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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

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Creating Spirulina Microentrepreneurs to Solve Malnutrition

Sailendra AppanahEnerGaia Bangladesh Ltd.Dhaka, Bangladesh
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

Sailendra Appanah of EnerGaia Bangladesh Ltd in Bangladesh will teach low-income women in rural Bangladesh to farm Spirulina, which is an edible protein- and nutrient-rich microalgae, to provide better nutrition and an income for them and their families. They have developed a low-cost Spirulina production system comprising closed tanks with filtered air and water inputs, and a business model that provides the farmers with a lease-to-own financing solution and guaranteed buyers of excess product. They will recruit 30 interested women from Dhaka, Bangladesh, and pay them a small wage to undergo three months of training at their local Spirulina farm. They will then provide them with tanks through the lease-to-own program, help them with installation and operation, and process the fresh spirulina produce for sale or for local consumption. They will evaluate the effect of their approach on income and malnutrition in the community.

Marketing an Iron-Fortified Food to India's Adolescent Girls

Mathew EdmundsonViolet HealthNew York, New York, United States
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Folic Acid and Iron: Next Generation Nutrition in Uganda

Lorraine WeatherspoonMichigan State UniversityEast Lansing, Michigan, United States
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

High-Quality Fish-Powder for New Cambodian Ready-To-Use Food

Lyndon PaulVissot Co LtdPhnom Penh, Cambodia
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Food-Derived Nutraceutical Encapsulation System for Food Fortification

Joachim LooNanyang Technological UniversitySingapore, Singapore
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Edible Micro-Balloons for Nutrition Enhancement

Muthupandian AshokkumarUniversity of MelbourneMelbourne, Victoria, Australia
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Creating a Market Solution to Treat Moderate Acute Malnutrition (MAM) in Rural Nigeria

Owens WiwaClinton Health Access InitiativeBoston, Massachusetts, United States
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Hybrid Value Chain for Vulnerable Populations

Gloraia PenaCooperativa Multiactiva De Madres Del Valle CoomacCali, Colombia
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Developing Spent-Grain Food Supplements in Ethiopia

Tsegaye NegaCarleton CollegeNorthfield, Minnesota, United States
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Development of Low-Cost Clean-Tasting Protein Isolates Using Upcycled Agricultural By-Products

Amanda StilesRipple Foods, PBCBerkeley, California, United States
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Improving Process Efficiencies: Assessing and Improving Immunization Clinic Workflows Using an Electronic Immunization Registry

Samantha DolanUniversity of WashingtonSeattle, Washington, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Obtaining Accurate Estimates of Subnational Vaccine Coverage

Joshua WarrenYale UniversityNew Haven, Connecticut, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

True Cover: Localized, Accurate Immunization Coverage

Matt BergOnaNairobi, Kenya
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Electronic Decision Support System for Accurate Immunization

Ali TurabInteractive Research and Development Global LimitedSingapore, Singapore
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Accessible Metrics of Access: Novel Tools to Measure Immunization Coverage

Ross BoyceUniversity of North Carolina at Chapel HillChapel Hill, North Carolina, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Using Technology to Deliver Timely Immunization Data to the Doorstep of the Program Staff and Managers for Evidence-Based Decision Making

James NjeruField Epidemiology Society of KenyaNairobi, Kenya
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Improving Immunization Coverage by Scaling-Up a Regional Data Platform

Michael NunanTupaia (Beyond Essential Systems)Thornbury, Victoria, Australia
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

DigiMat. Tracking Realtime Immunisation Data (DigiTrack)

Chibuzo OparaDrugStoc E Hub Ltd.Lagos, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Human-in-the-Loop Machine Learning and Improved Immunization Data

Benjamin FelsMacro-Eyes, Inc.Fall City, Washington, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Using Data-Driven Algorithms to Detect False Data Entries

Mustafa NaseemUniversity of MichiganAnn Arbor, Michigan, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Aerial Plant Disease Surveillance by Spectral Signatures

Pierluigi BonelloOhio State UniversityColumbus, Ohio, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

