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.

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.

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.

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.

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.

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.

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.

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.

Rozina Feroz Ali of IRD Global Limited in Singapore along with Subhash Chandir and Danya Arif will establish a subsidized carpool for Pakistani women in rural areas and urban slums to improve access to immunization centers and increase vaccination coverage. Poor vaccine coverage in Pakistan is a result of the combined effects of poverty, lack of education, poor access to transportation, and distantly located vaccination centers; populations in rural areas and urban slums are vulnerable to outbreaks of vaccine-preventable disease and an increased childhood mortality rate. They will develop a system to provide women with transport to vaccine centers at affordable rates, educate them on the importance of vaccination through short videos played during the ride, and promote the service in the community by branding the commuting vehicles with vaccine and schedule information. Dedicated vehicles will offer fixed-price, round trip transportation to vaccination centers along specific routes with designated pick-up and drop-off times. In addition to improving access to vaccination, this system will work to improve gender equality in Pakistan; the ability to travel independently decreases female dependence on male family members. They will test it in a rural setting or urban slum in Pakistan and evaluate the number of users, number of children vaccinated, and estimated impact on vaccine coverage.

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.

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.

Danya Arif, Subhash Chandir, and Qadeer Baig of IRD Global in Singapore will develop and implement a school-based initiative in Pakistan to train adolescent girls to provide practical immunization information to parents and caregivers and thereby increase vaccination coverage in peri-urban areas. Poor compliance with routine immunization schedules puts children at risk of vaccine-preventable disease; some of the most vulnerable are urban-slum communities where traditional methods to increase vaccination uptake have failed. As an alternative approach, they propose to create a strong community force of adolescent girls, trained in leadership and communication skills and educated on basic immunization facts, to counsel mothers in their community on the importance of timely vaccination and provide them with practical information on clinic locations and schedules. The girls will also be equipped to identify never- and under-vaccinated children. They will pilot test their approach in ten schools in two peri-urban slums in Karachi city with 500 female students in grades eight to ten. They predict that mothers will be more likely to accept and act on information delivered by these girls as accepted members of their community, and training the girls as adolescents will have a sustainable impact: as they themselves become mothers they will be lifelong advocates for childhood immunization.

Subhash Chandir, Danya Arif, and Ali Habib of IRD Global in Singapore will develop a text-based immunization chatbot that uses artificial intelligence (AI) and natural language processing to provide vaccine education and practical information to caregivers to improve vaccine coverage in Pakistan. Although free clinics exist, many children remain incompletely vaccinated because caregivers are unaware of the importance of immunization and uninformed about clinic locations and schedules. They will develop Bablibot – a chatbot to replicate interactive human conversations and able to understand caregiver queries and respond with automated text messages. The bot will provide information on immunization locations and schedules, address post-vaccination concerns, and prompt caregivers when vaccinations are due, easing the burden on overworked health workers. Chatbot conversations will be validated through human-in-the-loop (HITL) to enhance AI potential and, if needed, connect the caregiver with a human being. It will be widely accessible as it works via text. It will be pilot tested by integrating with the existing digital immunization registry of over one million children and recruiting 5,000 caregivers. The ability of Bablibot to provide accurate information, continuity of care, and convenient interaction with the healthcare system could increase immunization demand and coverage.

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.

Anne de Groot of the GAIA Vaccine Foundation in the U.S. will design and distribute fabric baby wraps that graphically display the infant vaccine schedule to new mothers in Niger to encourage vaccine completion and reduce child mortality in West Africa. Lack of access to education, early marriage, and a high adolescent birth rate contribute to the fact that one in ten children in Niger die before age six, many from vaccine-preventable diseases. The government provides free vaccinations for the first year of life, but a low literacy rate and lack of trained staff offer little support for mothers to follow the chart, which is currently provided in booklet form, resulting in poor vaccination coverage. They will collaborate with Nigerian artists to translate the chart into a pattern of local shapes and symbols that can be understood without the need to read. The pattern will be printed on fabric wraps traditionally used by West African mothers to carry infants and distributed to new mothers at medical centers. When worn in the community, they will increase awareness of the vaccination program and create positive peer pressure among mothers to follow-through with the full schedule of vaccinations in the first year.

