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.

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.

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.

David Anderson of the Macfarlane Burnet Institute for Medical Research in Australia will develop a low-cost, simple to use, sample collection device to improve sample quality and ensure accurate and timely diagnosis in remote, low-resource areas. Obtaining high quality serum samples needed for diagnosing a variety of diseases is challenging in these regions due to the lack of equipment and expertise to process the samples and stabilize them for transport to the diagnostic laboratories. They have developed a device comprising an integrated two-step process based on lateral flow chromatography that separates plasma from other blood cells and dries it on paper so it can be stably transported. The dried plasma samples can also be used directly in the laboratory, which accelerates analysis. They will modify the device to separate and store larger volumes of plasma using 25 healthy volunteers, and test its performance for diagnosing patients with different infections, including Hepatitis B and C, compared with fresh plasma.

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.

Amadou Alpha Sall of Institut Pasteur de Dakar in Senegal will add quantum dots to liquid patient samples for better tracking of results and to store diverse types of information relevant for diagnostics and research that can be retrieved in real-time. They will tag samples using stable semiconductor quantum dots to generate unique signatures that can be read by a mobile-based, lens-free, fluorescence microscope. They will develop algorithms to enhance the efficiency of encoding and decoding the data from the quantum dot signatures, and design a cloud-connected database using commercial infrastructures for sample data storage and retrieval. They will perform a field trial with a local laboratory network and real clinical samples to evaluate sample collection, tracking capability, and ease of use.

Gershim Asiki of the African Population and Health Research Centre in Kenya will develop a mobile phone application and centralized electronic database to link birth records with immunizations to increase the coverage of BCG and polio vaccines in newborns in Kenya. Births and immunizations are initially recorded on paper and then transferred to separate electronic databases, meaning that many infants fail to receive the standard vaccinations on time. They have developed an integrated database that collects both birth and immunization data directly from nurses and health workers via mobile phones. They will evaluate the feasibility of their approach by registering around 450 newborns from an urban slum, and train community health workers to register pregnancies, due dates and delivery dates using the mobile phone application. They will monitor the newborns up to two months after birth, and test the effect of their approach on the timeliness of vaccinations.

Folusho Balogun of the University of Ibadan in Nigeria will train older women who are traditionally involved in childcare in Nigeria to ensure infants in their communities are fully immunized. Many young children in Nigeria, particularly those in urban slums, are not fully immunized, or are immunized too late, leading to an unacceptably high under-five mortality rate. This is due in part to the mothers not understanding how critical immunizations are. In many African nations, the care of young children is also overseen by older women in the community such as grandmothers or neighbors. They hypothesize that training these older women to be formally involved in promoting immunizations will help to ensure all children complete the full package on time. They will select five urban slum communities in southwest Nigeria and use focus group discussions to explore the views of the older women on current immunization programs. They will use this to design a manual to train a group of older women who will be associated with pregnant women in the community, and evaluate the effect on immunization of the infants up to nine months.

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.

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.

Rebecca Dempster of HIAS in the U.S. will develop an online game- and mentorship-based intervention to improve the mental health of refugee adolescent mothers in Kenya that integrates into their daily lives and helps them develop new skills. Digital games can help treat mental health disorders such as depression particularly in young people because they have a natural appeal and are easy to access from home. They will recruit ten young mothers, a psychologist, and software programmers to design a mental health game so that it can be used to identify those with mental health disorders and connect them with counselors, and provides interactive challenges to help treat and protect against those disorders as well as build relevant life skills. They will then train these young mothers to act as mentors to support the online game, and pilot test their approach on a sample of 15 refugee adolescent mothers over three months to evaluate feasibility, acceptability, and effect on maternal depression.

Syed Usman Hamdani from the Human Development Research Foundation in Pakistan will develop a program that teaches life skills such as self-awareness, communication, and parenting skills, to adolescent newlyweds in poor areas of Pakistan to help them cope with the challenges of marriage, pregnancy, and bringing up children. Pakistan has one of the highest adolescent birth rates in the world, with 10% of girls giving birth before the age of 18. Many of these girls go to live with their new in-laws, but they lack the skills needed to handle these major events, leaving them more susceptible to mental health issues such as depression. The Thinking Healthy Program is an existing WHO intervention involving community health workers providing coping strategies using cognitive behavioral techniques to depressed young mothers in rural Pakistan. They will develop and incorporate selected life skills into this program, in consultation with young women and other community members, and evaluate its feasibility and impact on mental health in a randomized controlled trial with 60 married women under 19 years old.

Allya Paramita Koesoema of the eHealth and Telemedicine Society in Indonesia will develop a pro-vaccination campaign to counteract the widespread negative views of vaccinations in Indonesia by engaging religious leaders and health workers in local communities to directly address misconceptions. Anti-vaccination narratives, many based on religious misconceptions, have spread through the country, largely via social media, leading to a decrease in child vaccination coverage. Health workers often do not have the knowledge to explain away these misconceptions to mothers when they refuse to have their children vaccinated. To address this, they will engage stakeholders to identify the anti-vaccination messages and build a database of effective reasoning to directly challenge those messages that can be accessed by health workers and other respected, senior community members. They will perform a randomized controlled trial in different districts in Indonesia, and supplement the pro-vaccination messengers with vaccination reminders and schedules sent directly to mothers via mobile phone. They will test the usability of their approach and its effect on the willingness of the mothers to vaccinate.