PLANT-DX: Field-Based Multiplexed Crop Pathogen Surveillance

Julius LucksNorthwestern UniversityEvanston, Illinois, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Smart Armyworm Surveillance (SAS)

James BellRothamsted ResearchHertfordshire, United Kingdom
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Low-Cost Paper Sensor for Surveillance of Cereal Crops

Jun KameokaTexas A&M UniversityCollege Station, Texas, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Biomimetic In-Field, IoT, "Sentinel" Fungal & Viral Sensor

Bruce GrieveUniversity of ManchesterManchester, United Kingdom
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Accurate Phone-Based Plant Disease Diagnostics

Jan KreuzeInternational Potato CenterLima, Peru
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Integrated Platform for Effective Surveillance

Christopher GilliganUniversity of CambridgeCambridge, United Kingdom
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

A Crowd-Sourcing Approach to Large-Scale Monitoring of Pests by Smallholder Farmers

Menale KassieInternational Centre of Insect Physiology and EcologyNairobi, Kenya
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Zero-Power Chemical Sensors for Pests and Disease Monitoring

Matteo RinaldiNortheastern UniversityBoston, Massachusetts, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Milk Exosomes and RNA for Optimal Growth and Immune Function

Janos ZempleniUniversity of Nebraska-LincolnLincoln, Nebraska, United States
Grand Challenges Explorations
Next Generation Nutrition
1 Nov 2018

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

Crowd-Sourcing Vital Records to Improve Subnational Data

Chinedu ChugboAvigo Health L.L.C.Washington, District of Columbia, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Pest and Disease Surveillance via High-Resolution Satellites

David HughesPennsylvania State UniversityUniversity Park, Pennsylvania, United States
Grand Challenges Explorations
Crop Disease Surveillance
1 Nov 2018

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

Optical Scanning of the Mother and Child Protection Card

Aaditeshwar SethOnionDev Technologies Pvt. Ltd.Gurgaon, Haryana, India
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Uganda Vacc+: User-Centered Data Collection and Use

Monica NolanMU-JHU Care LimitedKampala, Uganda
Grand Challenges Explorations
Immunization Delivery
1 Nov 2018

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

Blood Separator Device

David AndersonBurnet InstituteMelbourne, Victoria, Australia
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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.

Mobile Nudges to Increase Early Vaccination Coverage in Rural Areas - A Pilot Investigation

Günther FinkSwiss Tropical & Public Health InstituteBasel, Switzerland
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

Saliva and Dried Blood Spot Therapeutic Drug Monitoring for Multi-drug Resistant Tuberculosis

Jan-Willem AlffenaarUniversity Medical Center GroningenGroningen, Netherlands
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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.

"Just-Add-Water" Nucleic Acid Amplification

Apostolos AlissandratosThe Australian National UniversityActon, Australian Capital Territory, Australia
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

Apostolos Alissandratos of the Australian National University in Australia will develop a biotechnology platform for the low-cost production of simple, just-add-water diagnostic tests for the early detection of infectious diseases in resource-limited settings. Diagnosis of infectious diseases generally involves detecting pathogen-specific nucleic acids in human samples, which requires unstable reagents, costly procedures, and skilled workers. They have engineered a safe bacterium that produces the biochemical reagents needed to detect the pathogenic nucleic acids as an extract. They will develop a method to freeze-dry this extract so that it is stable at room temperature, simplifying production and storage, and a protocol for incorporating it into a reaction mixture that only requires the addition of water to an individual tube for a diagnostic polymerase chain reaction. They aim to reduce the cost per test by at least 100-fold, and will evaluate their approach for detecting a malaria-causing pathogen.

NETTALIS: One Sample-Endless Metadata

Amadou AlphaInstitut Pasteur de DakarDakar, Senegal
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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

10+10+30 Infant Vaccines Communication via Radio in Ethiopia

Bernard AppiahTexas A&M School of Public HealthCollege Station, Texas, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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.

