 dosages will be possible with a table-top dispenser.

Novel Approach to Reduce Zinc Malnutrition in Rural Women and Children Through Agronomic Biofortification of Food Crops

Kuldeep SinghAmity UniversityNoida, , India
Grand Challenges India
Agriculture and Nutrition
16 Sep 2014

This project aims to reduce human Zinc deficiency through biofortification by foliar zinc application. It aims to prove that this traditional and efficient strategy of agronomic biofortification, can be a rapid solution for improving zinc concentration in grain to address the ongoing human zinc deficiency.

Empowering RNTCP Stakeholders with Effective TB Monitoring and Control Using Mobile and ICT

Anuradha LeleCentre for Development of Advanced ComputingPune, Maharashtra, India
Grand Challenges India
Tuberculosis Treatment
15 Sep 2014

Anuradha Lele and team from CDAC are building an integrated SMS and voice calling solution, which involves mobile-based applications with forms to register patients, a lab form for sputum examinations, IVRS/missed call reminders, and a patient monitoring application for doctors and DOTS workers. The system also plans to include next of kin and friends to enable seamless monitoring of drug intake of the patient.

Eco-Toilet

Dinesh BindiganavalePradin Technologies Pvt. LtdBangalore, , India
Grand Challenges India
Reinvent the Toilet
13 Sep 2014

This project aims to utilize ultrasound to move and settle human waste collected in a specifically designed latrine. This redesigned latrine uses less water and therefore provides a more sustainable solution to collect human waste.

99DOTS: Using Mobile Phones to Monitor and Improve Adherence to Tuberculosis Medications

Bill ThiesInnovators in Health (India)Patna, Bihar, India
Grand Challenges India
Tuberculosis Treatment
12 Aug 2014

Bill Thies and the team of 99DOTS aim to achieve 99% TB drug adherence using a combination of basic mobile phones and augmented blister packaging to provide real-time medication monitoring at drastically reduced cost. The approach is to utilize a custom envelope, or blister card, into which each pack of medication is inserted and sealed by the care provider. When the patient dispenses medication from the blister pack, the pills also break through perforated flaps on the blister card. On the back side of each flap is a hidden number. Patients submit these numbers using their mobile phone as evidence that they have dispensed medication. To avoid incurring any mobile charges, the numbers are used to complete a phone number and deliver a "Missed call" (Missed calls are free if they are not pointed to a VoiceMail). Using this system patients also receive a series of daily reminders (via SMS and automated calls). Missed doses trigger SMS notifications to care providers, who follow up with personal, phone-based counseling. Real-time adherence reports are also made available on the web.

mDOTS: Improving Tuberculosis Detection, Treatment, and Adherence in Rural India

Krishna SwamyDimagi Software Innovations Private LimitedNew Delhi, Delhi, India
Grand Challenges India
Tuberculosis Treatment
6 Aug 2014

Krishna Swamy and team are building a comprehensive tuberculosis (TB) mobile application to improve TB detection, treatment, and adherence. The team will build upon its open-source, mobile health (mHealth) platform CommCare and predeployed CommCare mobile applications for TB in India to develop a comprehensive, SMS-enabled mobile application for TB detection, treatment, and adherence. Dimagi will work with the International Union against Tuberculosis and Lung Diseases, South-East Asia (USEA) in the Khunti District, Jharkhand in India to design, test, evaluate, and scale the proposed mDOTS application, which will be designed around the World Health Organization's recommended directly observed treatment, short-course (DOTS) protocol for TB.

CoxBox: An Affordable Medicine Dispenser for Checking Non-Adherence

Manjari DebCalcutta RescueKolkata, West Bengal, India
Grand Challenges India
Tuberculosis Treatment
6 Aug 2014

Manjari Deb and team are developing a small, electronic pill dispenser called the CoxBox that enables real-time tracking of patient treatment adherence and inventory. The CoxBox innovation provides a relatively inexpensive and easily implementable solution for action-oriented monitoring and controlling of anti-tubercular drug adherence through the use of a microcontroller-based electromechanical pill box with programmable alarm annunciator and a built-in mobile device.

mDOTS: Integrated TB Platform with Mobile Connectivity for Active Compliance

Hilmi QuraishiZMQ DevelopmentNew Delhi, Delhi, India
Grand Challenges India
Tuberculosis Treatment
24 Jul 2014

