Lorraine Weatherspoon of Michigan State University in the U.S. will develop a blended instant bean sauce in an edible pouch that provides a culturally-acceptable iron and folic acid supplement for low-income pregnant women in Uganda. Iron and folic acid are particularly important during pregnancy as they reduce the risk of low birth weight and neural tube defects amongst many other morbidities and mortalities also for the mothers. Supplements provided as tablets are available, but have not been widely accepted. They are developing a more appealing iron and folic acid supplement by combining it with a commonly used product: a bean and silver fish sauce that can be made with local ingredients. They are using dried namulonge beans as they have high yields and a desirable taste, mixed with roasted, milled silver fish and micronutrients, packaged in an edible film to protect the food during storage and transport. The food is cooked in hot water and eaten with traditional foods such as cooking banana or rice. They will assess the nutritional composite of the product and acceptability by the target group. Their product will then be tested in a randomized controlled trial with teenage women at different stages of pregnancy at an antenatal clinic in Kampala to determine its effect on nutrition during pregnancy and the overall health of the mother and child at birth.

Joachim Loo of Nanyang Technical University in Singapore will develop techniques to encapsulate micronutrients such as iron for food fortification using okara, which is a nutritionally-rich pulp that is made as a wasted by-product during the production of soybean products. Micronutrient malnutrition affects two billion people globally. Providing micronutrients in the diet is difficult because they are unstable by themselves, and so need some form of protection, for example by encapsulating them in a stable, digestible material. Okara is produced in large quantities during the production of soybean products like tofu and soya milk, leading to high environmental and economic costs for disposal. They will determine whether okara can be repurposed as an encapsulation material for micronutrients by developing and testing drying and sterilization methods and designing protocols to encapsulate vitamin A and iron. They will then evaluate the ability of the okara microcapsules to release bioactive micronutrients when exposed to artificial gastric and intestinal fluids.

Owens Wiwa of the Clinton Health Access Initiative in the U.S. will determine whether providing free vouchers for mothers to receive a nutrient-dense food can help infants with moderate acute malnutrition in Nigeria. By linking the vouchers to attendance at immunization clinics, they also hope to boost immunization coverage. Malnutrition is a major public health concern in Nigeria, where almost one third of children are underweight, and ten percent are wasted. However, improving nutrition in poor and rural households is difficult because of a lack of education and limited access to nutritional foods. They will pilot test their approach in a randomized controlled trial at two locations by training healthcare workers at immunization centers to council mothers on feeding practices and to monitor infant growth to identify malnutrition. The mothers of malnourished infants between six and 23 months old will be provided with vouchers to receive three months' worth of an existing fortified food, which will be provided at a local health facility. They will evaluate the effect of their approach on the infants' nutritional status and immunization coverage.

Tsegaye Nega of Carleton College in the U.S. will develop methods to produce and distribute affordable nutritional food supplements made from excess, dried spent grains from the brewery process. Beer production has grown recently in Ethiopia, and a by-product, brewer's spent grain, is rich in fiber and protein and can be easily added to bread to boost its nutritional content. They will perform a pilot study in Addis Ababa and Dukem, Ethiopia, where they will partner with a major brewing company to access the starting materials, and determine the standards needed for this human-grade food and the production and distribution setups required. They will also further develop nutritional product marketing and testing. Their approach is a low-cost, sustainable solution to combat malnutrition in Ethiopia.

Samantha Dolan and Peter Rabinowitz of the University of Washington in the U.S., and Ian Njeru of I-TECH Kenya, will improve digital data collection and monitoring of childhood immunizations at Kenyan health facilities by optimizing workflows. Using electronic tools to track immunizations has the potential to improve the accuracy of data collection and reporting, identify children who have not been vaccinated, and free up time for health care workers. To fully realize this potential, workflow patterns need optimizing for different types of health facilities. They will use an iterative approach with so-called Lean methods to maximise value while reducing waste, and time-motion study techniques to evaluate current workflows and identify bottlenecks that reduce efficiency. These workflows will then be redesigned and tested across different sizes and types of facilities in Kenya. They will also compare the efficiency and performance of electronic registries with paper-based registries.