Timeliness of Administering Birthdose Vaccines

Gershim AsikiAfrican Population and Health Research CenterNairobi, Kenya
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization

Jerome AteudjieuMeillerur Acces aux Soins de SanteYaounde, Cameroon
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

Ensuring Infant Immunization Timeliness and Completion in Urban Slums Through Older Women's Participation

Folusho BalogunUniversity of Ibadan, College of MedicineIbadan, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

A Voice-Based Social Networking Platform for Rural Mothers

Manish BhardwajInnovators In Health (India)Patna, Bihar, India
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

Building Resilience through Self-Help Groups for Adolescent Sex Workers with Young Children in Zimbabwe

Joanna BuszaLondon School of Hygiene and Tropical MedicineLondon, United Kingdom
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

Optimizing Mother and Child Health and Development in Botswana

Lisa ButlerUniversity of ConnecticutStorrs, Connecticut, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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.

Indigenous Communities Mobilize for Adolescent Girls' Healthy Minds

Anne Marie ChomatMcGill UniversityMontreal, Quebec, Canada
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

Innovative Tuberculosis (TB) Sputum Collection Container

Chris de VilliersSinapi Biomedical (Pty). LtdStellenbosch, South Africa
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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.

A Blended Intervention: Digital Mental Health Game and Mentoring for Treatment of Common Perinatal Mental Disorders in Adolescent Refugee Mothers

Rebecca DempsterHIASSilver Spring, Maryland, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

The Medical Record is in the Sample: "Salting" Specimens with Microtransponder Chips to Permanently Link Samples with Data

William GroverUniversity of California, RiversideRiverside, California, United States
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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

Preparing for Parenthood

Syed Usman HamdaniHuman Development Research FoundationIslamabad, Pakistan
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

Using Participatory Quality Improvement Methods to Improve Vaccine Timeliness

Tara HopkinsMali Health Organizing ProjectCambridge, Massachusetts, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

Integrated Support Program Against Anti-Vaccine Narratives

Allya Paramita KoesoemaMasyarakat Elektronika Kesehatan & Telemedika IndonesiaBandung, Jawa Barat, Indonesia
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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.

StandStrong - Sensing Technologies for Maternal Depression

Brandon KohrtGeorge Washington UniversityWashington, District of Columbia, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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.

SamPi - A Simple Integrated Blood Draw and Processing Tool

Jeroen LammertynKatholieke Universiteit LeuvenLeuven, Belgium
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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.

Enhanced Group Antenatal Care for Adolescents in Mali

Sarah MurrayJohns Hopkins Bloomberg School of Public HealthBaltimore, Maryland, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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.

mHealth for Mental Health of Young Mothers in Nepal

Aleksandra PerczynskaPeople In NeedPrague, Czech Republic
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

"Krik Krak": Mental Health for Pregnant Haitian Teens

Guitele RahillUniversity of South FloridaTampa, Florida, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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.

Ask, Boost, Connect, Discuss for Improved Mental Health of HIV+ Adolescent Mothers in Africa

Agnes RonanPediatric Adolescent Treatment AfricaCape Town, South Africa
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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

Catalyst: Better Mental Health for Young Mozambican Mothers

Tatiana SalisburyKing's College LondonLondon, United Kingdom
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

Tatiana Salisbury of King's College London in the United Kingdom along with colleagues at the Royal College of Art in the United Kingdom and the Manhiça Health Research Centre in Mozambique will develop a strategy to improve the mental health of young mothers in Mozambique by adapting existing technology-based and group-based methods to teach them life skills such as parenting and social skills. Almost half of Mozambican girls have had a baby by the time they are 18 years old. Together with associated events including being excluded from school and family conflicts, this can damage their mental health and lead to suicide. They will recruit experts in mental and maternal health and implementation science, analyze resources and local infrastructure, and, together with young mothers, their families, and other stakeholders, co-develop the skill-strengthening and delivery methods. Delivery methods to be analyzed include text messaging, mobile phone applications, and group meetings. They will then pilot test their strategy with three different delivery methods using up to 60 pregnant and young mothers (aged 15-24 years) over four months, and evaluate their effect on mental health.

Creating Demand for Immunization Through Gameplay

Dyuti SenInnovators In Health (India)Patna, Bihar, India
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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.

Vaccination Beads: A Visual and Digital Vaccination Record

Arun ShanbhagManipal Academy of Higher EducationManipal, Karnataka, India
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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.