Hilmi Quraishi and team are building a system to enable adherence to TB treatment. The proposed solution is sliced from ZMQ's Fully-Technology Linked Model (F-TLM) for TB treatment and management called the Open and Universal Technology based TB (OUT-TB) Management and Treatment Framework. The framework was developed by ZMQ under its Freedom TB initiative. The proposed solution empowers the patients with active compliance reporting, gamification, and effective self-management of TB treatment using mobile-based tools integrated with miniature DOTS Center Systems and DOTS Provider Toolkit. The solution is based on a bottom-up technology model, which empowers patients to take control of treatment with reminder systems, compliance reporting, dosage tracking, test scheduling, and provider connection for need-based supervision. The solution will help in creating networks of treated patients as new knowledge providers, who will serve as peer educators to provide assistive support to patients in their communities. The approach will make the treatment a community-lead model.

myTBdoc Program

Nakul PasrichaPharmasecure Product Authentication Services India Pvt LtdNew Delhi, Delhi, India
Grand Challenges India
Tuberculosis Treatment
24 Jul 2014

Nakul Pasricha and team are working to develop special cards, called myTBdoc cards, with unique alphanumeric identifiers printed on them to be given to medical representatives (MRs). TB medicines manufactured by Lupin will also have unique identifiers printed on them. MRs will give myTBdoc cards to private doctors that see TB patients, educating them on correct TB prescription methods. Doctors will then give these cards to new TB patients, instructing them to SMS the unique code on the card (enrolling them in our program) and to SMS the unique codes printed on their TB drugs as they take them. PharmaSecure will then deliver phone interventions, such as reminders to take medicines, follow up calls, and TB health tips via SMS and voice calls. Lupin holds a major market share in the Indian TB drug market, and hence the solution will reach out to a larger affected population easily.

TB Prasakti

Janardan SureshKavin CorporationBangalore, Karnataka, India
Grand Challenges India
Tuberculosis Treatment
24 Jul 2014

Janardan Suresh and team are building a mobile-based application to improve TB adherence. The system, called TB Prasakti, involves SMS-based reminder and follow up, automated telephone reminder and follow up, and a total patient information system, which ensures maximum utilization of technology for TB. It provides for easy scalability and affordability and provides a "single window" to capture, store, remind, follow up and generate reports, thus ensuring a comprehensive and all-encompassing solution. The novelty lies in the solution being a total end-to-end tracking of the TB patient treatment and adherence life cycle, in which all the stakeholders are able to communicate through a single system.

Holistic TB Drug Adherence System Using Mobile Phones Augmented with Smart Hardware Apps

Nishant KumarEmbryyo Technologies Private Ltd.Pune, Maharashtra, India
Grand Challenges India
Tuberculosis Treatment
21 Jul 2014

Nishant Kumar and team are building a mobile hardware app which can serve an electronic pill box and can be attached to a conventional mobile phone. The hardware attachment has a rectangular sleek design, which can be fixed onto the mobile phone or can be used separately. A mobile application runs on the phone and controls the hardware attachment via Bluetooth. This product also facilitates a novel points-based incentives system to further encourage the patient towards continued adherence. A complementary mobile phone application runs on the handheld devices of the health worker. The hardware attachment can either be distributed as a standalone product or with a phone.

REAP TB Therapy

Saleem MohammedXcode Life Sciences Pvt LtdChennai, Tamil Nadu, India
Grand Challenges India
Tuberculosis Treatment
21 Jul 2014

Saleem Mohammed of XCode is developing a platform for publishing, through which "health signals" will be delivered. These health signals are delivered over a subscriber's mobile phone in a snack format comprised of a reminder system through SMS, a reply mechanism for confirmation, a 1-minute audio clip that educates about the disease, and a quiz for engagement and incentives to be awarded accordingly. The SMS acts as a teaser to the audio clip that expands and goes into greater detail about TB drug adherence. The technology is deployed in the cloud, which enables the solution to scale rapidly and dynamically. REAP TB also uses the services of TB survivors for counseling and following up with TB patients.

