Simon Mutembo of the Macha Research Trust in Zambia will develop a method to identify and map children who have never received vaccinations so that they can be targeted during mass vaccination campaigns. Many of these children live in remote areas and are missed by population estimates. Their method combines field work by community health workers with spatial intelligence using a geospatial application on smart phones to develop geographical maps of vaccination coverage at the household level. Households with low or no vaccinations can then be targeted directly by campaign health workers. They will test their approach using a non-randomized controlled before and after study associated with planned measles and rubella mass vaccination campaigns in 14 areas in Zambia. Their method will also provide a more reliable measure of vaccination coverage.

Sangeeta Jobanputra of Connecti3 LLC in the U.S. together with the University of Rwanda and Multiverse Investments will develop a method that uses existing datasets and predictive analytics to better plan all types of health campaigns to broaden their coverage and minimize costs. The challenge of identifying those in need of a specific health service is a barrier to successful health campaigns. To address this, they will use existing databases to identify and score predictors of higher risk to a specific health condition, such as level of poverty in vitamin A deficiency. They will also incorporate data on the health campaign resources needed, such as facility location and medicines. These data will be used to develop algorithms that can identify the target population and predict the resources needed for an effective campaign.

Pascal Geldsetzer of Stanford University in the U.S. will develop a computational tool to support health campaigns in low- and middle-income countries that can predict the number and location of the people that need targeting. They will use freely available databases, including the Demographic and Health Surveys (DHS), covering over 10 million households and high-resolution population estimates to estimate the percentage of children under 5-years-old who are un- or under-vaccinated within each 30m by 30m area. They will then use algorithms to determine the optimal numbers and locations of campaign posts needed to ensure a desired vaccination coverage within a given budget. This work will lay the foundation for developing a simple Android application to help managers increase the impact of health campaigns.

James Lavery of Emory University in the U.S. will adapt an organizational learning tool to enable global health campaigns to draw on their experiences, improve their partner interactions, and enhance their overall impact. Global health campaigns are primarily evaluated in terms of program delivery and outcomes. However, these large and complex organizations interact with many different partners, and there is an untapped opportunity to improve their performance by learning about how their design and approaches affect each other. They will modify an established research fairness initiative framework for two global health campaigns to measure 45 indicators, such as the nature of a relationship, across defined subtopics. These data will be analyzed to understand how the tool can improve campaign impact, and they will assess the value of the framework for global health campaigns in a qualitative case study.

Robert Miros of 3rd Stone Design, Inc. in the U.S. will adapt their portable vaccine refrigerator, which is battery powered and can be monitored remotely, to maximize the charge life so that it can support vaccination campaigns in low- and middle-income countries. Vaccines are normally stored in ice boxes and manually tracked, both of which are unreliable and can cause spoiling. Their vaccine refrigerator integrates thermo-electricity cooling and battery power together with an algorithm that can sense temperature and adjust it according to the available power. They will develop a new algorithm that can correlate charge times with vaccination routes, and integrate upgraded battery technologies to prolong charge life. This will then be field-tested in a selected vaccination campaign.

France Daigle of the University of Montreal in Canada will identify the microorganisms that enable the survival of the typhoid fever-causing bacterium, Salmonella enterica serovar Typhi, at low levels in water, and thereby enhances disease spread. Typhoid fever spreads through contaminated food and water, and results in over 125,000 deaths annually worldwide. S. Typhi are so-called auxotrophic bacteria because they rely on an external source of the essential amino acids that they need to grow. Microbial interactions may provide nutrients and also increase bacterial fitness and support persistence by protecting them from the environment, thereby increasing the rate of disease transmission. They will assemble a microbial community in water consisting of three components: one protozoan (from a group known to promote bacterial survival); a defined consortium of bacteria representative of the human fecal microbiota; and fluorescently-tagged S. Typhi. They will evaluate the ability of S. Typhi to grow in these microcosms, and how they grow, such as in biofilms or inside the protozoa. They will also determine whether these persistent S. Typhi are better able to infect and survive in human cells. Finally, water samples from an endemic region in East Africa will be analyzed for the presence of S. Typhi and identified beneficial microbial partners using quantitative PCR.

Matthew DeLisa of Cornell University in the U.S. will create a cell-free synthetic biology platform for low-income settings that produces thermostable polysaccharide-based conjugate vaccines against diarrheal pathogens upon the addition of water to a single tube. Half-a-million children under age five die each year from diarrhea and dysentery, the majority in low- and middle-income countries. Two major causes of bacterial diarrhea are enterotoxigenic E. coli (ETEC) and Shigella strains. Conjugate vaccines combine multiple antigens into one vaccine to increase its activity. However, they require a complex manufacturing process, living cells, and refrigerated storage, which limit their application in developing countries. They will develop the materials and methods for manufacturing thermostable anti-diarrheal vaccines in single tubes that only require the addition of water just ahead of administration. The tubes will contain a plasmid that can express an FDA-approved carrier protein, along with selected O-antigen-polysaccharides from ETEC or Shigella strains, and an enzyme that can conjugate the two via glycosylation, all within a freeze-dried pellet. Following development, they will test the safety, scalability and portability of the vaccines, and characterize their ability to generate effective antibodies that can kill the bacteria. The system is expected to reduce conjugate vaccine costs, and its modular nature will facilitate expansion to other vaccine-preventable diseases.