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.

Doyeon Pi of PiQuant and Ki-Hun Jeong of the Korea Advanced Institute of Science and Technology both in the Republic of Korea will develop their small, low-cost, water quality test equipment and a GIS-based monitoring system to continuously map water quality in real time across Vietnam. Despite the extensive river network running though the country, many Vietnamese remain short of clean water. Drinking water can be polluted by many different pathogenic microorganisms such as Salmonella that cause disease. Spectroscopic devices are used to monitor water quality, but they require expensive time-consuming procedures to remove background noise and improve accuracy. They have built a small spectroscopic device incorporating a noise-cancelling algorithm that can quickly and accurately measure water quality at a much lower cost than traditional devices. They will collaborate with universities and research institutes in Vietnam to identify the major water pollutants in each region and develop a prototype water scanner. This will be distributed in a pilot area to demonstrate preliminary proof of performance for measuring water quality. They will also set up a GIS-based monitoring system that maps the water quality data and provides users with easy access.

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.

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.

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.

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.

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).

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.

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.

Galaletsang Tsontswane of Congretype in South Africa will design low-cost, solar-powered insect detection traps equipped with wireless sensors to capture images of insects and transmit them to a central control point to improve rural crop surveillance in developing countries. Crop loss due to pest infestation negatively impacts both food supply and local economies, while rural farmers in developing countries lack resources to monitor crop disease and infestations and are unable to respond before substantial loss occurs. They will design and deploy intelligent insect traps equipped with cameras and test their ability to capture images of trapped insects within a study area and to wirelessly transmit the data to a central location via an existing TV white space network. The data can then be stored and accessed by local farmers and agricultural extension workers, allowing them to respond more quickly to crop threats than is currently possible based on data from laborious, human-based monitoring systems.

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.

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.

Tisungane Mvalo and Gerald Tegha of Lilongwe Medical Relief Fund Trust along with Msandeni Chiume at Kamuzu Central Hospital both in Malawi, Emily Ciccone from the University of North Carolina in the US and Pascal Lavoie of the University of British Columbia in Canada will establish metagenomic next generation sequencing at a research laboratory in Malawi to identify pathogens causing infections in young infants to ensure rapid treatment with appropriate therapy and limit unnecessary antibiotic use. It is estimated that over a quarter of the 2.9 million neonatal deaths that occur each year are caused by infections. Given these high numbers, antibiotic treatment has become the standard practice for all young infants that have a suspected serious bacterial infection. However, a recent study using clinical microbiology approaches only identified an infectious agent in half of suspected cases, suggesting that antibiotics are often being used unnecessarily. They will sequence blood samples taken from infants under three months of age with suspected infections and vaginal swabs from mothers enrolled in an existing study in an urban hospital to identify infectious agents. They will also evaluate the presence of antimicrobial resistance genes and see if they can be linked with maternal vaginal flora. Overall, they aim to characterize the pathogen landscape associated with suspected infectious diseases in young infants.

Fatema Khatun of the International Centre for Diarrhoeal Disease Research, Bangladesh in Bangladesh will develop a digital intervention to enable sharing of existing digital health data between community health workers and provide them with feedback indicators along with tailored messaging to parents to improve timeliness and coverage of vaccination against tuberculosis in rural Bangladesh. Tuberculosis is the number one cause of death by infectious disease worldwide, and 95% of deaths occur in developing countries. In Bangladesh, the bacille Calmette-Guerin (BCG) vaccine against childhood tuberculosis is usually administered at six weeks of age, despite the fact that vaccination at birth could decrease mortality by three percent – a significant number of cases in this tuberculosis-endemic country. Immediate vaccination is especially important for high risk neonates including low-birth-weight babies and those born to hepatitis B-positive mothers. The digital intervention strategy will be developed to combine the existing electronic health record system with the pregnancy and childbirth registry and to provide digital communication between the community workers providing prenatal and delivery care and those providing BCG vaccination. This will ensure that newborns at increased risk for tuberculosis are prioritized for immediate vaccination. The system will also send direct messages to mothers before and after birth, reminding them of the importance of timely vaccination. Their approach uses existing data in a new way to improve overall vaccination rate and timeliness and decrease infant mortality.