Matt Berg of Ona in the U.S. will combine high-resolution satellite images, spatial sampling statistics, and mobile data collection to better calculate local immunization coverage in Bangladesh. Current approaches often vastly overestimate coverage because of the difficulty in calculating actual population sizes from nationwide data and birth registries. As a more effective approach, they will use satellite imagery to detect liveable structures within a set area, and software that selects possible households that require verification by community surveillance teams. These teams will be supplied with offline maps and a mobile application to note actual households and record the immunization status of any children under five. These data will then be used to generate maps to visualize actual coverage and identify areas with the greatest immunization needs. They will develop tools for automation, coverage calculations, and map visualizations to supplement their existing mapping and mobile data collection tools and test their approach in a research site in Bangladesh.

Ross Boyce at the University of North Carolina in the U.S. will develop an approach that uses new methods of mapping households together with available health data to better identify places that have limited access to healthcare to improve immunization coverage. Many sub-Saharan African countries have very poor rates of childhood vaccination coverage. Improving coverage requires identifying those households and areas with poor access to healthcare, but this is challenging with the limited data available. To more accurately measure healthcare access and thereby immunization coverage, they will perform a six-month study in a rural sub-county of western Uganda. By providing user-friendly tools to health workers and providers, they will generate more accurate household maps and assess three different metrics of healthcare access using freely available software and a Bayesian statistical framework. They will evaluate the accuracy of their approach for predicting coverage by conducting a cross-sectional survey to determine the vaccination status of all children aged between 12 and 23 months in the sub-county.

Michael Nunan of Beyond Essential Systems in Australia will build on their existing data platform to collect and analyze vaccine data in real-time to provide an early warning of areas or facilities with low immunization coverage. The platform integrates data from various sources, including vaccine supply and healthcare infrastructure such as equipment and staff. They will further develop it to record actual vaccine administrations from health workers entering details on mobile phones, and to produce local estimates of vaccine demand and actual coverage and provide alerts. They will also integrate real-time monitoring of the cold supply chain using sensors. Their system will be evaluated in the Solomon Islands and Vanuatu by comparing it with current methods for estimating vaccine demand and coverage.

Benjamin Fels and Suvrit Sra of Macro-Eyes, Inc. in the U.S. will engage with frontline health workers in immunization centers and combine their knowledge with existing supply chain and immunization data using machine learning to better predict vaccine demand and thereby improve immunization coverage. Vaccine supply levels in Ethiopia are predicted using data that may be inaccurate or outdated. These low-confidence data could be enhanced with the unique insights of frontline health workers by using machine learning, which is a valuable statistical method for increasing the accuracy of predictions. They will test this at three health centers in Ethiopia by exploring approaches such as WhatsApp to engage health workers and collect relevant information on vaccine stocks and demand in the clinics. These data, along with available supply data, will be used to train so-called classifiers, or algorithms, that transform the input data into more accurate predictions of monthly vaccine use. They will test whether their method improves the accuracy of predictions compared to the original methods.

Pierluigi Bonello of Ohio State University in the U.S. will develop a surveillance system for crops using unmanned aerial vehicles (drones) to position sensors to help diagnose plant diseases in low-income countries. Plant diseases are usually identified first by the farmers or human scouts and then confirmed by laboratory testing. This process is inefficient and requires resources often unavailable in low-income countries, calling for alternative approaches. It is known that when a plant becomes infected, it produces specific chemicals. In addition, functional chemical groups in biological samples are known to vibrate in predictable ways after absorbing light. They will test whether this information can be exploited for the rapid and widespread detection of two plant diseases, rice blast and maize dwarf mosaic, by vibrational spectroscopy that could be positioned inside crop canopies by drones. Rice and maize grown in greenhouses and fields in the U.S. will be infected, and they will develop statistical methods to evaluate whether handheld spectrometers can distinguish between infected and uninfected plants. This technology could ultimately allow crop managers to control the spread of a disease even before plants show visual symptoms.

James Bell of Rothamsted Research in the United Kingdom will test an integrated surveillance system for the real-time detection of ground and upper atmospheric levels of the fall armyworm, which is a moth that devastates maize crops. Maize is a vital food source in Kenya but is currently largely imported and has become too expensive for most households. They propose to help local farmers grow maize by developing an early warning system for the African moth pests. Their system will integrate an entomological radar to detect moths flying up to 1,200 metres overhead, with twenty ground traps covering 7,000 km2 that transmit data to a central institute, and a smart-phone application for workers and growers that automatically detects the caterpillars and moths. They will optimize the equipment and software to detect the specific moth species and test it in a region of Western Kenya over one year. Their system will also reveal details of seasonal moth migrations, ground spread, and crop growth to help develop effective pest management strategies.