Jessica Craig of the Center for Disease Dynamics, Economics and Policy in the U.S. will use existing food distribution networks in low-income countries to publicize the importance of vaccination and inform caregivers when, where, and how to access local vaccine services by printing them on food labels, food and water carrying tools, and receipts. They will test whether their approach can improve vaccination rates using one rural and one urban area each in Kenya and in the Central African Republic. They will map their food distribution systems and health service clinics and consult local healthcare workers on the design of vaccine information materials to reach both literate and illiterate populations. They will evaluate the number of caregivers interacting with the materials using surveys in clinics, as well as the change in vaccination rate before and after a six-month period with materials in circulation. The approach is relatively simple and cost-effective because it leverages an existing network with a wide audience, and requires no additional work from frontline healthcare workers. It is also adaptable to any setting with a food distribution network, and can be expanded to deliver other types of health information.

Aaron Jenkins of the University of Sydney in Australia will combine genomics approaches with physical chemistry to identify the organisms and environmental factors in riverbeds that support the survival and spread of the bacterium, Salmonella enterica serovar Typhi, which causes typhoid. Aquatic environments are a major reservoir of typhoid, but how the bacteria survive in these conditions is unclear, making it difficult to prevent the disease spreading to humans. They hypothesize that S. Typhi survive in biofilms associated with sediments in riverbeds, and that the composition of this niche promotes its ability to infect humans. To test this, they will sample aquatic biofilms from areas of high, low, and zero typhoid incidence in Fiji, and identify the microbial communities supporting S. Typhi survival using antibody capture and metagenomics. They will also use fluorescence in situ hybridization to determine the spatial organization of S. Typhi in multispecies biofilms. In addition, they will analyze the composition of the sediments and soil of the riverbeds, and the nutrients being taken up by resident fish and crustaceans. By combining these results with their epidemiological data, they can identify the ecological niches that support high typhoid incidence, which will help develop and guide intervention strategies to block transmission to humans.

Ernest Darhok of Broadreach in South Africa will use mobile technology to improve access to child immunization services for populations living on the Kenya-Uganda border and help ensure all children are fully vaccinated. Refugee populations living in cross-border settings and migrant communities are particularly difficult to cover because of limited access, poor coordination across borders, and lack of efficient tracking. They have been using a human-centered approach to understand what these populations need to vaccinate their children, and have pilot tested the use of near-field communication cards with an immunization application that holds a child’s vaccination and health data for caregivers, which they can also use to plan more convenient appointments. This card can then be viewed and updated by health workers on both sides of the border using a mobile system. They will extend this pilot study to a wider population in Kenya and Uganda to evaluate the effect on vaccination rates against polio, and apply machine learning methods to better forecast vaccination needs at cross-border facilities to avoid stocks running out. They will obtain user feedback at all stages to help improve their approach.

Amos Kahwa of Damax Solutions Company Ltd. in Tanzania will use human-centered design principles to develop a community-supported, social marketing approach that breaks down misconceptions and psychosocial barriers to immunization in developing countries and thereby increases demand. Research has identified several causes of the current low demand for vaccinations including misconceptions about safety, inadequate knowledge of schedules, and negative experiences at clinics. Current approaches designed to increase demand such as better education and incentives have had a limited effect. As an alternative, they propose to directly target the misperceptions and societal influences and empower the communities to help. They will first consult with community members and local government to gain further insight into the drivers of low demand that will be used to design a prototype package of interventions in collaboration with the local community. They will perform several rounds of testing and refining this package, and they will evaluate its ability to improve perceptions and social norms towards vaccinations and ultimately to improve demand.

Pietro Alano of the Instituto Superiore de Sanità in Italy will develop a biochip that mimics the midgut of the Anopheles mosquito and can be used to more easily and quickly test candidate anti-malarial compounds for blocking transmission of the causative Plasmodium parasite. Malaria is a potentially fatal infection caused by parasites transmitted between humans through the bites of infected mosquitoes. When a mosquito bites an infected person, immature Plasmodium gametocytes enter the mosquito and transform into an invasive ookinete stage in its midgut. They then traverse the gut wall to the external gut lumen, where they enter their parasite stage. To eliminate malaria, compounds are needed that block the transmission of Plasmodium. However, current methods to evaluate the candidate transmission-blocking drugs or vaccines that are under development are slow and involve feeding malaria-infected blood to mosquitoes, which is potentially dangerous. As an alternative, they will create a biochip to reproduce the mosquito midgut environment that can support the development of parasites, and develop a bioluminescent antibody-based technique to count successfully traversing ookinetes. They will test the performance of the biochip using known anti-transmission drugs.