Sasa Mama Teen Project: Strong Minds for Stronger Adolescent Mothers in Nairobi Slums

Estelle SidzeAfrican Population and Health Research CenterNairobi, Kenya
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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.

A Mobile-Based Training Platform for ASHA workers

Pushpendra SinghIIIT-DelhiNew Delhi, Delhi, India
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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.

Introducing Capacity Building and Mentorship Program

Ashenafi TazebewUniversity of GondarGondar, Ethiopia
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

Development and Testing of a Community-Based Peer-Support Intervention to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Harare, Zimbabwe

Chiwoneso TinagoWest Chester University of PennsylvaniaWest Chester, Pennsylvania, United States
Grand Challenges Explorations
Maternal Mental Health
1 May 2018

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.

Using Super-Absorbent Polymer (SAP) Beads to Extend the Shelf Life of Liquid Samples

Xing XieGeorgia Institute of TechnologyAtlanta, Georgia, United States
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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.

Unstructured Supplementary Service Data Mobile Technology for Specimen Tracking and Results Delivery

Owens WiwaClinton Health Access InitiativeBoston, Massachusetts, United States
Grand Challenges Explorations
Immunization Delivery
1 May 2018

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

Oral Swabs for TB Diagnosis: Stability, Transport, and Quality Control

Gerard CangelosiUniversity of WashingtonSeattle, Washington, United States
Grand Challenges Explorations
Diagnostics Systems
1 May 2018

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.

Improving Childhood Immunizations with Cellular Technology

Sanjay JainJohns Hopkins UniversityBaltimore, Maryland, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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.

Neo-PATch: Plasma Analyte Transdermal Wearable Sensor for Newborns

Patricia ConnollyUniversity of StrathclydeGlasgow, United Kingdom
Grand Challenges Explorations
Wearable Sensors
1 Nov 2017

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

A Marketplace App for Connected Pathology Services in Africa

Jacob McKnightUniversity of OxfordOxford, United Kingdom
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

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.

Confidential Order and Delivery of Contraceptives Using Mobile E-Commerce for Urban and Rural Areas of East Africa

Joanna BichselKashaKigali, Rwanda
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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

Last Mile Healthcare Delivery by Unmanned Aerial Vehicles in Senegal

Daniel PepperVAYU inc.Ypsilanti, Michigan, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

FutureStock Solution

Shahnoza EshonkhojaevaSinostream ABStockholm, Sweden
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

Inventory Visibility Using Radio-Frequency Identification Tags and Near-Field Communication

Mitesh ThakkarArthify IncJohns Creek, Georgia, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Mitesh Thakkar and Harsh Shetty of Arthify Inc. in the U.S. will use radio-frequency identification tags (RFID) on vaccine packages that can be detected by near-field communication (NFC) now found on most smartphones to better track vaccines and improve supply chains in developing countries. They will develop an application for health workers to automatically read the tags and store the data in a cloud, which can then be used to take inventories. They will also build a website so that the data can be easily monitored by supply chain managers to analyze performance and predict demand. They will test their platform for accuracy, feasibility, and cost in a network of 20 primary health centers with 100 sub-centers.

Blockchain: A New Backbone for the Vaccine Supply Chain

Roice FultonDenominator GroupGeneva, Switzerland
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

Engaging Local Shopkeepers for Last-Mile Delivery of Medical Supplies in Hard-to-Reach Areas

Zawadi MageniIfakara Health InstituteDar es Salaam, , Tanzania
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Zawadi Mageni of the Ifakara Health Institute in the United Republic of Tanzania will train local shopkeepers to deliver essential medical supplies to remote areas. Delivery of health products to hard-to-reach areas is problematic due to the poor surrounding transport infrastructure, which suffers further during the rainy seasons. This often means that essential products are out of stock. However, shopkeepers in these areas, with their local knowledge and support, still regularly travel to their central suppliers to maintain their own stocks. These shopkeepers could also be used to deliver medical supplies. They will identify test villages in Tanzania, and the location of medical stores for pick-up points. They will develop a database to map the local health centers and establish an inventory of their medical supplies. Selected shopkeepers will be enrolled and trained, and they will evaluate their approach for avoiding stock-outs of medical products.