Matthew Edmundson of Violet Health in the U.S. will develop iron-rich biscuits and tailor marketing campaigns to combat iron deficiency in adolescent girls in India. Iron deficiency is a global health concern and is particularly dangerous during pregnancy when it can increase the risk of maternal death and health problems for the infant. Nearly half of all adolescent girls in India are iron-deficient, and although iron tablets are available they are not taken properly, partly due to their bad taste and a cultural aversion to tablets. Thus, more culturally acceptable alternatives are needed. To address this, they developed a low-cost, iron-rich biscuit that could overcome anemia and non-compliance to iron tablets in clinical tests with pregnant women in India. They will now focus on helping low-income adolescent girls by adapting the biscuits to their nutritional needs and preferences, which will be determined by interviewing 50 girls from different areas. These insights will also be used for a pilot marketing campaign to generate demand amongst the girls and their families and community members. They will test their approach with 300 girls from rural and urban locations in India to determine the effects of different marketing methods on demand.

Lyndon Paul of Vissot Co Ltd in Cambodia will reduce production costs for their nutritional wafer biscuits, which are made from a micronutrient-fortified fish powder, to help treat severe acute malnutrition in children and prevent malnutrition in young children and pregnant women in Cambodia. Acute and chronic malnutrition are a major public health concern in Cambodia. They previously developed a fortified fish powder and showed that it could replace milk in food for infants and was effective at reducing malnutrition. However, unstable supply and variable quality of the inland fish used to make the wafers have led to fluctuating prices. To address this, they will set up an optimized supply chain to reduce production costs by 60%. They will train workers in five communities where the fish are caught to sort, clean and pack the fish for transport to their factory in Phnom Penh. There, the fish will be processed into fish meal with acceptable taste and texture. They will evaluate the supply chain by collecting data from the fishers to the final product and evaluate quality and food safety.

Muthupandian Ashokkumar at the University of Melbourne in Australia, along with Francesca Cavalieri, Meifang Zhou, and Srinvas Mettu, will produce edible microballoons made from protein that contain essential nutrients for adding to common foods to combat malnutrition in mothers and infants. Encapsulating the nutrients, rather than adding them directly to food, helps keep them stable and promotes their absorption in the body. It can also mask unpleasant tastes, and control the timing and location of nutrient release, which can increase their performance. They have developed a method that uses ultrasound waves to encapsulate oil- and water-soluble vitamins and minerals within edible shells made from a range of proteins including milk and pea proteins. They will analyze the stability and strength of microballoons made from different materials that contain the recommended daily doses of nutrients for mothers and infants. They will also develop methods to encapsulate water, which could be used to reduce the fat content of fat-rich products.

Gloraia Pena of Cooperativa Multiactiva De Madres Del Valle Coomac in Colombia will implement a hybrid value chain business model to leverage collective purchasing power in a community of low-income families in Colombia to reduce the price of nutritious local foods. Current food prices are relatively high for low-income families because they buy in small volumes. They will combine collective purchasing power with a hybrid value chain model, which incorporates the needs and roles of the public and private sectors, to increase access to nutritional foods. They will collect social and economic data from an existing group of 9,000 families in a poor neighbourhood in Colombia to understand how their approach should be implemented. This will include the numbers of participants needed to reduce the cost sufficiently to encourage people to buy the healthier foods and ultimately produce a positive long-term impact.