Hasan Uludag of RJH Biosciences in Canada will develop an affordable immunotherapy system based on genome-integrating transposons that works inside the body for the treatment of a wide variety of diseases such as cancer and diabetes. Emerging immunotherapies offer promising treatment for many diseases, but they require genetic modification of immune cells outside the body, and are thus labor intensive and expensive, limiting their utility in developing countries. They will use engineered nanoparticles in a new approach to immunotherapy that modifies immune cells inside the body. The nanoparticles are derived from polymeric materials that can encapsulate nucleic acids and proteins and release them into host cells. These nanoparticles will be dispersed in a hydrogel matrix with immunostimulatory molecules to create a living bioreactor inside the host that will attract and genetically modify immune cells. They will select polymers for their ability to deliver DNA-based transposons (to facilitate integration into the host genome) to immune cells and to stably express a reporter gene. Optimal polymers will be transferred into mice and they will evaluate transfection efficiency into immune cells with a fluorescent reporter gene. Finally, they will test the therapeutic efficacy of their in situ immune cell engineering approach in a mouse leukemia model.

Fredos Okumu of the Ifakara Health Institute in Tanzania will develop technology to evaluate mosquito control interventions using a combination of artificial intelligence, infrared spectroscopy, and entomology. Malaria caused over 400,000 deaths in 2017, the majority in the developing world, and an effective way to control the disease is to target the mosquitoes that transmit it. Current tools cannot precisely measure mosquito age or life-expectancy, and are therefore unable to predict the impact of mosquito control interventions. The biochemical composition of the mosquito exoskeleton varies with species and age; as the types of chemical bonds change so does the amount of light absorbed in the mid-infrared region. This can be measured with mid-infrared spectroscopy (MIRS), and they will combine this with machine learning to measure the age of mosquito populations. Using a dataset collected from over 25,000 lab-raised mosquitoes, they have developed a supervised machine learning model that accurately predicts mosquito age and species. They will optimize this model to work also on wild mosquito populations, develop an online platform for real-time analysis of mosquito MIRS data, and test its ability to measure the effectiveness of malaria control interventions.

Denise Monack of Stanford University in the U.S. will use a genetic approach to identify the molecular mechanisms that enable the typhoid fever-causing bacterium S. Typhi to survive in aquatic environments and to rapidly adapt to transmission to humans. Annually, S. Typhi causes over 20 million infections and 200,000 deaths, mostly among populations that lack access to clean drinking water. Understanding how S. Typhi persists in water and then quickly adapts to its human host is critical for controlling transmission. Bacteria use various mechanisms to adapt to environmental changes, including so-called RNA thermometers (RNATs), which form secondary structures in mRNAs that can rapidly activate gene expression when temperatures change. They will use their established genetic screening approach to identify new RNATs in S. Typhi and validate their ability to promote bacterial persistence within aquatic microbial communities by generating mutants. They will also follow up on past work in which a bioinformatics approach identified new RNATs that may regulate the expression of the chitinase enzyme, which is used by the cholera-causing bacterium to bind to plankton and create a protective environmental niche. They will evaluate whether chitin is also important for S. Typhi persistence and transmission.

Chijioke Kaduru of Corona Management Systems in Nigeria will use a human-centered approach to develop a community theater production that showcases real stories to educate caregivers on the value of vaccinations and increase childhood vaccine coverage. Almost half of caregivers in Nigeria lack awareness of the value of vaccines, which has increased the incidence of childhood diseases. To address this, they will stimulate social change by showcasing aspects of immunization - identifying concerns and discussing potential solutions - in a community theater production based at the income and education level of caregivers. They will work with stakeholders including immunization teams, community health workers, women's groups, and religious leaders to develop the production. The cast will be made up of community members with real experiences, and performances will be held in public places, traditional meeting spaces, schools, and places of religious worship, and be recorded for future airing. By better engaging caregivers with their human-centered approach, they expect to generate a greater demand for immunization services.

Olukemi Amodu, Mofeyisara Omobowale and Folakemi Amodu of the University of Ibadan College of Medicine in Nigeria will develop a three-part intervention to provide more convenient and accessible vaccinations for children of working mothers to increase the timeliness and completion of childhood vaccinations. Despite education campaigns, the demand for childhood vaccination in Nigeria is low, partly because working mothers have limited time to attend vaccination clinics. The three-part intervention comprises priority and more convenient immunization services at existing clinics, mobile vaccine clinics for the many mothers who work long hours in the marketplace, and a smartphone-based application to send vaccine reminders. They will test their approach in the city of Ibadan by setting up mobile clinics at three market places to provide weekly vaccination services and education counseling for mothers in their own shops. These mothers will also be supported with a savings program (VaccoSavings) to help them track money saved to pay for vaccines not paid for by the government. They will also enable mothers working in the formal sector to book vaccine appointments at more convenient times at a child welfare center where they will be attended to promptly. All mothers with smartphones will be supported by the VaccApp application to track vaccine schedules and provide automatic reminders. The impact of these combined strategies on the demand for vaccinations will be evaluated after one year.