Low-Cost Technology Solutions to Connect the First and Last Mile and Redefine Medication Supply Chains Across East Africa

Jessica VernonMaisha MedsPalo Alto, California, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

Demand Sensing and Digital Tracking for Maternal and Child Health in Uganda

Yuehwern YihPurdue UniversityWest Lafayette, Indiana, United States
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

Bacterial Factories for the Production of Diagnostic Enzymes

Andrew EllingtonThe University of Texas at AustinAustin, Texas, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

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

A Smart and Safe Biosample Transportation and Banking

Cheikh Tidiane DiagneInstitut Pasteur de DakarDakar, Senegal
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Cheikh Tidiane Diagne of the Institut Pasteur de Dakar in Senegal will enable real-time remote sensing and monitoring of specimens during transport to laboratories in low-resource settings to facilitate diagnosis and assist researchers and health workers. Containing outbreaks during epidemics requires the early detection and rapid identification of pathogens, which means quickly and carefully collecting and transporting samples to laboratories. They will develop smart biosample preservation and transportation tools that can be monitored in real time with a remote digital interface. They will evaluate their platform for delivery of samples from several rural locations to a centralized laboratory.

Information Chain Management System (ICMS) for Low- and Middle-Income Countries

T.J. CorcoranHemalytics, LLCGoshen, Ohio, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

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.

Flexible, Two-dimensional Nucleic Acid Preparation, Storage, and Shipping Device

Catherine KlapperichBoston UniversityBoston, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

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

Ride-Sharing for Sample Transport

Ruth BetchelVillageReachSeattle, Washington, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

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.

Improved Sample Collection Method for Dried Blood Spot Cards

Charles MaceTufts UniversityBoston, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Charles Mace of Tufts University in the U.S. will develop paper-based cards to improve the collection, storage, and transport of blood samples from remote areas to diagnostic laboratories in low-resource settings. Dried blood spot cards are a low-cost and simple method for collecting and storing blood samples for analysis. However, they have a very basic design, which makes it difficult to control sample volume and elute specific types of molecules, which are needed to properly perform many diagnostic tests. To address this, they will improve the design and fabrication of the spot cards by patterning them with a specialized network of channels to trap the samples, and incorporating complementary materials to separate specific components of the blood. They will evaluate the manufacturing, storage capacity, and performance of their device using clinical samples in the laboratory.

Development of a Digital HIV Self-testing Support Platform

Natasha GousSystemOneSpringfield, Massachusetts, United States
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

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.

Large-Volume Clinical Sample Stabilization Cassettes

Bhushan ToleyIndian Institute of ScienceBangalore, India
Grand Challenges Explorations
Diagnostics Systems
1 Nov 2017

Bhushan Toley of the Indian Institute of Science in India will develop a device that protects DNA specimens from destruction during transport to laboratories for diagnosis of infectious diseases. Sputum, urine, and blood contain the DNA of infectious agents that can be used to diagnose diseases to aid treatment and help prevent spread. Diagnosis is generally performed in specialized laboratories, but the DNA can be damaged during transport from remote locations due to the length of time it takes or exposure to high temperature. Drying the samples would help protect the DNA but this requires a sterile method that can handle larger volumes of multiple types of specimen. They will develop a device incorporating microfluidics for spreading out large-volume samples onto a porous paper membrane for rapid drying. They will test various agents for coating the membrane to stabilize the DNA and keep it sterile. They will optimize the design and test its ability to detect tuberculosis in clinical sputum specimens from infected patients.

A Demand-Driven Supply Chain Technology Demonstrator

Sara GrobbelaarStellenbosch UniversityStellenbosch, South Africa
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

HealthSIM: A Supply Chain Simulator for Supply Chains

Jim DugganNational University of Ireland GalwayGalway, Ireland
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Jim Duggan of the National University of Ireland, Galway, in Ireland will develop a simulator for public health supply chains in low- to middle-income countries that incorporates the stakeholders and steps needed to provide health care products from the manufacturer to the individual under different conditions, to optimize their performance and ultimately improve health. A key challenge is to ensure that the right medicines are available when needed, particularly when demand is high, for example during epidemics. The supply chain model will be built using the systems dynamic tool and tested in collaboration with public health professionals for its ability to improve the supply of health care products, and to support information sharing and decision making.

