Carlton Evans of Asociacion Benefica PRISMA in Peru will use conditional cash incentives to encourage individuals in poor communities that have been newly diagnosed with tuberculosis to help identify neighboring tuberculosis sufferers and encourage them and their families to receive treatment. Effective treatments exist for most forms of tuberculosis, but reaching the poor and most vulnerable individuals has proven challenging. By incentivizing and educating recently diagnosed tuberculosis sufferers in these communities, they hope to stem the spread of the disease and bring treatments to those who were previously left untreated.

Philip Baker from the University of Aukland in New Zealand will determine whether the presence of specific metabolites in a mother's hair during pregnancy can be used as an early marker of defective neurodevelopment in the child. Early diagnosis of neurodevelopmental disorders such as autism could lead to better treatment. Because hair stably incorporates chemical compounds, they will use samples of maternal hair from a previous study to search for metabolic markers such as fatty acids and amino acids that may correlate with subsequent developmental defects in the infants. The resulting predictive algorithm will be validated in a new study of over 1000 pregnant women from Malawi and Western China.

Hans Super of Braingaze in Spain will develop a low-cost application for smart phones that can measure eye vergence, which is when the two eyes align on one object, as a potential proxy for cognitive development in infants. They will generate software that presents visual images, and incorporate an eye tracking system that records eye position binocularly. The application will be tested on 10 infants between 6 and 24 months old, followed by cognitive performance tests to associate changes in eye vergence with brain development. This would lead to a low-cost, non-invasive, and simple-to-use tool for the early detection of atypical cognitive development.

Mary-Lynne Lasco of INMED Partnerships for Children in the U.S. will evaluate whether on-site sustainable food production and associated education in schools improves child health when combined with semi-annual deworming treatments and a new school feeding program in Peru. Many Peruvian children are malnourished, and soil-transmitted helminth infections are endemic and a significant cause of mortality. They will study two primary schools in Peru's Ucayali region, one of which will receive an aquaponic system, comprising fish farming and growing plants without soil, to produce healthy food and to educate children, teachers and parents on the value of eating healthily. They will analyze the effect of aquaponics and integrated education on nutrition and helminth infection rates at the schools, as well as on the attitudes of parents and the community.

Alexander Drobyshevsky of Northshore University HealthSystem in the U.S. will test whether olfactory learning in newborns can predict cognitive learning and behavior later in childhood. Current tests of learning and memory can only be performed in infants from 4 months old. However, if defects are identified earlier, treatment may be more effective. Olfaction is one of the earliest developed senses and plays an important role in the first days of life. Using a rabbit model of different brain injuries they will measure odor response in newborns and later analyze cognitive performance to link them together. They will also recruit around 100 human newborns and measure their olfactory memory, which will be followed up by cognitive testing when they are 18 months old.

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.

Margaret McConnell and Jessica Cohen of Harvard School of Public Health in the U.S. will evaluate whether motivating pregnant women to choose a health care facility for delivering their baby prior to the onset of labor, along with offering free transportation to that facility, increases the safety of childbirth in Kenya. Currently, maternal and neonatal deaths in developing countries remain high despite the availability of high quality facilities for child delivery. Obstacles to using these facilities include lack of transportation and limited information on their quality, which means many couples avoid deciding and end up either giving birth at home or going to a suboptimal facility, sometimes after a long delay. They will conduct a pilot study by recruiting 1,200 pregnant women in Nairobi, and evaluate whether offering transportation vouchers to a pre-chosen facility positively impacts delivery outcomes and timing of arrival at health care facilities.

Ranjan Shrestha of SNV (Netherlands Development Organization) in Rwanda will facilitate communication between smallholder coffee producers and district coffee taskforces to boost the coffee sector in Rwanda. District coffee taskforces composed of public, private, and non-profit members meet quarterly to discuss current issues, including production and market access, and to develop action plans. Coffee producers are largely excluded from these proceedings due to communication barriers. A pilot test will be conducted by training youths to record the current concerns of local coffee producers using smart phones, and to visually present the data for ease of transmission to the taskforces via internet. The approach will be monitored by analyzing the numbers and types of issues raised and by who, and how they are addressed, as well as evaluating how the approach is perceived by users.

Lijuan Yuan of Virginia Polytechnic Institute and State University in collaboration with Sylvia Becker-Dreps and Andrea Azcarate-Peril from University of North Carolina at Chapel Hill in the U.S. and Samuel Vilchez from University of Nicaragua will develop a pig model with impaired intestinal function and altered types of gut microbes to mimic the condition of many children in developing countries who do not respond to vaccines against rotavirus infection, which causes infectious diarrhea. They will implant stools from vaccine-responsive and non-responsive children in Nicaragua into the pigs and use them to identify factors that improve vaccine-mediated immune responses. This model can also be used to test disease prevention strategies, such as feeding probiotics or special diets.