Jason Andrews of Stanford University in the U.S. will study the association between the typhoid fever-causing bacterium Salmonella Typhi and its bacteriophage in both aquatic environments and the human gastrointestinal tract to see if they influence geographic and seasonal disease outbreaks in Bangladesh. The ecology and evolution of many know bacterial pathogens including V. cholerae are affected by the viruses (bacteriophage) that infect them. Indeed, seasonal cholera epidemics are inversely correlated with phage prevalence in water. They will study this relationship in S. Typhi, which contaminates half of city water supplies in Bangladesh. They will generate a library of local phage strains infecting S. Typhi and use a computational approach to identify indicator S. Typhi strains that may be susceptible to these phage, which they will then test experimentally. They will also characterize the abundance and strains of phage in municipal water supplies, and in stool samples from typhoid cases, and compare these with clinical cases of typhoid to determine if they shape temporal and spatial patterns of typhoid.

Andrew Greenhill of Federation University Australia in Australia, along with partners at the Papua New Guinea Institute of Medical Research, will use advanced environmental microbiology methods to study microbial community dynamics associated with survival of the typhoid fever-causing bacterium Salmonella Typhi in aquatic environments in Papua New Guinea. "Typhoid Mary" Mallon was an Irish-American cook, written into infectious disease folklore as the first asymptomatic carrier of S. Typhi. More than eighty years after her death, little is still known about how the bacteria persists in environmental niches such as contaminated water, which is a major route of disease transmission. They will collect and filter water samples from streams in areas where the disease is common over an eight-month period covering both wet and dry seasons and analyze the microbial communities within by qPCR. This will be combined with physiochemical parameters of the water (temperature, stream height, photosynthetic activity) collected using DIMPP - a low-cost, late-stage prototype suitable for use in low-resource environments - to build network models. These models will be used to identify mathematical connections between environmental factors, aquatic populations, and the presence of antibiotic resistance genes. These connections could be used to develop an early warning system for impending outbreaks.

Marnie Winter and Benjamin Thierry from the University of South Australia, together with Tina Bianco-Miotto, Claire Roberts, and Clare Whitehead of the University of Adelaide in Australia and the University of Toronto in Canada, will develop and test short-interfering RNAs (siRNA) high-density lipoprotein (HDL) nanocarriers for the treatment of preeclampsia. Globally, ten million women develop preeclampsia during pregnancy each year, which results in the deaths of 76,000 women and 500,000 babies; 99% of these are in developing countries. Most current treatments focus on treating the symptoms (high blood pressure and proteinuria) rather than the molecular causes. Some of the causative molecules, such as the angiogenesis inhibitor sFlt1, can be blocked by specific siRNAs, but the challenge is targeting the siRNAs to the right cells in the body. HDL delivery systems for this purpose are effective and safe, and both siRNAs and HDLs are stable at room temperature, important for therapies in resource-poor areas. They will optimize the formulation of their HDL nanocarrier manufacturing platform, and characterize siRNA loading, carrier stability, size, cellular uptake, and silencing ability in 2D culture. Further, they will bioengineer an ex-vivo placenta model that fully recapitulates the structural and phenotypic complexity of a preeclamptic placenta and use it to evaluate tissue penetration and silencing abilities of the siRNA-nanocarrier complex.

Hanseup Kim of the University of Utah in the U.S. will develop small, ultra-low power, chemical sensors that can be distributed around farms to help detect crop diseases in low-resource settings. Plants under attack from pests and diseases release low levels of volatile organic compounds that could be used as an early warning system to reduce crop losses, which can be substantial. They will design chemical sensors that trigger a change in electrical conductivity when they bind a target compound to minimize energy consumption so that they can be operated over the eight-month farming season in low-resource settings. The sensors will first be developed to bind trace levels of hexenol, hexenal, or indole, which are released from damaged maize and sorghum. They will optimize sensitivity by testing different sensor materials and correlate compound detection with different types and stages of crop damage. They will also evaluate wireless monitoring of multiple sensors distributed around a small plot of crops ready for scaling up to future in-field testing on these and other crops. Note: This grant is funded by the Foundation for Food and Agriculture Research (FFAR).

Paul de Figueiredo and Daniel Alge of Texas A&M University in the U.S. will develop a portable, disposable bioreactor for the low-cost production of gut microbial biotherapeutics at an estimated $0.09 per dose in low-resource settings. Dysfunction of the human gut microbiome is a common consequence of malnutrition in poor countries. It may be effectively treated with live biotherapeutics, yet current production methods are complicated and expensive. Glucose oxidase consumes oxygen as a co-substrate in glucose oxidation and has been shown to create hypoxic microenvironments in vitro, similar to that in the human gastrointestinal tract. They will engineer an inexpensive bioreactor by immobilizing glucose oxidase in a hydrogel placed in dialysis tubing and incubated in liquid media; the glucose oxidation reaction will deplete the bioreactor of oxygen and create an oxygen gradient to mimic the intestinal lumen. This will enable growth of a consortium of anaerobic bacteria, after which the microparticles will be removed by filtration. They will optimize the system using an artificial consortium of at least ten strains of common gut bacteria.