Bruce Grieve of Manchester University in the United Kingdom will develop a low-cost, stereo-printed sensor that mimics plant leaves and stems and can detect and signal the presence of live pathogens as an early warning system to help protect crops in low-resource settings. They will demonstrate proof-of-concept of their approach in the laboratory by designing three dimensional sensors with specific patterns of cells and chemically-doped polymers to identify an ideal surface on which pathogenic fungal spores can grow and differentiate. Incorporated sensor cells will be designed to detect the live pathogens and produce a detectable response, such as a visible density change, and results can be stored locally or transmitted wirelessly. They will test different sensor designs for the detection of rust pathogens in wheat. Their approach can be adapted to detect multiple pathogens simultaneously, including viruses, as well as for human and livestock pathogens, and when deployed in the field can ultimately be linked to national surveillance systems.

Christopher Gilligan of the University of Cambridge in the United Kingdom will develop a data collection and analysis platform for crop diseases that uses Bayesian modelling frameworks to better integrate data from diverse sources and identifies cost-effective pest and disease control solutions for small-holder farmers. Current crop disease surveillance programs generally collect data from limited sources and lack the capacity to use the data to advise farmers how to manage any disease outbreaks. By integrating a wider variety of data, including meteorological data, and grower and market behaviour such as household nutrition, their approach can predict much broader consequences of crop diseases on individual households and thereby provide more valuable solutions. They will focus on pests and diseases of maize, wheat, and cassava in East Africa and pilot test their SMS and smart phone platform by holding training workshops for participants, testing data analytics and validating the results.

Menale Kassie of the International Centre of Insect Physiology and Ecology in Kenya along with Ram Fishman and Opher Mendelsohn from Tel Aviv University in Israel will take a community-based crowdsourcing approach to crop protection of smallholder farms in low-resource settings by developing a simple software platform for basic feature phones to monitor pest incidence. Human-based monitoring of crops is the most accurate way to identify pests, but there are too few public monitoring agents in low-resource settings, leaving the majority of farms unprotected. Engaging the smallholder farmers to monitor their own crops is a promising solution, but most of them lack sophisticated equipment like smart phones and have low technical knowledge, so simpler solutions are needed. Therefore, they will adapt commercially-available software that collates and analyzes pest incidence data for basic feature phones and, together with smallholder farmers, design simple interfaces for SMS communication. They will test their approach by performing a pilot study to monitor wheat and maize, covering one to two counties in Kenya, and teach smallholder farmers and government agents how to use the monitoring system and compare the data with that collected by expert field agents.

Janos Zempleni of the University of Nebraska-Lincoln in the U.S. will test whether supplementing milk formula with exosomes from milk could have the potential to improve the growth of babies aged between 6 and 12 months and help protect them from infections. Exosomes are membrane-bound vesicles naturally present in all bodily fluids and are thought to transfer small molecules such as RNAs between different cells to regulate various cell functions. However, during the production of milk formula for babies, the exosomes are destroyed. They have preliminary data demonstrating that RNAs and exosomes in milk enhance growth and the immune response in mouse pups. They will expand these studies to confirm their results in mice, with a view to progressing to clinical trials to test the value of exosome-fortified milk formula in humans.

Aaditeshwar Seth of OnionDev Technologies Pvt. Ltd. in India in collaboration with the University of Montreal Hospital Research Centre (CRCHUM) via the Tika Vaani project, will develop a smartphone application and digital processing techniques to digitize childhood immunization data from photographs of vaccination cards taken by health workers during clinic visits and store the data in a cloud to monitor adherence and send reminders to families. They will perform an 18-month pilot project to develop the application and optimize data collection and analyses, use by health workers, and performance of the messaging service for encouraging families to get their children properly vaccinated. The application will be designed around field conditions to account for low internet connectivity and the capabilities of health workers in India and will be linked with other digital health platforms to improve the overall quality of healthcare.

Amanda Nguyen of Rise Inc. in the U.S. will scale-up the existing grassroots social justice movement that they have established in the U.S. to create actionable recommendations to support the rights of survivors of sexual violence worldwide. Thirty-five percent of women – 1.3 billion people worldwide – are survivors of sexual assault, but many are denied basic rights and access to justice. Rise International’s approach involves communicating survivor stories, building alliances with influential people, and maximizing visibility through media coverage.