A Mobile Workflow-Based Solution for Closed Loop Monitoring of Adherence to TB Treatment

Shashank GargHandheld Solutions and Research Labs Pvt LtdBangalore, Karnataka, India
Grand Challenges India
Tuberculosis Treatment
21 Jul 2014

Shashank Garg and team will develop a mobile solution that addresses problems in adherence to TB treatment through the key technologies of mobile phone-based electronic forms, workflow management, identity management, and electronic health records. The objective is to achieve automated tracking and monitoring of individual TB patients for adherence to the TB treatment protocol. ASHA workers will use the mobile application for collection of dosage intake data in the field. A workflow system will provide a closed loop through SMS alerts in case a patient defaults. Along with identity management and a TB treatment record, the system will ensure patients are able to seek treatment even on migration, thus maintaining continuity of treatment. This mobile solution is novel because it will use a form-based mobile application capable of running in disconnected or offline mode, with data connectivity being required only for the duration of data upload to the server.

Technology-Based Solutions Towards Grand Challenges in TB Control

Avin AgarwalNestingBits Technologies Pvt LtdBangalore, Karnataka, India
Grand Challenges India
Tuberculosis Treatment
21 Jul 2014

Avin Agarwal and team will develop an electronic pill box with the software architecture based on a client-server software solution with hardware integration. The technique involves tracking the weight of the remaining pills through an electronic pill box with GSM connection and pressure sensor. This approach tracks if the pill is taken out of the pill box for consumption and reports this information to the central server. The solution could be as effective as DOT and a lot cheaper to implement. Addressing the cost of implementation will be emphasized for long-term execution, and an alternate SMS-based solution is suggested to reduce the dependency on pill boxes, in case the objective can be met using a less expensive SMS solution. By the nature of its design, the application will identify defaulters and escalate them for more stringent techniques of monitoring and at the same time alert healthcare professionals only when necessary.

Real-Time Remote Monitoring and Tracking of Treatment Adherence

Shweta RoyAtharvWin Healthcare Pvt LtdHyderabad, , India
Grand Challenges India
Tuberculosis Treatment
21 Jul 2014

Shweta Roy and team are developing a small, electronic, tablet strip holder that enables real-time tracking of patient treatment adherence and inventory. The tablet strip holder will be small in size, embedded with a weighing scale to monitor change in weight of tablet strips and thereby monitor treatment adherence. Any change in the weight of the strip will be recorded on a server via SMS using a telemetric SIM within the holder. If the change in weight is not detected within a given time period, the device will trigger a non-compliance alert through SMS to the patient and caregiver DOTS observer. The holder will also have an inbuilt alarm to alert the patient in case of missed dosages. The final product will be light weight and sleek in design and the patient will be able carry the tablet strip holder like a mobile phone. Minimal patient input is expected, making this device user friendly, and alerts can be customized as per regional language. The cost of the final device is expected to be $10 - 12 USD per piece.

Improving BCG Vaccine to Make it Compatible with Skin Test

Johnjoe McfaddenUniversity of SurreyGuildford, United Kingdom
Grand Challenges Explorations
Human and Animal Health
28 Apr 2014

Johnjoe McFadden of the University of Surrey in the United Kingdom will modify the BCG vaccine currently used against bovine and human tuberculosis, and develop a complementary diagnostic test that can distinguish between tuberculosis infection and vaccination. BCG is the only effective tuberculosis vaccine, however it interferes with diagnostic tests, preventing the distinction between infection and vaccination, which is important for control efforts in developing countries. They will identify genes in the BCG vaccine that can be removed without affecting its activity in cattle and determine which of those genes are potentially strongly immunogenic and therefore easy to detect. Selected genes will be used to develop a complementary diagnostic skin test that would not cross-react with the modified vaccine. Next steps would be developing and evaluating the vaccine and skin test in cattle and subsequently in humans.

Integrating Cash Transfer and Nutrition Promotion With Mobile

Tanvir HudaInternational Centre for Diarrhoeal Disease Research, BangladeshDhaka, Bangladesh
Grand Challenges Explorations
Behavior Change
28 Apr 2014

Tanvir Huda of ICDDRB in Bangladesh will improve care and nutrition for pregnant women and young children by setting up a system whereby mobile phones are used to receive nutritional information and financial incentives for positive health-related behavior, such as attending clinics. They will perform a pilot study in Bangladesh by recruiting 350 pregnant women, providing them with mobile handsets, and establishing trained health workers who will send weekly nutritional advice and supply nutritional supplements. Cash will be transferred using bkash (a mobile banking system) when certain conditions are met, including intake of supplements, prenatal and antenatal care checks, and listening to mobile messages. The approach will be evaluated by discussions with relatives, and assessing birth outcomes and infant growth.

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