Jessica Manning and Fabiano Oliveira of the National Institute of Allergy and Infectious Diseases along with Daniel Parker of the University of California Irvine, all in the U.S., will develop a combinatorial approach to better define the incidence of vector-borne diseases in Cambodia in order to limit their transmission. The global incidence of vector-borne diseases such as malaria and dengue are increasing globally. However, accurately defining the disease-burden is challenging, particularly in resource-poor settings where diagnostics and expertise are limited. They will perform an exploratory clinical study in a peri-urban referral hospital with a catchment area of over 60,000 people in Kampong Speu Province, Cambodia, using a combination of approaches to define the high-resolution landscape of vector-borne diseases in the heart of the Greater Mekong Subregion. The study will involve next generation sequencing to identify pathogens in prospectively collected samples from infants with fever in their existing pediatric cohort as well as in new samples to be collected from febrile individuals aged between 0 and 45 arriving at the hospital; ELISA to generate antibody reactivity profiles of vector saliva, which plays a critical but often overlooked role in disease transmission; and geolocating cases using open-source (Quantum GIS) software. These data will be used to model transmission risk and identify target areas for interventions.

Joyce Nakatumba-Nabende of Makerere University in Uganda will use artificial intelligence to mine data from local village radio stations to generate timely data on crop pests and disease in sub-Saharan Africa. Crop loss due to pests and disease threatens the economic survival of smallholder farmers, and access to surveillance data is critically important yet often unaffordable. Local radio shows are a powerful source of information flow in rural African villages: they cover topics including politics, policy, climate, and social circumstances, in addition to crop concerns. Collectively, this information provides a holistic representation of current events in these communities. They will analyze local broadcasts to generate crop surveillance data that is linked to the local community situation. Radio content will be collected at low cost through a collaboration with Pulse Labs Kampala, and they will build artificial intelligence models based on deep neural networks and keyword identification to mine the data. The results will be combined with photographs of diseased crops provided by local farmers and used to train machine learning models to ultimately extract radio information in multiple languages and with diverse accents. This project will provide near real-time crop surveillance data and allow for timely responses to threats.

Gregory Medlock of the University of Virginia in the U.S. will develop a method to predict the optimal combinations of different strains of human gut microbes with health-promoting (probiotic) properties to maximize their yield by fermentation and minimize production costs. Microbes tend to grow better when they are in a mixed population (co-culture) because they can share resources and are more resistant to pathogens. Co-culturing can also lower production costs. However, identifying the right mix is challenging as it depends on the properties of each strain and how they interact with other strains. To simplify this, they will build an algorithm that can be applied to any strain of interest. Metabolic and growth profiles will be collected from 10 probiotic strains grown under different conditions to determine their nutrient preferences. These profiles will be used to model the metabolic space occupied by each strain for identifying the combinations that maximize the potential for cross-feeding and minimize resource competition when grown under specified culture conditions. They will test their predictions by comparing biomass produced using the predicted combinations with random combinations and with strains grown on their own.

Shabir Madhi, Vicky Lynne Baillie, and Courtney Paige Olwagen of Wits Health Consortium in South Africa will use next generation sequencing to identify pathogenic causes of neonatal deaths and stillbirths to help develop new treatments such as vaccines and better prevent disease spread. There are around 2.5 million neonatal deaths annually, and an estimated 2.6 million stillbirths, the vast majority of which occur in low- to middle-income countries. Conventional assays have recently indicated that infectious diseases cause far more of these neonatal deaths and stillbirths than previously thought. They also revealed a worryingly high proportion caused by multi-drug resistant, hospital-acquired infections. They will apply a next generation sequencing approach to 80 archived blood samples from stillbirths obtained in an earlier study and analyze the results using the Global IDseq software platform to identify any novel or unculturable or untargeted pathogens that were not identified using the more traditional microbiological methods. They will also use in silico approaches to analyze virulence factors and antimicrobial resistance profiles of identified pathogens.

Christophe Lacroix of ETH Zürich in Switzerland will develop a new method to grow mixed strains of bacteria in bioreactors more efficiently and at lower cost for producing microbial-based biotherapeutics by immobilizing the bacteria on porous polysaccharide gel beads. Damage to the naturally-occurring bacterial populations in the human gut often occurs as a result of malnutrition and can cause serious illness. Healthy populations may be restored by gut microbial biotherapeutics - the ingestion of mixtures of naturally-occurring gut bacteria. Traditional processes to manufacture these mixtures is complex and expensive because many strains have strict growth requirements and do not grow well in mixed culture. They will immobilize bacteria on microbeads to allow multiple strains of bacteria to grow in the same culture: antagonistic strains will be spatially separated, less competitive strains will be maintained, and diversity will be preserved. Using inoculums from healthy human adults, they will optimize individual components of the system including the composition of the bacterial mixture, method of immobilization, and fermentation conditions within a continuous-culture stirred-tank reactor. The result will be the controlled, reproducible and efficient production of gut microbial biotherapeutics.

Ahmad Khalil of Boston University in the U.S. will develop a low-cost bioreactor platform to simultaneously optimize growth conditions of multiple bacterial species for large scale production of biotherapeutics. The human gut microbiome plays an essential role in health and development and living microbial biotherapeutics could be an effective treatment in the case of damage by illness or malnutrition. Commercial production is limited by the capacity of bioreactors, which are costly and challenging to scale and relatively inflexible. Using their eVOLVER continuous culture system, which is modular, inexpensive, and highly scalable, they will adapt the set-up and optimize protocols to allow for the management of unique growth conditions for individual species in parallel, and dynamic mixing of cultures from individual pools to precisely tune multi-species formulations. They will conduct full-scale tests to evaluate their approach for optimizing production of human gut microbiota.