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.

Joanna Busza of the London School of Hygiene and Tropical Medicine in the United Kingdom will help vulnerable young mothers who sell sex in Zimbabwe by involving them in designing self-help groups incorporating virtual meetings via social media to build support networks and teach them life skills such as money management and parenting. Adolescent sex workers who become mothers are at high risk of developing mental health problems such as anxiety and depression, and often have little support caring for their children. They will involve adolescent women in the design stage by holding interviews and group discussions to gather opinion on social media and group meetings, as well as identify the types of skills they most need and how best to teach them. They will train peer educators to lead six-month virtual support groups and recruit young, pregnant sex workers to pilot test the approach in two urban sites in Zimbabwe.

Tara Hopkins of Mali Health in the U.S. will develop methods to improve vaccination coverage in rural communities in southern Mali by engaging community health workers together with traditional birth attendants who are present during home births. In southern Mali, particularly in rural communities, most children are born at home, so they are not registered with a health clinic or present for critical childhood vaccinations. Local health services have limited funds and resources to manage the health records of all the babies born in their communities, or to follow-up with families regarding the necessary vaccinations. This translates to low vaccine coverage of around 9% in some regions, and increased incidences of deadly infectious diseases. They will pilot the project in three rural health districts and create a quality improvement team in each, consisting of a coach, local health workers, birth attendants, and mothers. The teams will be given tools to engage in a group effort to identify the barriers to timely vaccinations, and generate solutions to test.

Xing Xie of the Georgia Institute of Technology in the U.S. will test whether super-absorbent polymers in sample tubes can improve the accuracy of diagnostics by absorbing molecules like DNA and viruses from liquid samples such as blood, and protecting them during transport to the laboratory. Normally, blood and urine samples degrade over time, particularly when they are exposed to heat or cold. This makes the subsequent diagnostic result unreliable. They propose that low-cost, super-absorbent polymers can preserve diagnostic target molecules by separating them from contaminating cells and bacteria, which can be poured away from sample tubes, and providing a pH buffer and preservatives to extend their shelf-life. They will optimize synthesis of the beads and test their ability to preserve different analytical targets including a human virus surrogate and an antibody against HIV.

Gerard Cangelosi of the University of Washington in the U.S. will develop reagents to visually validate oral swabs and stabilize them for storage and transport to diagnostic laboratories in low-resource settings without the need for a cold chain. Oral swabbing to extract saliva is a non-invasive and effective method for diagnosing tuberculosis, and is faster and safer than traditional sputum collection. However, it is more difficult to review the quality of a swab sample as they are hard to see, and processing currently requires refrigeration. To address these limitations, they will develop a low-cost, quality control test with chemical reagents for detecting human mitochondrial DNA using human oral swabs from U.S. volunteers spiked with an avirulent strain of Mycobacterium tuberculosis. This will be coupled to a visual fluorescent readout that can be used to distinguish adequate from inadequate samples. They will also test different buffers for their ability to stabilize the swab samples at different temperatures for up to six months.

Dyuti Sen and Tushar Garg from Innovators in Health in India will test whether a communal game of snakes and ladders in maternity health clinics and in homes of pregnant couples can demonstrate the value of childhood immunization to improve coverage in rural communities in Bihar, India. Gameplay may be a valuable way of informing parents about the importance of immunizing their children because it is fun and interactive. Snakes and ladders, which is a popular game in India, can also visually illustrate the positive (ladder) and negative (snake) effects of immunization, such as the economic cost of having a sick child. The board is built up interactively by the parents as they make choices about vaccinating their children from the start (newborn) to the finish (fully protected child). They will train community health workers to facilitate communal games of snakes and ladders, trial their approach in around 15 municipal wards over 12 months, and determine its impact on immunization coverage and local knowledge.