Jeroen Lammertyn, Jaroslav Belotserkovsky, and Michael Kraft of KU Leuven in Belgium will develop a low-cost device to simplify blood collection and processing for monitoring of HIV viral load in low-resource settings. Most diagnostic assays work on blood, which must be manually collected from the patient, and then processed and stored before analysis. This requires trained health workers and infrastructure, is time-consuming, and can be unsafe. They will develop a simple, integrated device to collect and process blood. This will allow blood collection to be less invasive and safer than conventional methods, and integrating collection and processing in a single device would cut the time needed to produce diagnostic-ready samples. Because of the simplicity of the device, only minimal training is required to operate it. They will optimize their device for the removal and preparation of sufficient volumes of blood for subsequent analysis, and test it in model systems.

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.

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.

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.

Estelle Sidze of African Population and Health Research Centre in Kenya will work with adolescent mothers in Nairobi slums to develop a toolkit of information, skills, and coping mechanisms, to protect their mental health during pregnancy and early motherhood. Many girls in Nairobi slums become pregnant, but have limited knowledge about how to care for a baby, and are often excluded from their homes. They will interview adolescent mothers to find out what harms their mental health during pregnancy, what effect this has on their behavior, and how they try to cope. They will also work with them, and with health workers and community members, to build the toolkit to protect them from these stressors. This toolkit will include providing information, and teaching problem-solving and confidence-building skills. They will test their approach on a sample of 150 adolescent girls who are pregnant or are new mothers using trained adolescent mentors with two delivery methods: organized two-hour meetings with up to ten participants in selected safe spaces; and five-person online discussion groups via the WhatsApp messenger application.

Ashenafi Tazebew of the University of Gondar in Ethiopia will develop a training and supervision program whereby medical and nursing staff working at local health science colleges in Ethiopia are trained to teach and mentor local health care workers to improve their skills, and the quality and safety of immunizations, thereby increasing uptake. They will develop supervisory and mentorship guidelines and tools, and train college workers how to coach primary health care providers and review their performances. They will conduct a randomized field trial over six months to evaluate the quality of the mentorship and its impact on the knowledge and skills of the health workers.

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.

Patricia Connolly of the University of Strathclyde and colleagues in the United Kingdom will develop a low-cost, wearable skin patch that can continuously monitor metabolite levels in newborns without the need for blood sampling, and can alert mothers and health workers to potential problems via mobile phone. Changes in metabolites such as those of hemoglobin and bilirubin are used to assess many aspects of newborn health, but current methods require invasive blood sampling and access to laboratory analysis, which is often unavailable in low-resource settings. To address this, in consultation with users in Sierra Leone, Vietnam and India, they will develop a flat patch incorporating their new technology, which painlessly enhances the flow of analytes through the skin for detection, and a Bluetooth connector that can communicate levels to a smartphone. The prototype patch will be laboratory tested to refine the design.

Joanna Bichsel of Kasha in Rwanda will adapt their mobile ecommerce platform to enable women in Kenya to confidentially order health products such as contraceptives and sanitary pads by mobile phone. There are many social barriers preventing women in developing countries from accessing products at health clinics. Their platform, Kasha, requires only a mobile phone to order and pay for products that are then delivered to local pick-up points. They have successfully implemented Kasha in Rwanda and will now perform a pilot study in several counties in Kenya. They will customize the platform to the language and existing technology in Kenya, and develop private and public partnerships to tap into existing distribution networks, thereby minimizing costs. Their pilot study will evaluate how well the platform is received by Kenyan women, and how effective it is at delivering products.

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.

Andrew Ellington of the University of Texas at Austin in the U.S. and the Alliance for Global Health will create stable enzymes that can be produced in developing countries and used directly in diagnostic assays to reduce costs. Enzymes are required in many diagnostic tests to detect pathogens such as malaria and HIV. However, they can be very expensive to buy and require refrigerated transport, making the tests prohibitively expensive in many developing countries where they are often most needed. Current enzymes, which are made by bacteria, can only be produced in sophisticated laboratories. They will adapt a novel, heat-stable enzyme to enable simple, on-site production for diagnostic tests at low cost and with minimal infrastructure. These features will facilitate accessibility and use in resource-poor conditions.

T.J. Corcoran of Hemalytics LLC in the U.S. will create a platform incorporating a web portal and smartphone application to track patients and their samples during diagnostic testing in low-resource settings to ensure they receive the results, and in a timely manner. They will develop a suite of mobile health tools for storing encrypted patient and sample data, capturing test results in the laboratory, and notifying patients and health workers of the results. They will test their platform using patients, laboratories, and administrators located in different cities in the U.S. This approach will help interconnect patients, health workers, and diagnostic laboratories, and thereby improve disease management.

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.

Sidney Sampson of Sydsam Integrated Services Limited in Nigeria will produce a low-cost wristband that can be worn by infants from birth until nine months that uses a flashing light to remind mothers when one of the five standard childhood vaccinations is due. Timely childhood vaccinations are critical for preventing deadly diseases, but many low-resource settings such as northwestern Nigeria have low immunization coverage rates and high dropout rates. They will design a waterproof silicon wristband in different colors and test it for user friendliness and safety. The prototype will then be pilot tested over 10 months in 132 urban and rural health facilities across Nigeria for improving timely immunization coverage.

Emmanuel Ihedioha of Lifespan Healthcare Resource Ltd in Nigeria will develop a web-based platform that acts as a lifetime register to track the immunizations of all Nigerian children from birth, issues timely reminders to parents and community members via SMS, and informs medical facilities which vaccines are needed. Currently, immunization cards issued to mothers are used to record and plan immunizations, but they can be lost or contain errors. An added problem is that the required vaccine is not always available at every clinic because it is difficult to know how much will be needed and where. The platform will be functional offline and can be periodically synchronized with the web-hosted platform when internet connection is available to keep the register up to date. They will pilot test their platform through Nigeria's national program on immunization in six states to evaluate its effect on timely vaccine uptake, and get feedback from users.