Rajeev Shrestha and colleagues at Dhulikhel Hospital, Kathmandu University in Nepal will apply metagenomic, next generation sequencing technology to identify causative pathogens of fatal acute encephalitis to improve diagnosis and treatment. Acute encephalitis syndrome (AES) annually affects over 100,000 individuals in low- and middle-income countries, causing substantial morbidity and mortality. It is a diverse disease caused by over 100 different pathogens, including viruses and parasites, making accurate diagnosis difficult, even in high-resource settings. This hinders prevention and treatment efforts, even though several effective vaccines exist. To better characterize the pathogens causing AES, particularly treatable and emerging ones, they will apply metagenomic, next generation sequencing technology to 60 banked cerebral spinal fluid samples collected from fatal acute encephalitis cases in Nepal as part of a nationwide AES surveillance program that covered 189 hospitals. They will validate and refine their technique using previously validated samples.

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

Kindie Tesfaye-Fantaye of the International Maize and Wheat Improvement Center in Mexico will develop a computational model that incorporates the variable characteristics of households and farms to better predict the outcomes of agricultural interventions in Ethiopia in order to inform policy choices. Agriculture is central to the Ethiopian economy; it accounts for almost 50% of the gross domestic product and 80% of total employment, yet the industry struggles with limited infrastructure and environmental challenges. Prioritization of agricultural policies has generally relied on analysis of past observations, which are static and tend to ignore variability. They will build and validate an agent-based model that uses current data to model future outcomes, and input biophysical (e.g., soil, climate) and socioeconomic (e.g., household characteristics, land use, access to market and financing) data. They will test their model by comparing five candidate policy options under consideration by the government in terms of impact, effectiveness, efficiency, and inclusiveness. Once established, the model will be scaled up for policy intervention in other Sub-Saharan countries including Tanzania and Nigeria.

Amit Lal of Geegah LLC in the U.S. will develop battery-powered ultrasonic imagers to collect and wirelessly transmit high-resolution images of soil and airborne pests for the early detection of crop threats across large farming areas in rural Africa. Crop losses due to pest infestation negatively impact both food security and local economies. Damage caused by nematodes is particularly difficult to detect because the symptoms visible above ground are not unique and are often incorrectly attributed to deficiencies in soil nutrients or moisture. Currently the only way to test for nematodes is through root and soil samples taken after harvest, when it is too late to respond to an infestation. They will integrate complementary metal-oxide semiconductors (CMOS) with GHz ultrasonic imagers to detect nematodes and survey soil properties over large areas to detect infestations before crop damage occurs and transmit the data in real time. They will optimize the sensor technology in a controlled laboratory setting to maximize sensitivity and specificity and minimize power consumption and then transition to a farm setting for incorporating data transmission via the radio frequency wireless network.

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

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

Christine Lamanna and Todd Rosenstock of the World Agroforestry Centre in Kenya will develop a strategy that combines local knowledge and a Bayesian network model to prioritize agricultural policy using Tanzania’s Agriculture and Food Security Investment Plan as a case study. Agriculture is responsible for nearly one third of Africa’s gross domestic product, yet productivity suffers from limited infrastructure and lack of access to markets and financing. Many policy options exist to stimulate agricultural transformation, however countries struggle to prioritize them and progress is limited. They will develop a Bayesian network to model the cost and risks of implementing specific agricultural policies as well as the economic, social and environmental benefits. Using the Tanzanian plan as a case study, they will develop a data-driven model for policy prioritization that incorporates risk (financial, climate, logistical, political) and reflects stakeholder perspectives to create a sense of ownership over the process. This strategy will allow for direct and transparent comparison of diverse policy options and provide decision-makers with clear prioritization information.

Anne De Groot of the GAIA Vaccine Foundation in the U.S., along with Mika Kunieda of Keio University in Japan and Eliza Squibb and Julia Shivers of ZTwist Design in Boston, will design and distribute printed fabric baby-wraps that use West African iconography to represent the infant vaccination schedule to new mothers in Niger to encourage vaccine completion and reduce child mortality in West Africa. Due to low literacy rates among women in Niger and lack of adapted vaccination information, there are high dropout rates for pediatric vaccination and 40% of Nigerien children are unprotected from measles. In partnership with the Niger Ministry of Health's Social Mobilisation team, the Vaccine Calendar Baby-Wrap addresses key barriers to vaccination coverage in Niger by leveraging local textile traditions to bridge the information gap between the Ministry of Health's efforts to promote free vaccination and mothers’ understanding of the schedule. This visual tool provides mothers with a personal understanding of the vaccination series while enabling them to become health advocates who can educate their peers. As a practical educational intervention for children's health, the Baby-Wrap serves as a strategy for improving information equity in populations with low literacy.