Agnes Ronan, from Pediatric Adolescent Treatment Africa, in South Africa will develop a training and supervision tool for young health workers that combines screening and support in an accessible format to reduce depression in HIV-positive, adolescent mothers. There are an estimated two million adolescent mothers living with HIV in Africa, and stigma prevents many of them accessing health care. Young HIV-positive peer supporters work in local clinics and use informal chats, text messages, and home visits to support HIV-positive adolescents. However, they lack the skills to support the mental health of HIV-positive adolescent mothers. They will adapt existing cognitive behavioral therapy methods based on the WHO's Thinking Healthy program, and co-develop their approach with adolescent mothers, peer supporters, and developers. They will train 70 peer supporters from six southern African countries and each will recruit three HIV-positive adolescent mothers to test the approach.

Jan Willem Alffenaar of the University Medical Center Groningen in the Netherlands will develop two simple tests that measure the concentration of anti-tuberculosis drugs in treated patients in low-resource settings in order to optimize dosage and limit the emergence of deadly multi-drug resistant Mycobacterium tuberculosis (MDR-TB). The increased incidence of MDR-TB is due in part to low levels of anti-tuberculosis drugs, thus dosage optimization during treatment is important. However, doing this in low-resource settings is currently challenging. They will develop a method for use in Tanzania to measure the concentration of the anti-TB drug fluoroquinolone in saliva using a battery-operated UV spectrophotometer. They will also modify a high-performance liquid chromatography (HPLC) platform for detecting drug concentrations in dried blood spots, which are collected on filter paper and do not require refrigeration to remain stable. The on-site saliva test will allow detection of patients with too low levels of drug at risk for treatment failure, who can then have their dose optimized following the more detailed dried blood spot analysis at a centralized laboratory.

Jerome Ateudjieu of Meillerur Acces aux Soins de Sante in Cameroon will test whether training community volunteers to record demographic movements and monitor births and immunizations of residents and visitors in their villages can improve timely childhood vaccination coverage in Cameroon. Many health districts in Cameroon have reported outbreaks of vaccine-preventable diseases. One underlying cause is that many people in these regions travel extensively, making it difficult for health facilities to identify newborns that need vaccinating, and to inform parents when and where the necessary vaccinations can be received. They will select 60 villages in the Noun Health District of West Cameroon, and train community volunteers to record the movements and immunization status of infants up to 11 months in their village. These records will be sent by the WhatsApp mobile messaging application to the relevant health facility to identify the children eligible for the next immunization session. The necessary appointments will then be communicated back to the parents by the community worker, who will also inform them of the importance of timely immunization, and encourage pregnant mothers to give birth in health facilities.

Anne Marie Chomat of McGill University in Canada will design an intervention to overcome the mental health problems faced by young mothers in Guatemala by engaging them, along with their partners and fathers, elders, and adolescents in their communities, in order to address the complex factors affecting maternal health. Women in Maya indigenous areas of Guatemala, which has recently faced a civil war, experience particularly high rates of poverty, gender inequality, adolescent births, and mental health disorders. This in turn harms their children, with over 50% suffering from severe developmental delays. They recognize that community members are best placed to find solutions to their own problems and can better promote community-level change. So, they will engage community members from multiple generations and positions, including traditional healers and spiritual leaders, to co-develop an intervention. Their project will take place in four communities in two rural regions of Guatemala, and the community groups will work together to define the problems and contribute to designing and implementing the intervention.

Aleksandra Perczynska from People in Need in Nepal will develop two approaches, namely mobile phone voice messaging (mobile health [mHealth]) and workshops, to improve the mental health of young mothers in Nepal. In 2016, over 15% of Nepali girls aged 15-19 years had children. These adolescents are particularly vulnerable to mental health disorders such as depression, and often have limited support from the community and their new in-laws. They will recruit young mothers and mental health workers to help design the two approaches. mHealth will deliver mental and infant health information using interactive media such as audio dramas via simple mobile phones, which many of these women own, as well as tests to determine whether they understood the information, completion of which will be rewarded with phone credits. The workshops will cover health issues, safety issues such as those related to violence, and life skills such as confidence building, and be held by female community health volunteers who will be further trained in psychology and leading interactive workshops for young women. The workshops will also reach out to the in-laws of the young mothers to educate them on the benefits of mental health. They will implement their approach in an earthquake-affected area and evaluate its impact on the mental health and empowerment of the young mothers.

