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.

Lisa Butler of the University of Connecticut in the U.S. will develop an approach to improve the mental health of pregnant and new mothers between 15 and 19 years old in Botswana that incorporates interactive group sessions mediated by trained community workers, informative text messages, and an SMS-based mental health screening tool. Between 19-25% of women in low- to middle-income countries suffer from depression during pregnancy, which can also have serious effects on the child. In Botswana, there are large numbers of young, single mothers, who lack support and are particularly vulnerable to depression. They will develop the materials and format for their approach with support from a community working group of adolescent mothers and health providers to ensure it is culturally appropriate and addresses their specific needs. They will also incorporate a theoretical model designed to address the triggers and reduce the stigma of mental health disorders. Their approach will be field tested with 80 pregnant adolescents in a traditional village in Botswana to evaluate its feasibility and acceptability.

Pushpendra Singh of IIIT Delhi in India will develop interactive training and mentoring sessions for community health workers in India (ASHAs) using mobile phones and interactive voice response systems so they can provide better public healthcare in rural communities. Current training programs are run by medical professionals and require the workers to visit a health center, which may be inconvenient. The lack of medical experts has also reduced the frequency of these programs. These limitations could be overcome with online sessions whereby one expert trains multiple health workers remotely. They have already developed the format of the sessions, which involves an expert delivering a defined curriculum to groups of health workers followed by a question and answer session, and shown that it improved the knowledge and confidence of the health workers in a pilot test. They will now scale up the testing to 500 health workers, and also evaluate the platform as a peer-to-peer learning mechanism for health workers to share their experiences and learn from each other without the need for an expert.

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.

Chiwoneso Tinago of West Chester University of Pennsylvania in the U.S. will partner with adolescent mothers and local health workers in Zimbabwe to create peer-support groups incorporating cellphone-based technology such as the WhatsApp messenger application to provide coping and parenting skills to improve the mental health of young mothers. Young mothers less than 18 years old in Zimbabwe are often socially isolated due to forced marriages and exclusion from school, and therefore have no help when bringing up their children. This leaves them vulnerable to physical, emotional, and mental health problems, which also harms their children. They will hold one-hour focus groups with around 100 adolescent mothers and other community members including health workers and teachers, to identify the important topics and the best set-up for the support group meetings. They will then train community health workers and educators to run the peer-support groups, and evaluate its effect on depression and anxiety.

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.

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.

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.

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.

Guitele Rahill and Manisha Joshi of the University of South Florida in the U.S. will harness the Haitian tradition of storytelling to produce online videos, brochures, and posters that support pregnant teenagers in Haiti who are at high risk of depression. There has been an increase in unplanned teenage pregnancies since the 2010 earthquake, due in part to the loss of parents, and a rise in transactional sex and sexual assaults facilitated by very limited resources. Pregnancy places a substantial additional stress on these children, which in turn causes long-term difficulties for their children. In Haiti, to tell a story you announce "Krik?", and to hear it you respond "Krak!" They will use this familiar story-telling framework and actors who resemble the target group to teach pregnant teenagers about childbirth, motherhood, and how to cope with depression. They will conduct two focus groups of six pregnant teens to identify the specific challenges they face, and use their feedback to help ensure the approach will work.

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.

Arun Shanbhag of Manipal University in India will use near field communication (NFC) tags to transform traditional bracelets worn by infants in India into portable vaccination records that better track particularly migrant communities to promote full childhood vaccination coverage. Vaccinations are recorded on paper, which are easy to lose and make it difficult for health workers to monitor children in migrant communities. They created beaded bracelets that can store vaccine records on a digital tag, and have developed a mobile application that can read the tag using an Android smartphone. In consultation with local communities, they have also developed a universal color code for the beads to represent the required individual vaccines so that they can be easily monitored by health workers. They will now evaluate their approach in a larger study across five villages to assess its overall performance including the stability of the records over time, data storage capacity, the effect on vaccination coverage, and ease of use.

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.

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.

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.

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.