Jignesh Patel of the Indian Institute of Technology Hyderabad in India will increase vaccination coverage among low-income urban populations in India by designing a mobile vaccine service including a smartphone-based management application that provides customized vaccinations at homes and schools and at lower cost. Vaccination offers excellent protection against many diseases, however coverage is low among low-income populations in urban centers: immunization at private clinics is unaffordable, and public clinics have longer wait times leading to lost wages. They will develop an affordable, convenient, in-home vaccination service and a smartphone-based management application to schedule appointments, automate routes, record vaccination data and collect customer feedback. They will pilot test their approach among low-income populations in three cities by recruiting and training healthcare workers and drivers and evaluating its effect on vaccination coverage.

Suparna Kalghatgi of Bempu Health Private Limited in India will introduce an online, personalized messaging platform to educate parents and caregivers on immunization and address their concerns to increase vaccine compliance and decrease childhood morbidity in India. Despite the existence of a universal immunization program, there are 7.4 million unvaccinated children in India, and only 65% of infants are fully vaccinated by age one. Limited caregiver knowledge is a key barrier to vaccination: parents must understand why vaccination is important and know the prescribed immunization schedule and where vaccine services are available. They will develop BabyOnTrack - an online support system that runs through WhatsApp, a free online messaging application widely used across India, to provide daily communications including practical infant health education, personalized counseling, and vaccination reminders, to new parents. They will test their approach by running small pilots in private and government hospitals where babies will be enrolled as they are discharged after birth and evaluate its effect on parent engagement and vaccination compliance. The program will also help health centers better manage vaccine supplies to reduce waiting times, which will further improve the vaccination experience for caregivers.

Sumeet Singh of Onekeycare Ventures Private Limited in India will develop a voice-based platform to store immunization records and improve caregiver attitudes toward vaccination in rural India. Adherence to a standard immunization schedule is essential to reduce childhood death from vaccine-preventable diseases. However, many mothers in rural and remote India are unaware of the recommended childhood immunization schedule and how crucial it is to follow it. They will develop a voice-based platform for health workers to easily update immunization records and to provide automated reminder calls to caregivers when vaccinations are due. They will also develop voice-based games to educate caregivers on hygiene best practices and the importance of immunization for health and provide the opportunity to earn points that can be redeemed for rewards. Importantly, these systems are independent of internet or smartphone access, which are largely absent in remote areas. They will test their platform in a target area by training a group of health workers and influencer caregivers and evaluating its effect on awareness and behavior.

Do-yeon Pi of PiQuant in the Republic of Korea will develop a small, low-cost, water quality test equipment and a GIS-based monitoring system to continuously map water quality in real-time across Vietnam. Despite the extensive river network running through the country, many Vietnamese, especially in rural areas, remain short of clean water. Drinking water can be polluted by many different pathogenic microorganisms such as Salmonella and E. coli that cause waterborne diseases. Spectroscopic devices are used to monitor water quality but they require expensive time-consuming procedures to remove background noise and improve accuracy. They have built a small spectroscopic device incorporating a noise-canceling algorithm that can quickly and accurately measure water quality at a much lower cost than traditional devices. They have identified the major water pollutants in each region and have developed a prototype water scanner. This will be distributed in a pilot area to demonstrate preliminary proof of performance for measuring water quality. They will also set up a GIS-based monitoring system that maps the water quality data and allow users to analyze the potential causes of water pollution and react quickly.

Noshad Ali of Precision Health Consultants Pvt Ltd in Pakistan will develop a speech recognition platform to record child vaccination data and increase efficiency at vaccination clinics. Adherence to the recommended vaccination schedule is critical for reducing vaccine-preventable disease in developing countries and is increased when caregivers have positive interactions with healthcare workers. They will implement a system that will allow caregivers to dictate and record child vaccination information via speech recognition. This will decrease the amount of time spent recording data, allowing vaccinators more time with caregivers to address any concerns. This should help strengthen the relationship between healthcare workers and caregivers and thereby promote vaccination adherence. Software developers will shadow vaccinators in clinics during the design phase, noting the main discussion topics and questions asked. Once functioning, the success of the platform will be measured by software precision and satisfaction of vaccinators using the technology.

Bolanle Oyeledun of the Center for Integrated Health Programs in Nigeria will develop a new approach that involves teaching Nigerian parents to leverage their motivations for ensuring their children were fully immunized so that they can persuade other parents in low-income settings to do the same. They will hold interviews and group discussions with around 250 parents and grandparents of children who are fully immunized across four regions of Nigeria. These will be used to identify their positive and negative experiences during the vaccination process and why they ultimately ensured their children were fully immunized. From this group, around 40 will be selected to act as mentors who will be trained to deliver some of the key lessons learned from the interviews via group discussions. The ability of their approach to increase knowledge and demand for vaccinations will be tested with the 40 mentors along with 400 caregivers of infants younger than five months who have already missed at least one vaccination.