Bernard Appiah of Texas A&M School of Public Health in the U.S. will produce a one-hour community radio program to be aired twice per week comprising a 10-minute radio drama serial on infant vaccines, a 10-minute panel discussion by community health workers, and a 30-minute phone-in by listeners, to improve on-time childhood vaccinations in Ethiopia. In 2016, on-time and full immunization coverage in Ethiopia was only achieved for 39% of children between one and two years of age, despite long-term efforts to improve it. One of the main reasons for this was lack of communication with mothers about immunizations. To address this, they will harness the popularity of community radio in Ethiopia. They will engage mothers, community health workers, and radio actors to help design a radio drama incorporating relevant topics on childhood immunizations, and train 20 health workers to be part of radio panel discussions. They will air the radio program for six months in two districts, and determine its impact on timely immunization coverage in a selected cohort of mothers with infants.

Chris de Villiers of Sinapi Biomedical in South Africa will produce an improved sample container that ensures sputum samples are of sufficient quantity and quality to diagnose tuberculosis (TB). South Africa has one of the highest burdens of TB, and has implemented a rapid testing program that diagnoses the disease from sputum. However, over 8% (around 218,000) of sputum samples cannot be tested, largely due to insufficient volumes or leaky sample containers. This causes additional costs and leaves many sufferers undiagnosed. In collaboration with clinical, academic, and commercial partners in South Africa and the U.S, they used an iterative design process to develop a new container. They will finalize this design by testing different versions in the laboratory and clinic, and producing two prototypes along with an instruction manual and other training materials. In collaboration with their clinical partner, they will also produce a protocol ready for a large-scale clinical trial that will evaluate the reliability of sputum collection with their new container and collect user feedback.

William Grover of the University of California, Riverside, in the U.S. will create a medical record that is permanently attached to its human sample using micron-sized microtransponder chips added to the samples during collection. These chips will permanently link the sample to the patient, and provide their contact details, when and where the sample was collected, and the test results. Medical records are generally kept separately from the samples, which means that samples can be mixed up or misplaced, particularly when they are shipped to a central laboratory, or split into smaller samples. Their industry partner has developed silicon microtransponder chips carrying a unique identifier that can be read by an ID reader. They will first develop methods to use the chips for medical samples to ensure they function properly also during sample transport and processing, and that they don't interfere with standard diagnostic assays. They will also develop software to link the chips with existing open-source medical records.

Manish Bhardwaj of Innovators in Health in India will build a social networking platform consisting of voice messages accessed via mobile phone that is monitored by community health workers to connect small groups of young pregnant women and new mothers in India. Currently, community health workers provide home visits to help adolescent mothers combat mental health disorders. However, their capacity is limited. An additional difficulty for adolescent mothers is the lack of social networks caused by moving to new neighborhoods to live with their husbands. Social networks can protect against mental health disorders by providing peer support and the relevant knowledge and experience to overcome any challenges. They will trial their approach in a rural area in India and recruit young mothers with no access to mental health care into specified social groups. Each group will be associated with trained community health workers who provide additional support to the mothers, and manage the messages and posts.

Sanjay Jain of Johns Hopkins University School of Medicine in the U.S. and colleagues in the U.S. and India will develop a cloud-based platform to record the location, caregiver relationships, and immunization records of infants in developing countries, and provide personalized reminders and incentives via mobile phone to improve the coverage of childhood immunizations. Low immunization coverage has been linked to inaccurate or incomplete records, and the difficulties of encouraging follow-up immunizations and identifying those who miss them. Their platform will store data in a cloud to ensure universal access to records, and use fingerprint identification of the caregiver for accuracy. It will also document each child's care network and location, and use this to send multiple text message reminders, and manage group and combined vaccinations to improve efficiency. They will test their approach in a low-resource rural community by training health workers equipped with mobile tablets, and recruiting around 800 mothers with infants or pregnant women provided with mobile phones.

Jacob McKnight and Mike Wilson of the University of Oxford in the United Kingdom will develop a simple application that contains information about the quality, location, and the nature and cost of services provided by the different pathology laboratories in Kenya so that doctors and patients can choose the one that best suits their needs. They will conduct surveys to collect key information on the pathology laboratories in the Nairobi area, and consult with doctors and medical associations to find out how they use those laboratory services and what needs to be improved. They will build the application using these data and in collaboration with users. Ultimately, the system should also help to improve the overall quality of services.