Amanda Stiles of Ripple Foods, PBC, in the U.S. will produce a low-cost protein isolate upcycled from locally-sourced agricultural by-products that can be used as a nutritious food additive or standalone high-protein broth. Protein malnutrition is a major health concern in southern Asia and sub-Saharan Africa. However, protein is expensive to produce and often has a bad taste. They have developed an automated approach to identify low-cost, efficient methods to isolate plant proteins from agricultural by-products in the U.S. They will apply their approach to by-products from low-resource settings, such as wheat bran, and perform a high-throughput protein isolation screen to identify optimal extraction and purification protocols for yield and purity. The final products will be taste-tested to ensure they have a limited impact on flavor when used as food additives.

Joshua Warren and Daniel Weinberger of Yale University in the U.S. will develop an analytical framework to improve local estimates of vaccine coverage in low- to middle-income countries. Current estimates can be unreliable, due to errors and biases in record-keeping and difficulties in estimating local population sizes, and are further complicated when children are vaccinated outside of their home administrative district. They will develop advanced spatial analytical methods including bias adjustments that take these issues into account and can generate more reliable local estimates also from poor quality data. They will collect higher quality survey data on vaccine coverage and population sizes from selected locations to calibrate and ultimately validate the estimates. Their approach can be used in other low-income settings to improve vaccine coverage.

Ali Turab of IRD Global Ltd. in Singapore will develop a decision support tool that can be integrated with digital immunization registries to automatically construct optimal appointment schedules for every child that can adjust for missed immunizations and the introduction of new vaccines. A large majority of children, in both developing and developed countries, are not immunized at the recommended times, which can increase the risk of severe diseases. When a vaccination is missed, it is left to the health care professional to work out the best alternative schedule, which is often inaccurate. To help with this, they will design software that incorporates a child's vaccination history and age to automatically construct a new immunization schedule after every appointment, and that can also identify opportunities to vaccinate children even when they are at a clinic for other reasons. The software will integrate with existing health systems in several developing countries. They will conduct a mixed methods study at the Indus Hospital Korangi Campus in Pakistan to validate their approach for generating optimal schedules and assess usability by health workers.

James Njeru of the Field Epidemiology Society of Kenya will develop an integrated electronic platform that collects immunization and health data from existing registries and automatically sends regular, user-defined reports via SMS and email to health workers to improve vaccine coverage. Healthcare facilities record their immunization data on District Health Information Systems, but access to the data is limited. To widen access, they will build a platform that analyzes relevant health data from various sources, which will improve data accuracy, displays it on dashboards, registers users, and tracks their activity. They will pilot test their platform over seven months by registering program staff and managers so that they can access the platform and receive reports. The platform will be evaluated for its ability to integrate data and produce reports such as coverage and dropout rates. Feedback from users will also be used to refine the platform.

Chibuzo Opara of DrugStoc E Hub Ltd. in Nigeria will equip vaccine storage and transport sites with calibrated weighing mats (Digimats) that automatically transmit vaccine quantities in real time to better monitor delivery chains in the community and improve supply. Monitoring the movement of vaccines at the national and district level is currently performed by the Nigerian immunization program. However, accurate monitoring at the local level requires alternative, more automated approaches to avoid human error. They will calibrate their Digimats to recognize the weight of specific vaccines, and identify 20 sites across three states, including storage warehouses and trucks, where they will be positioned to automatically transmit data over a period of six months. These data will be collected by mobile tablets and interfaced with the national vaccine delivery dashboard to provide real-time stock counts and resupply alerts.

Mustafa Naseem of the University of Michigan in the U.S. will apply machine-learning algorithms to identify potentially falsified digital vaccination records in Pakistan. Pakistan is one of only three remaining countries where polio is still endemic. Particularly rural healthcare facilities are struggling to provide enough vaccinations due to highly populous provinces and a lack of resources and staff, and there is a risk that records are falsified to save time or bias the results. They will first perform fieldwork to identify any putative recently falsified records by auditing 2,000 recorded vaccination events across 200 randomly-selected villages. These data will be used to generate an algorithm by using features such as record patterns that can then detect if a data-point is likely to be true or false. They will test their approach by auditing another 1,000 vaccination events that the algorithm predicted were falsified compared to 1,000 randomly selected vaccinations.