Brandon Kohrt of George Washington University in the U.S. will develop a tool using sensors associated with mobile phones that can identify and monitor young mothers suffering from perinatal depression in low-resource settings in Nepal so that personalized psychological treatments can be provided. The tool comprises a mobile phone for the mother and a small Bluetooth beacon attached to the baby's clothes. It can record location via GPS, the proximity between phone and beacon, and sound. They will build sensor data models that can associate specific activity recorded from the sensors with maternal depression, such as the length of time spent with the baby, the level of vocal interactions, and the frequency of outings. A community advisory board composed of young and older mothers, family members, and health workers will be established to evaluate the approach and help test and refine the tools. They will also co-develop a user-friendly interface with the mothers and health workers so that they can easily access the information and use it to improve their mental health.

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.

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.

Robert Steinglass of JSI Research & Training Institute, Inc in the U.S. will teach community members to use traditional methods such as a drum to signal the arrival of a vaccination team to villages in India to improve vaccination coverage. Children in remote villages are vaccinated by outreach services. Although visits are scheduled on specific days, they often change, and there is no simple way to inform all the relevant families. Sound can travel long distances and is used to call communities together in many cultures. They will pilot test their approach over 12 months in a remote and hilly district in India, and train health workers and a community member to use a culturally-acceptable sound to alert the villagers to the arrival of the vaccinations. They will evaluate its effect on timely vaccination coverage.

Diana Negoescu of the University of Minnesota in the U.S. will ensure routine vaccinations are given to infants during the first year of life in resource-limited settings by providing free, shared transportation to medical centers, and text message reminders. In low-resource countries, public transportation, if available, is often unreliable and infrequent. However, newborns require regular, on-time vaccinations to prevent a variety of potentially deadly diseases. Network transportation providers such as Uber for cars and Safeboda for motorbikes have recently been implemented in Kampala, Uganda, and provide a potential solution. To determine the feasibility and value of free transportation and timely reminders, they will conduct a survey in Kampala to collect information on the associated costs, practical issues, and potential impact on vaccination coverage and infant health.

Marc Mitchell of D-tree International in the U.S. will develop an application that enables community health workers in Zanzibar to register children for immunizations before they are born, to ensure all children are vaccinated on time. Children are currently registered when they are already around four weeks old and only at health facilities, which excludes a lot of children born at home. They will build on their existing program in Zanzibar to develop the mobile phone technology used by Community Health Volunteers, who engage with pregnant women in their homes, for registering infants in the third trimester, generating immunization plans, and providing a support tool to educate mothers on the importance of timely vaccinations. They will test their application in the field by recruiting 100 health volunteers and evaluating immunization levels and timing in around 500 infants.

Pratyusha Pareddy and Manoj Sanker of the Centre for Healthcare Entrepreneurship in collaboration with NemoCare Wellness in India will develop a small, battery-operated wearable device for newborns that continuously monitors vital signs in premature babies to alert health workers when a life-threating situation might occur, and provides vibration to stimulate breathing. Premature babies are susceptible to a variety of potentially fatal conditions such as apnea (suspension of breathing) and hypothermia. The lack of sophisticated monitors for these conditions in resource-poor settings means that nurses often have to continually check up to 40 babies, which makes timely detection very challenging. They will design and build a prototype made of soft fabric to fit snugly on the child's foot, and incorporate a photoplethysmography sensor, which measures rate of blood flow, and a thermistor to measure temperature, as well as an audio-visual alarm. A platform will also be developed for wirelessly connecting multiple devices to a hub installed at the nurses' station, which is also fitted with an alarm. They will compare their prototype with currently used monitoring devices in the laboratory, and perform a small-scale field trial to get feedback from health workers and mothers.

Prem Mony of St John's Research Institute in India along with the Indian Institute of Science, Bangalore, will develop a temperature sensor to be worn by caregivers during kangaroo mother care of infants up to four weeks old combined with a mobile device to transmit data for analysis and real-time feedback. Kangaroo mother care involves continuous skin-to-skin contact with the mother to keep the infant warm, and is particularly valuable for protecting preterm infants. However, how long and how often it is actually used in the home, and thus its value, has been difficult to quantify. They will build a mobile phone application and establish a data-monitoring platform that can be combined with their wearable, energy-independent temperature sensor, which has already been tested in India. They will also add visual or audio alerts to remind mothers to use kangaroo mother care, and alert them when the baby's temperature gets too high or too low. Their approach will be tested in a small-scale clinical trial of 30-40 mothers.