Daniel Pepper of Vayu in the U.S. will assess the value of using unmanned aerial vehicles integrated with existing healthcare supply chains to transport healthcare products and diagnostic samples in Senegal. Healthcare supply chains are critical for saving lives but are restricted by poor road infrastructure in developing countries. Unmanned aerial vehicles can overcome these restrictions and ensure rapid transport in temperature-controlled conditions. They will engage stakeholders from the Pharmacie National d'Approvisionnement (PNA) to National laboratories, the Expanded Program of Immunization, the National Blood Bank and the Ministry of Health to explore the feasibility of using unmanned aerial vehicles for delivering vaccines, essential medicines, contraceptive products and blood, and also to pick up tuberculosis samples for diagnosis. They will perform a test over a three- to four-month period to evaluate the impact of their approach on delivery and costs, and gather feedback from users.

Shahnoza Eshonkhojaeva of Sinostream AB in Sweden will use machine-learning algorithms to predict the amount of medicines and supplies needed at individual health clinics in low-resource settings, and to inform medical stores for delivery. Their approach involves obtaining daily consumption patterns that are recorded on smart paper stock cards at rural health clinics, which requires no training, internet access, or electricity. These cards will then be scanned at district health service centers, the data digitized, and algorithms used to calculate consumption patterns and waste, and automatically predict future demand. They will build a prototype system and field test it in Uganda to evaluate how well it avoids under- or overstocking products, and the cost-saving and time-saving benefits of having an automated stock management system.

Roice Fulton of the Denominator Group in Switzerland will test the value of blockchain, which is a decentralized secure database, for stakeholders such as distributors and health workers to record and monitor the movement of a vaccine along a supply chain, to ensure the availability of sufficient levels of working vaccines. Following the route of a vaccine from the producer to the patient would ensure its safety and allow for better monitoring of stock and supply chain performance, which would improve vaccine availability and help identify ways to increase efficiency and lower costs. Blockchain is an efficient and secure way to share information. They will test their approach in Tanzania, which has a fairly robust supply chain, by tailoring blockchain to integrate with existing platforms, and evaluate its ability to reliably monitor vaccines.

Jessica Vernon of Maisha Meds in the U.S. will develop a smartphone-based point-of-sale system and online ordering platform to better supply medications to the private healthcare markets across sub-Saharan Africa. Local private pharmacies supply important health care products to a large number of people, particularly those without employer-funded health care. However, they are often understocked, or stocked with poor quality or expensive medicines, and require cash payments. Because many pharmacy owners have smartphones, they are developing a point-of-sale system for Android devices that records information associated with each sale such as price, brand, and patient phone number. This will enable the shop owners to better manage their inventory and predict future demand, thereby improving their performance. They will also leverage partnerships with trusted suppliers and develop an e-Marketplace so that pharmacists can order stocks electronically based on these predictions. They will test their platform over nine months in selected pharmacies in Kenya.

Yuehwern Yih of Purdue University in the U.S. will develop a cloud-based digital tracking tool to record data from local health centers in Uganda on the health status of pregnant women and the turnover of their stock, as well as diagnostic laboratory data, to optimize ordering and improve the availability of medical supplies. They will develop applications mimicking the current time-consuming paper-based registry formats to digitally record the relevant data, and adapt a material requirement planning system, which is used in manufacturing to track parts and maintain stocks. They will test their approach in two Ugandan hospitals to evaluate its effect on the efficiency of ordering and maintaining supplies, and on patient health.

Lee Schroeder of the University of Michigan in the U.S. will develop a smartphone application that can be used by health centers in Ghana to request independent drivers to transport patient samples quickly and at low cost to laboratories for diagnostic testing. Current courier services in resource-poor settings, when available, can be unreliable or expensive. A 'sharing economy' approach to delivery, by hiring independent drivers online, could improve services and reduce costs. They will develop a simple application for different devices, and recruit and train health workers and drivers to use the application, and package and transport the samples. They will then pilot test their approach for timely delivery of excess samples to two district level hospitals.

Katherine Klapperich of Boston University in the U.S. will develop a simple device that prepares and stores nucleic acid molecules from the blood for diagnostic testing without the need for a cold chain. Current costs for tests such as those to detect HIV are high, due largely to the need to keep the samples cold during transport to district laboratories. Removing the cold chain would also enable samples to be taken at more widespread locations and transported in batches to further reduce transport costs. They will develop a flexible, layered plastic and paper fluidic card that uses a specialized lysis buffer to extract the nucleic acids from small volumes of blood that are then cleaned and dried on a membrane for transport. The nucleic acids can be easily extracted from the membranes, reducing processing costs in the laboratory, and the flexibility of the materials means that they can be processed as reels to reduce manufacturing costs. They will test the cards using blood spiked with HIV and assess the heat stability of the samples.