Nisre-Tena: Drones for Blood Delivery in Hard to Reach Areas

Fassika Fikre HailemeskelMaisha ICT Technologies PLCAddis Ababa, Ethiopia
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

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.

Blockchain Technology-Based Computer Application for Vaccine Supply Chain Management

Agnes MindilaJomo Kenyatta University of Agriculture and TechnologyNairobi, Kenya
Grand Challenges Explorations
Health Supply Chains
1 Nov 2017

Agnes Mindila of the Jomo Kenyatta University of Agriculture and Technology in Kenya will develop a software application along with blockchain technology to monitor the supply chains delivering vaccines from the producers to the health workers to ensure good quality vaccines are available when needed. They will use blockchain technology, which involves digitally storing information in blocks that are shared across a network of computers and can be continually updated. They will also develop and test a software application so that everyone in the supply chain can access and record information about a specific vaccine to improve transparency and ensure the vaccine is authentic.

The Immunity Charm

Daniel CarucciThe Immunity Charm FoundationWashington, District of Columbia, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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.

The VIMS Model: Digitalizing Immunization in Three Rural Health Centres in Uganda's Low-Resource Regions

Ephrance NuwamanyaBushenyi Intergrated Rural Development (BIRD)Bushenyi, Uganda
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

Ephrance Nuwamanya of Bushenyi Integrated Rural Development (BIRD) in Uganda will improve routine immunization coverage in Uganda by developing a digital system for health centers to record births and vaccinations, send automated reminders and education messages to families via SMS, and monitor vaccine orders and supplies. Vaccinations can prevent many potentially deadly diseases. However, few children are properly vaccinated across many sub-Saharan African countries, and there is no effective way to monitor vaccinations and educate families. To address this, whey will optimize their digital system for data collection and management of newborns and vaccinations, and integrate it with existing databases and hospital management systems. They will pilot test their approach in three district health centers in rural Uganda by teaching the health workers and local communities about their vaccination and information management system (VIMS), and evaluating its impact on the timeliness and coverage of vaccinations.

Using Bracelets to Improve the Timeliness of Immunizations

Inuwa Barau Ya'uNational Primary Health Care Development AgencyAbuja, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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.

Improving Routine Immunization Timeliness, Completeness and Coverage Using an Automated Tracking, Reminder and Notification System

Olorunsogo Bidemi AdeoyeAfrican Field Epidemiology NetworkAbuja, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

Olorunsogo Adeoye of the African Field Epidemiology Network in Nigeria will set up an immunization tracking system based on SMS in Nigeria to register children's immunizations, send out reminders of vaccination schedules, and educate families on the importance of routine childhood immunizations. Late or missing vaccinations are a major cause of morbidity and mortality particularly in developing countries. Poor vaccination coverage is due in part to a lack of information given to families on the importance and time-sensitivity of vaccinations and on the recommended schedules. They will develop an SMS-based tracking tool to work with an existing health management system so that health facilities can record each child's data, and SMS reminders can be regularly sent to families and health facilities to inform them when vaccinations are due. Automated voice jingles and messages will also be designed to provide families with useful information. Their system will be tested using 20 health facilities in Sokoto State in Nigeria where 2014-15 records show that none of the children in 40 districts received the complete set of vaccinations.

Wristband for Immunization Alert (WIA)

Sydney SampsonSydsam Integrated Services LimitedAbuja, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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

Improving the Timeliness of Infant Vaccinations Through Network Transportation Providers

Diana NegoescuUniversity of MinnesotaMinneapolis, Minnesota, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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.

Immunization Schedule Alert Platform (ISAP)

Emmanuel IhediohaLifespan Healthcare ResourceEnugu, Nigeria
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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

Before Your Birth Day: Pre-Birth Immunization Planning

Marc MitchellD-Tree InternationalWeston, Massachusetts, United States
Grand Challenges Explorations
Immunization Delivery
1 Nov 2017

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.

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