Shaun Ferris of Catholic Relief Services in the U.S. will build and test different ways of obtaining feedback from farmers who are using business-focused agricultural services, which his organization provides. This suite of services, including courses on business planning and production, is designed to improve farmer productivity and profitability using a system of web-based applications and mobile phone information delivery. To transfer the management of some of these services back to the local communities, they need feedback on their performance and value in the field. They will build three different methods of obtaining feedback, including SMS polls and direct calls, into their existing service provision system, and evaluate them for efficacy and cost.

Debby Herbenick and Frank Sadlo of Indiana University in the U.S. will design a new female condom that is easier and more comfortable to use, and enhances sexual experience. The new condom will have a more natural elliptical opening as opposed to the more conventional Round one, and will be ribbed on one side to provide directed internal stimulation for the female, making it potentially more enjoyable than using no condom. They will also test an alternative method for securing the condom in place using an additional latex coating at the internal, closed end of the condom, which should be more comfortable. Prototypes will be created for evaluation by couples in India, and performance compared to a conventional female condom.

Liam Morrison and Ivan Morrison of the Roslin Institute, University of Edinburgh in the United Kingdom will develop a new type of drug for treating diseases in animals and humans caused by African trypanosomes, which cause significant disease in sub-Saharan Africa. African trypanosomes evade the host immune system by varying their surface proteins, which can be recognized by conventional antibodies, precluding the development of an effective vaccine. They will exploit an unconventional antibody subtype discovered in cattle, which they hypothesize targets unvarying conserved epitopes on African trypanosomes, as a more effective treatment. They will identify specific antibody fragments that bind to trypanosomes and test whether they can eliminate the pathogen using animal models. Subsequent work will focus on identifying the target pathogen proteins of these unconventional antibodies with a view to developing a vaccine.

Charles Long of the College of Veterinary Medicine and Biomedical Sciences in the U.S. will develop a strategy for generating single vaccines against diseases that infect both humans and animals (zoonotic) for use in both species that can be locally produced in goat milk. They will select two antigens from pathogens causing seven zoonotic diseases, including tuberculosis and trypanosomiasis, and incorporate them into vectors for producing the vaccines in lactating dairy goats. The ability of each vaccine to induce a protective immune response in combination with a variety of adjuvants will then be tested in goats. Vaccine-producing goats could be shipped to regions in need where local farmers and businesses would be trained to produce the milk and prepare the vaccines.

Heidi Larson of the London School of Hygiene and Tropical Medicine in the United Kingdom will establish simple touch screens in Kenyan health clinics to gather immediate feedback from young women seeking reproductive and sexual health services on their experience as they leave the clinic. A negative patient experience during a doctor's appointment has a harmful effect on subsequent health decisions. They will design a touch screen interface comprising a simple red and green option along with a data collection tool, and implement them in two high volume provincial facilities in Kenya in consultation with health providers. Summaries of patient ratings will be publicly posted to motivate health providers to improve their services. The data will be analyzed for patient experience, and related to clinical performance.

Egil Lien with collaborators Beth McCormick and Mike Brehm of the University of Massachusetts Medical School in the U.S. will evaluate two mouse models for studying human typhoid fever. Typhoid fever is a major cause of environmental enteric dysfunction, which is associated with significant morbidity and mortality particularly in young children from developing countries. The causative Salmonella bacterium does not normally infect mice, hindering the development of mouse models for testing new treatments and vaccines. However mice lacking the innate immune receptor toll-like receptor 11 (TLR11) and humanized NOD-SID-IL-2Rg (NSG) mice can be infected. They will analyze the characteristics of typhoid fever in these two mouse models and the effect of current treatments.

Lakshminarayanan Ragupathy of HLL Lifecare Limited in India will make a male condom from the biodegradable polymer poly(glycerol sebacate) as an environmentally friendly alternative to conventional condoms with improved performance. In contrast to currently used condoms, poly(glycerol sebacate) may be compatible with oil-based lubricants, and can be more easily combined with other materials, such as anti-viral drugs, contraceptives and vasodilators, to enhance safety and user experience. Poly(glycerol sebacate) is also completely biodegradable, transparent, odorless, and the raw materials are renewable. They will modify some of the mechanical properties of poly(glycerol sebacate), such as tensile strength, to make it more suitable as condom material and to reduce thickness, thereby increasing sensitivity during use. Once the ideal material has been identified, they will produce the condom and evaluate it for safety and biocompatibility.

Jennifer Downs of Weill Cornell Medical College in the U.S. will use the influence of the church to encourage more male circumcision in order to reduce HIV incidence in Tanzania. Male circumcision can inhibit HIV infection, but it is uncommon, particularly amongst non-Muslim communities in African nations due to negative religious and social perceptions. They will train male and female church leaders to educate their congregations on the medical, historical, religious, tribal, and social aspects of male circumcision, and explore ways that they can integrate these teachings into the church. They will compare circumcision rates before and after this intervention, and use matched villages receiving no church-associated training as controls. Their approach could be expanded to neighboring countries.