Shola Dele-Olowu of the Clinton Health Access Initiative in Nigeria will consult with a team of community members and health professionals to improve the efficiency of routine immunizations in primary health centers in Nigeria. The vaccination rate in Nigeria varies: while the overall average is 33%, in some areas only 3% of the population is vaccinated. Historical issues with service delivery including long wait times and lack of information have caused fear and mistrust of the healthcare system among caregivers. Although the government is working to improve vaccine coverage, the focus on increased efficiency without consideration of consumer perspective does not address this fear. They will apply a human-centered design (HCD) approach, increasingly applied in healthcare, to identify deficiencies and implement a workflow redesign to meet both caregiver expectations and the needs of overworked healthcare workers. They will consult with caregivers, healthcare workers, and community members to work through the core HCD phases of inspiration, ideation, and implementation, and develop two solutions. These will be tested in a randomized-control trial in healthcare facilities in Katsina state and evaluated for their impact on wait times, caregiver satisfaction, and efficient use of resources.

Erika Linnander of Yale University in the U.S. will use the social influence of rotating savings and credit associations (ROSCAs) – groups who save and borrow together– to increase demand for routine immunizations in Cameroon and Ethiopia. Both these countries have lower than average vaccination coverage and high levels of ROSCA participation. ROSCAs, associations whose members contribute to a fund that can be paid out in whole or in part to each member in rotation, are a savings vehicle for those who may not have access to formal financial institutions. They are also an important part of community structure; it is estimated that 50-95% of adults in parts of Africa belong to at least one. Invitation to join is a signal of belonging and the associations yield powerful social influence also on health behavior. They will develop a program to leverage this influence to increase routine immunization coverage for children. They will locate three ROSCAs in each country in areas with poor coverage and work with local innovators using a human-centered design approach to develop and test ways to increase demand for immunization. Success will be evaluated by changes to member knowledge of and attitudes toward immunization and increased demand.

Ritvik Sahajpal of the University of Maryland College Park in the U.S. will develop an early warning system for low-income countries that predicts the threat to crops from pests and diseases by combining machine learning and crop pest modelling with freely available earth observation data. Existing monitoring systems allow farmers to share data on pest incidence to ensure the timely and limited use of treatments. This maximizes crop yield while minimizing cost and environmental damage. While effective, these systems are expensive and logistically challenging in low-resource settings, particularly as they require widespread coverage and monitoring of a range of pests and diseases. They have designed a new, low-cost early warning system to automatically predict a variety of different crop threats using freely available data and will first test it on maize and sorghum crops in Tanzania. They will use an ensemble-based machine learning model to estimate crop losses two to three months before harvest using earth observation datasets including vegetation indices, temperature, and soil moisture. They will then determine how much of these pre-harvest losses are caused by crop pests such as fungi and insects using the Environmental Policy Integrated Climate Model, which simulates their impact on plant health including growth. They plan to integrate their warning system with existing agricultural monitoring networks to improve accuracy. Note: This grant is funded by the Foundation for Food and Agriculture Research (FFAR).

Casey Brown of the University of Massachusetts in the U.S. will design and test a water supply platform that uses digital technology to integrate vehicular water delivery with existing water infrastructure to provide affordable access to safe drinking water for poor and vulnerable households. Existing public water infrastructure in low- and middle-income areas provides water at lower costs but are often poorly maintained and unable to meet the quality and quantity of water needed by rapidly growing cities. This has led to additional water being supplied directly to households in need by tankers owned by private companies. This is a valuable service but expensive, and water quality is often poor. They have a fully integrated digital simulation model of the water system in Mexico City, a system maintenance cost model, road network data, household water use data, and surveys of water vendor cost and pricing data. Using these data, they will perform advanced analytics to design an integrated water delivery system that identifies priority delivery locations and cost-effective suppliers and supply routes for safe water. This prototype will be evaluated for financial viability, scalability to other regions, and cost effectiveness compared to extending the existing infrastructure.

Shivani Malla of Oxfam in Nepal will improve the management of solid waste in Nepal using technology including geographic information systems (GIS) to map populations and optimize collection routes, mobile phone-based customer services, and digital monitoring for the public and private sectors. Solid waste management in the Birendranagar municipality in Nepal is becoming increasingly challenging as the population increases, and the private sector tasked with handling it has quite basic resources. Effective waste management is crucial for the health of the population and the planet and provides opportunities to generate value by recycling waste to produce sellable resources. They will work with the municipality, private sector, local communities, and existing waste management companies to develop an implementation plan for the different technologies and also provide support to encourage the start-up of businesses for example to convert waste into organic manure. They will also launch a digital awareness campaign to change public attitudes.

Etienne Berges and team of Christian Aid in the United Kingdom will develop a Facebook-based program to increase the demand for and convenience of vaccination services in rural Myanmar. Fewer than 60% of children under two years of age in Myanmar have received all of the recommended vaccinations; the percentage in rural areas is lower as the process is seen to be inconvenient and of low priority. Facebook is widely used for information sharing between caregivers: 85% of Myanmar’s internet traffic goes through Facebook. They will leverage this platform to establish communities among healthcare providers and caregivers in rural settings to create positive peer pressure to pursue immunization and increase convenience of vaccination services by coordinating appointments. The program will be tested in a trial with a rural healthcare center serving 30 villages in Kachin and evaluated for its effect on adherence to the basic vaccination schedule. The results will help researchers to understand the influence of social networks on parental vaccination decision-making.

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