Julius Lucks of Northwestern University in the U.S. will develop a low-cost diagnostic test that can detect multiple plant pathogens with a simple visual output for farmers in low-income countries to better monitor their crops. Current diagnostic field tests can only detect one disease and are generally difficult to use and costly. The alternative is laboratory testing, which is often unavailable in low-resource settings. Taking a different approach, they will develop a sensitive, multiplexed test that only requires basic sample preparation, such as mixing and using body heat, and can detect multiple pathogens using biosensors. The results will be visually presented using color changes that can be recorded by cell-phone cameras for analysis and reporting to aid global plant pathogen surveillance efforts. They will develop the methods and tools to detect three model plant pathogens and field test their diagnostic system in the U.S., Uganda, and Kenya.

Jun Kameoka of Texas A&M University in the U.S. will develop multiplex, battery-less and wireless durable paper sensors for positioning under the soil in crop fields to detect the early signs of pests and diseases, and communicate the data to overhead drones via radio frequency to improve pest management. The sensor will be designed to monitor physical, biological and chemical soil conditions that are altered by plant diseases. They will test its performance in commercial garden soil with maize and sorghum plants in a vinyl house.

Jan Kreuze of the International Potato Center in Peru will develop a low-cost, mobile phone-based diagnostic test for African farmers that uses artificial intelligence to quickly and accurately detect plant diseases such as cassava brown streak and banana bunchy top, which devastate crops and are threatening to spread. Accurately diagnosing plant diseases is difficult because visual symptoms can be highly variable. Artificial intelligence (AI) has shown promise for analyzing images of plants taken by mobile phone to detect diseases in low-resource settings, but it is not accurate enough. Alternatively, chemical-based diagnostic tests that detect the underlying viruses are far more accurate but difficult to use without training and require costly equipment. They will enhance the accuracy of AI for diagnosing a range of plant diseases by mobile phone by training it with validated diagnostic test results from their microfluidic amplification and detection device used by researchers and inspection agents. Their approach has the potential to recognize hard-to-detect symptoms in plants that may even be missed by crop specialists.

David Hughes, and Nita Bharti of Penn State University in the U.S. together with James Legg at the International Institute of Tropical Agriculture in Tanzania and the Charity, Self Help Africa, will leverage daily, high-resolution satellite imagery of farms in Kenya to monitor crop pests and diseases. Publicly funded satellites have the capacity to measure crop health, soil moisture, and water availability across wide areas. However, they are unable to accurately diagnose crop diseases particularly in smallholder farms because of the presence of many different types of often unhealthy-looking vegetation caused by lack of water or nutrients rather than plant diseases. They will use ground data on crop diseases and pests being collected as part of a five-year EU-funded project at 1,400 farms in seven counties growing a variety of crops. They will also collect maps of the farms using drones flying at different heights and see how well any pests and diseases can be detected using the daily satellite data. They will validate their approach for detecting pests and diseases on an additional 1,400 farms.

Matteo Rinaldi of Northeastern University in the U.S. will develop a miniaturized, maintenance-free chemical sensor that can detect specific volatile organic chemical vapors released from diseased crops as an effective surveillance system suitable for low-resource settings. Manual surveillance is time-consuming and requires prior knowledge of disease symptoms. Automated, sensor-based crop surveillance is far more effective, but relatively expensive, and the sensors constantly consume power, making them unsuitable for low-resource settings. They will develop a low-energy sensor-based monitoring system by exploiting a recently developed technology that comprises a micromechanical switch made of two cantilever beams. One of the beams will be coated with a polymer sensitive to the plant-based chemical and exposed to the environment. In the presence of that chemical, the beam undergoes a change in mechanical stress, causing it to bend and make contact with the second beam to trigger the switch. They will develop the microswitch-based chemical sensors, integrate them with a low-power long-range wireless module to signal pest detection, and test the performance of prototypes in the laboratory.