James Nataro of the University of Virginia in the U.S. is developing new mouse models of environmental enteric dysfunction (EED) to explore how enteric pathogens commonly found among children in developing countries can affect intestinal function and cause growth retardation. In Phase I, they developed mouse models for five of the common pathogens and found that, as in humans, malnutrition (protein or zinc deficiency) enhanced the severity of infection, associated growth retardation, or the presence of intestinal inflammation. In Phase II, they will study the molecular mechanisms involved and analyze human candidate EED-associated biomarkers and metabolic states in their new mouse models to better compare them to the human disease. They will also test the effect of simultaneous and repeat infections on growth, and treat one of the models with alanine-glutamine to determine whether they can be used to evaluate new drugs.

Henry Baffoe of the Centre for Remote Sensing and Geographic Information Services in Ghana will develop an integrated system using existing technologies to gain feedback from smallholder farmers on agricultural projects that can then be analyzed by stakeholders. His team will recruit farmers from a district in Ghana, map their locations using GPS, record the type of farm, and launch an Instant Voice Response (IVR) platform, which collects responses to surveys by recording voice messages sent by mobile phone. The system will be pilot tested with a specific agricultural project and evaluate its impact on project development and farm productivity.

Naoru Koizumi of George Mason University in the U.S. will evaluate whether offering individuals a choice between different information and communication technologies (ICTs) will increase adherence to treatment for tuberculosis, which lasts six months. Treatment compliance particularly in urban poor populations is low, leading to the emergence of dangerous multi-drug resistant strains of the tuberculosis bacterium. Current methods used to increase compliance, such as sending SMS reminders and financial incentives, do not suit every patient. They will conduct a pilot test in India to determine whether offering tuberculosis patients a choice between different ICT-based options for receiving treatment reminders, recording compliance, and rewarding compliant behavior, rather than selecting the options for them, improves adherence to treatment.

Caroline Ochieng of the Stockholm Environment Institute in Sweden is evaluating an approach to stimulate women in Kenya to regularly visit health clinics during pregnancy and after birth to improve maternal health. Currently, the majority visits only once, and infant and maternal mortality are high. To encourage the women to keep additional appointments they will give them a health credit voucher that can be exchanged for a specific cash amount or retained for a subsequent appointment, for up to four appointments, when they receive another voucher worth twice as much. In Phase I, they enrolled 200 women in a county in Kenya to test the reward scheme, with preliminary results showing 90% went to a second appointment. In Phase II, Stacey Noel, also of the Stockholm Environment Institute in Sweden, will scale up the test to 3600 women across 18 health facilities, and prolong the award scheme to one year after birth, as a way to also promote infant health. They will also analyze the cost-effectiveness of the scheme, and its effect on health by conducting a cluster randomized control trial.

Danae Schulz and Erik Debler of Rockefeller University in the U.S. will test whether a drug that was originally developed to treat cancer and heart disease can also kill trypanosomes, which are parasites that cause African trypanosomiasis in humans and cattle. Repurposing a drug already approved for a different disease is highly cost-effective as expensive human safety trials are already complete. This particular drug is a bromodomain inhibitor that interferes with the structure of chromatin, and they have shown that it destroys trypanosomes grown in vitro. They will test whether the drug can cure trypanosome infections in mice, and determine how the drug and its derivatives interact with trypanosomes using binding and structural studies. Subsequent studies would test the drug in cattle and humans.

Scott Jordan Kerns of Harvard Medical School in the U.S. will develop a cell-based model of environmental enteric dysfunction, which causes substantial morbidity and mortality in developing countries. As a living model of the human intestine, he will use a gut-on-a-chip device composed of two microfluidic channels enclosing gut cells growing on a flexible membrane, which is coated with extracellular matrix proteins and other cell types. He will treat the gut-on-a-chip with factors that cause environmental enteric dysfunction, such as pathogenic bacteria, and monitor gut-related functions including nutrient absorption. A validated model could then be used to screen for new treatments. He will also engineer non-pathogenic bacteria as potential early-stage diagnostics and test their ability to sense environmental enteric dysfunction in his model.

Marie Lewis of the University of Reading in the United Kingdom will establish pig models of environmental enteric dysfunction (EED) and acute secretory diarrhea (ASD) to develop and test new therapeutic approaches. Rodents are commonly used to model human enteropathies, but their physiology is quite different and often therapies that work in rodents fail in humans. Pigs may be a more valuable disease model as their biology is more comparable to humans. Thus, to promote the clinical success of candidate therapies for EED and ASD, they will develop pig models of human enteropathies by abruptly weaning piglets, feeding them a defined diet, and infecting them with an enteric pathogen. Several weeks later, they will analyze nutrition and growth, the extent of gut dysfunction, and metabolic and gut microbial profiles to assess the value of the models and study the effects of these diseases. In the future, these models could be used to screen for new therapies for these and other gastrointestinal diseases.