Craig Goergen, Kirk Foster and George Wodicka from Purdue University together with David Reuter from Seattle Children's Hospital in the U.S. will develop a wearable sensor that can automatically measure blood pressure and body position, and transmit the results to a medical unit to identify pregnant women at risk of developing preeclampsia in remote, low-resource settings. They will develop smartphone-based automation for the well-established supine pressor test, which predicts preeclampsia based on an increase in blood pressure when changing position from lying on the left side to lying on the back. They will build and test a prototype using a non-invasive blood pressure monitor that can transmit results to a smartphone that will then integrate with a wireless accelerometer to determine body position. The team will build, test, and refine their device using healthy and pregnant volunteers. The team’s ultimate goal is to optimize test specificity by ensuring meticulous execution, and to improve test sensitivity by performing the diagnostic assessment longitudinally during the second half of pregnancy.

Molly Guy and Chemuttaai Lang'at of Medtronic Labs in the U.S. will lead a team seeking to redefine how pregnant women manage hypertension and how clinicians remotely monitor patients' health. Hypertensive disorders of pregnancy have overtaken hemorrhage as a main cause of maternal mortality in some sub-Saharan African settings. Management requires careful monitoring, which is problematic in settings with limited access to care. The team will assess integration of locally-appropriate wearable sensors into their existing hypertension management model of care. The model combines automated blood pressure monitors, mobile devices, and a software application, together allowing for data collection, real-time feedback, SMS messaging, and efficient access to referrals and prescriptions. The team will conduct a six-month pilot of 150 pregnant hypertensive women in Kenya to evaluate usability, feasibility, and desirability of this wearable-enhanced holistic care ecosystem.

Syed Imran Ahmed of the International Centre for Diarrhoeal Disease Research in Bangladesh will conduct a pilot study of a wrist-worn device that can continuously monitor blood pressure in pregnant women for the early diagnosis of pregnancy-induced hypertension, which can be dangerous for mother and baby. Hypertension is difficult to diagnose because it requires multiple measurements of blood pressure during normal activity due to daily variations. Current ambulatory methods can only take measurements over around 24 hours and lack portability. Their device combines two-contact electrocardiography and photoplethysmography, pulsewave analysis algorithms, machine learning, and neural network computing techniques and will be tested on a group of at-risk pregnancies for monitoring blood pressure from 20 weeks of pregnancy up to six weeks after birth.

Yamile Jackson of Nurtured by Design in the U.S. will develop a digital, wearable wrap with biosensors and a smartphone application to monitor kangaroo mother care - skin-to-skin contact between mother and infant - in low-resource areas, and improve its duration and frequency. The sensors will monitor the infant's temperature, position, and heart rate, and transmit the data to a smartphone provided to the mother, and to the cloud to be monitored by healthcare teams. The application will contain a user-friendly graphical interface and will also provide the mothers with information on the importance of kangaroo mother care and enable them to communicate with other mothers and health workers. They will build and test a prototype at a local research university with the participation of local kangaroo care leaders.

José Guilherme Cecatti of Cemicamp in Brazil will develop a small watch-like device to measure the sleep patterns and physical activity of pregnant women to help identify very early signs of serious medical conditions such as gestational diabetes and preterm birth so they can be better treated or prevented. Some chronic diseases such as diabetes and cancer are known to be associated with disturbances in sleep and physical activity. They will study whether this is the case also for complications during pregnancy. They will use established actigraphy technology and develop algorithms for measuring activity. The device will be tested in an exploratory study on a cohort of around 400 pregnant women across five centers in Brazil to identify patterns linked with serious medical conditions.

Oldimeji Oladepo of the University of Ibadan in Nigeria will use mobile phone messaging reminders to encourage parents in Nigeria to complete the full series of routine vaccinations for their children at the recommended times. They will conduct a 10-month study of 1800 mothers with infants aged up to two months at selected health clinics and collect mobile phone numbers also from their families and friends. They will develop a database to store this information and an SMS platform to deliver vaccination reminders, and let them know where they can be obtained and why they are important. They will also evaluate the mothers' views on immunizations, any barriers they experience, and their suggestions for improvements.

Ayumi Arai of the University of Tokyo in Japan will use anonymized mobile phone data to produce a dynamic census that reveals the movements of all individuals in a population over time broken down into age and gender to help reduce regional malaria transmission. Human mobility and distribution play key roles in malaria transmission but it is difficult to monitor the movements of everybody in a population. They will gather call detail records and use them to develop an algorithm that considers non-phone users such as children and the elderly, and can predict gender and age group, which are linked to malaria vulnerability. To generate the dynamic census they will build a system incorporating application programming interfaces to support different input and output data formats to promote use by third parties and in other countries. They will apply the system to create a dynamic census of Mozambique, and validate it using data from transport networks and small-scale surveys.