Ruth Betchel of VillageReach in the U.S. will create a hub to coordinate and track the transport of clinical samples from health facilities to laboratories for diagnosis in Mozambique so that diseases such as HIV and tuberculosis can be identified and treated earlier. Timely diagnosis of disease is also critical for preventing spread. In Mozambique, the existing transport system for patient samples relies on outside providers and is largely uncoordinated, unreliable, and inefficient. They will create a transport coordinating center equipped with an information system to enable dispatchers to match the planned transport routes of a network of existing drivers with samples waiting to be transported. They will also build a sample tracking tool that works via a smartphone application for health workers to request transport and to monitor samples during transport. This will help identify ways to increase the efficiency and speed of delivery.

Natasha Gous of SystemOne in the U.S. will develop a mobile application and digital platform to support people testing themselves for HIV by sending them reminders, offering guidance, and reporting the results. Simple and rapid diagnostic tests and self-testing are now being used across low-resource settings to improve the diagnosis of HIV infections. However, results need to be interpreted manually, which can be difficult for uneducated users, and linked with health facilities so the appropriate care can be given. To address these issues, they will develop a downloadable application so that users can enter their personal data, such as age, sex, and location, and receive instructions on how to perform the test. They will also develop a secure, online database that collects the test results, provides custom reporting, and integrates with the existing laboratory information systems so that health coordinators can monitor testing uptake and disease incidence, and HIV positive users can be informed of where to receive care. They will pilot test their approach for usability and accuracy of reporting with 300 individuals in a clinic in South Africa.

Sara Grobbelaar of Stellenbosch University in South Africa will develop a platform that can analyze existing real-time data on the stocks of health products at clinics across South Africa and present it to all players in the supply chain to ensure products are available when needed. In partnership with a Northern academic institution they will collect and sort relevant data, analyze trends, and develop decision-making tools. The platform will allow analysis, modeling, and forecasting in the health product supply chain so that unexpected changes such as supply disruptions or epidemics can be accommodated.

Fassika Fikre Hailemeskel of Maisha Technologies PLC in Ethiopia will build and field-test their drone for the rapid delivery of blood from blood banks to health facilities across Ethiopia. Almost 50% of maternal deaths in Ethiopia are caused by hemorrhage. Although there are 24 regional blood banks, difficult terrain and limited infrastructure on the ground mean that delivery to certain areas is almost impossible. A drone would bypass these obstacles. Their drone has been locally designed and will be locally built to keep cost to a minimum, and they will first test it for flight-performance and air-worthiness. They will then design a second, updated drone and test its ability to deliver routine and emergency blood from a single blood bank over two months. This will inform the design of a final version, which will be built and analyzed for drone and delivery performance, and impact particularly on maternal health.

Daniel Carucci of The Immunity Charm Foundation in the U.S. will produce a low-cost bracelet as a visual cue to encourage parents in south Asia to get their children fully vaccinated at the appropriate times. There is a widely held belief in south Asia that black beads on a bracelet protect children from evil spirits. Using that symbol of protection they have designed an 'Immunity Charm' bracelet for infants, which has the traditional black beads as well as a series of colored beads, each representing a vaccine that protects against one disease. The colored bead is added when the associated vaccination has been received. They will evaluate their approach for promoting vaccinations in five health centers in India by launching an awareness campaign with posters and flyers, training health workers, and supplying the bracelets.

Inuwa Barau Ya'u of the National Primary Health Care Development Agency (NPHCDA) in Nigeria will use bracelets of different colors to symbolize the order of the five routine childhood vaccinations to remind families with limited education when to get their children immunized. Bracelets are low cost and easy to see on an infant, and are a common adornment in many cultures, including the Fulani tribe found in remote areas in Northern Nigeria. Vaccination coverage is low across Nigeria, with vaccine-preventable diseases still accounting for over 20% of infant mortality. They will combine the bracelets with a peer education program whereby mothers are encouraged to spread information on the vaccines received by their children to their peers. Their approach will be tested in a pilot study with 300 mother/infant pairs in an urban and rural location to see if it improves on-time vaccination coverage.