Monica Nolan of MU-JHU Care Limited in Uganda will adapt the existing open source Smart Register Platform, which digitally stores health records, for the real-time collection and transfer of immunization data, to improve vaccine coverage and other healthcare services for women and children in Uganda. In many low- to middle-income countries, records of childhood vaccinations are usually written by hand and can be poor quality. Digital records are of better quality and value, as they also enable the integration of different types of healthcare services, such as HIV services and vaccinations, to improve overall health. They will adapt existing technology and infrastructure, including the Smart Register Platform, which is already integrated into several national health systems and can produce automated SMS reminders of appointments. They will also design methods informed by mothers with young families, health workers and managers, to optimize data use and delivery of health services. They will use surveys and analyze health data to evaluate their approach for improving vaccine timeliness and coverage at selected clinics.

Chinedu Chugbo of Avigo Health L.L.C. in the U.S. will develop an approach to crowdsource reports of infant births and deaths from community members by health workers to better monitor vaccine coverage in low- to middle-income countries. In Nigeria, only 30% of births are registered, making it difficult to estimate numbers of vaccine-eligible children and ensure every child is properly vaccinated. Current methods for estimating population sizes include household surveys, which are costly, or records from health clinics, which suffer from limited coverage. Crowdsourcing is a proven method for efficient data collection, although data quality may be variable. They will develop electronic data-collection and storage tools and pilot test their crowdsourcing approach in a selected region in Nigeria. Health workers will be trained to administer brief interviews to community members visiting clinics and during outreach programs to document local births and deaths. They will evaluate the performance of their approach and particularly data accuracy by comparing it with data collected by household surveys in the same region.

Owens Wiwa of the Clinton Health Access Initiative in Nigeria will develop an efficient and reliable system for tracking diagnostic samples and delivering results to improve the efficiency of HIV diagnosis and treatment of newborns in Nigeria. Over 3.5 million people in Nigeria are estimated to be living with HIV, and every year up to 40,000 newborns become infected. Many HIV-exposed infants are not properly diagnosed or monitored, leading to delays in treatment and worsening of the disease. With input from health workers and scientists amongst others, they will adapt an existing unstructured supplementary service data (USSD) platform linked to laboratory information management system (LIMS) software so that the health facilities and diagnostic laboratories can track individual samples and monitor results via mobile phone. They will select health facilities and train staff to pilot test the platform over 12 months.

Sarah Murray and colleagues of Johns Hopkins Bloomberg School of Public Health and School of Nursing in the U.S. along with colleagues at the University of Bamako in Mali will develop a group approach to provide better antenatal care to pregnant adolescents in Mali and protect them from common mental disorders such as depression. Over half of adolescent girls in Mali have a child before their 18th birthday, and as a consequence are more likely to live in poverty, be uneducated, and experience violence. Although antenatal health services and support are available, they are limited. To address this, they will develop a group format for more efficient delivery of antenatal mental health care that encourages open discussions and provides social networks and support. This will be done in collaboration with adolescent mothers, their husbands, and health care providers. They will train health care workers to teach relevant coping strategies in a group format using cognitive behavioral therapy techniques, and pilot test their approach on small groups of pregnant adolescents with partners in Bamako, Mali.

Günther Fink of the Swiss Tropical and Public Health Institute in Switzerland will develop a mobile phone-based system to improve the registration of births and the timeliness of childhood vaccinations in Ghana. Particularly in Northern Ghana, many women give birth at home and are less likely to ensure their infants get vaccinated on time, which exposes them to severe infectious diseases such as polio. Even in these low-resource settings, mobile phones are common, and have been successfully used to encourage healthy behavior. They will develop an automated mobile phone system that rewards users when they record a birth or obtain early vaccination, and sends text reminders to encourage mothers to get their infants vaccinated. They will conduct a pilot study with around 300 mothers and community volunteers in Northern Ghana to assess the feasibility and impact of their approach for improving birth tracking and for convincing mothers to get their child vaccinated within their first month of life.