Isabel Cruz of the University of Illinois at Chicago in the U.S. will build an ontology-based data integration framework that can predict where malaria incidence is likely to increase or decrease in Zimbabwe, to better target elimination efforts. Eliminating malaria requires being able to monitor the changing patterns of infection risk across an entire region, which is affected by multiple factors including the location of health centers, temperature, rainfall, type of landscape, and population distribution. Integrating these data is difficult because they come from different sources and are measured at different scales (resolution). Also, monitoring how a disease changes over space and time has been particularly challenging. They will develop methods using string matching to first translate the data into a common spatial data format, and then ontology matching to integrate the data. They will also introduce a novel resolution method that addresses uncertainty in spatial and temporal resolutions. These will be used for mapping a pilot region, and tools will be built to identify and visualize patterns of malaria progression in time and space.

Matt Berg of Ona Systems Inc. in the U.S. will develop a map widget that enables data collected by different platforms on different aspects of malaria, such as disease incidence and intervention efforts, to be accurately mapped and therefore more effectively integrated to help eliminate malaria. It is currently difficult to map specific events particularly in rural areas of developing countries, which lack formal addresses. Different groups use different naming schemes when recording disease-relevant data, making them difficult to cross-reference. They will develop the map widget so that users collecting or requesting data can pinpoint their location on a display of the layout of buildings and open spaces in their area using a mobile device. They will also adapt popular data collection platforms to be compatible with their system. Each location has an ID so a user can look up all disease-relevant events across different databases. In this way, the best intervention method to reduce malaria can be identified at each location. They will work with a national malaria elimination program to test their approach.

Jonathan Jackson of Dimagi in the U.S., together with James Faghmous from the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, will develop an open platform that combines real-time data on health, climate, and the environment at high resolution, and near real-time satellite data to inform on population density, in order to detect areas containing limited information (cold-spots) on malaria so that control programs can better allocate resources. Current efforts suffer from the absence of up-to-date information and the difficulty of predicting when and where interventions are needed. Platform development will be conducted in collaboration with academia and the private sector, and will be designed to use existing data recorded on mobile devices, which contain GPS data. The platform will be designed to use existing data recorded on mobile devices, which contain GPS data. These data will be supplemented by designing a machine-learning approach to extract population density from global satellite data. They will test the accuracy and usability of their software in Senegal.

Pradip Maiti of Immunimed Inc. in Canada will provide passive immunotherapy using chicken-egg-derived polyclonal antibodies against key proteins of the intestinal parasite Cryptosporidium. This orally-administered immunotherapy will prevent the chronic diarrhea and potentially lethal infection caused by this parasite. Treating patients directly with antibodies against a pathogen is quicker than using traditional vaccination methods that induce individuals to make their own antibodies, which takes days to weeks and can also be difficult in malnourished children. This immunotherapy is an alternative to antibiotics, which are becoming less effective. The immunotherapy will be in the form of an egg powder that can be ingested, which is also easier and safer than using injections. The resulting antibodies will be tested for specificity in vitro, and for their ability to treat the disease using a mouse model of Cryptosporidiosis.

Francisco Diaz of Pennsylvania State University in the U.S. will develop a high-throughput screening method to identify compounds that can block two biological events essential for female fertility without affecting ovulation or hormone production in order to identify new contraceptives with fewer side effects. These two events, which occur at the same time, are cumulus expansion, whereby cumulus cells release from the oocyte to enable it to enter the oviduct, and oocyte maturation, whereby the oocyte divides to produce the egg and a smaller polar body. They will extract cumulus oocyte complexes from primed female mice and apply them to a microwell array prototype that will contain 1,024 wells coated with different test compounds and connected in groups by microfluidic channels. Oocytes in the wells will be stimulated to undergo first cumulus expansion, and, after removal of cumulus cells, oocyte maturation. The ability of each compound to inhibit each step will be assessed by automated inverted microscopy. They will first optimize their platform using known inhibitors and then test it using a library of 1,200 FDA approved molecules.