Feng Fu of Dartmouth College in the U.S. will use social networks to promote positive attitudes and overcome negative views of vaccinations and thereby increase demand. The success of vaccinations has led to steep declines in the incidence of many serious diseases. However, this has decreased the perception of disease risk and thereby lowered vaccination coverage as parents concerns switch to other factors, such as cost and the perceived risk of the vaccination itself, which are fueled via social media channels. These current low vaccination rates exhibit so-called hysteresis whereby the past concerns about safety or necessity prevent the rates from increasing even when the concerns have been disproven. To overcome this, they will use computer modeling approaches to test the ability of targeting social networks to leverage social "contagion" (i.e., spread) of positive attitudes to vaccine knowledge. They will use a healthcare intervention dataset from a network of rural villages in Honduras to model how one or more health-related behaviors or beliefs of an individual affects the group to simulate the social contagion process related to vaccines. They will also evaluate the potential positive impact of influential individuals who publicly support vaccination. The results will be used to develop social network targeting algorithms to increase the demand for vaccination. Their modeling results will be validated using the real data from the village networks.

Caroline Aura from the University of Nairobi in Kenya will teach frontline health workers and caregivers new skills so they can apply simple techniques such as swaddling and rocking to lessen the pain and distress of infants during injections to improve vaccination rates. Vaccination rates are still too low in many low-resource settings, which may be due in part to the discomfort they cause infants. This in turn makes caregivers reluctant to obtain all the recommended vaccinations for their children. Methods exist to reduce the associated pain of injections, but health workers lack the knowledge and skills to implement them. To test their approach, they will recruit vaccinators and community health workers at four rural immunization centers and use seminars and workshops to teach them pain-relieving techniques, including using specific positions and making soothing sounds. They will also develop audio-visual training tools and illustrative guides to help teach the techniques to parents for them to use at home as well. All healthy children under 12 months old visiting the centers for a vaccination will also receive one of the pain relief techniques. They will evaluate the ability of the health workers to manage pain, the level of distress of the infants, and the experience of the caregivers.

Robert Kingsley of the Quadram Institute Bioscience in the United Kingdom will locate the typhoid fever-causing bacteria S. Typhi in water reservoirs in Harare, Zimbabwe, and identify any associated protozoa species present in the water that may be supporting disease spread. Typhoid fever is endemic in Zimbabwe, with several major outbreaks reported in the last decade. The bacteria persist in unclean aquatic environments, possibly supported by protozoa, and are transmitted to humans through ingestion of contaminated drinking water. They will detect S. Typhi in sewage effluent and low-quality drinking water in hotspots of typhoid transmission by enrichment culture and PCR, and use whole genome sequencing to establish the phylogenetic relationship between these bacteria and clinical typhoid isolates in the same city. They will also amplify 18S rDNA from the sewage and drinking water samples to characterize the microbial community in water and define the protozoa population. These data will help identify potential synergistic interactions between S. Typhi and other microbes to inform prevention strategies.

Anita Shet of Johns Hopkins School of Public Health in the U.S. will seek to increase childhood vaccination coverage in India and Nigeria by identifying opportunities for catch-up vaccinations when under-vaccinated children are hospitalized. Of the three million people who die each year from vaccine-preventable diseases, about half are children under the age of five, many of whom live in areas where vaccinations are available, but inequitably distributed. Inadequately vaccinated children frequently become sick and are hospitalized, yet most leave the hospital without receiving catch-up vaccines because of physical and policy barriers, or perceived contraindications. They will engage stakeholders, including hospital policy makers and community workers to launch MOVE (Missed Opportunities for Vaccine Equity) to identify and correct missed opportunities for vaccination by using child hospital visits to provide vaccine education and access. MOVE has three components: inpatient in-reach, where MOVE staff check immunization records and inform hospital personnel of missing vaccines; immunization service linkage to inpatient care, which ensures that vaccines are available and provides a vaccination schedule at discharge; and community outreach to provide follow-up reminders and education. They will modify an immunization application and reminder tool to record the data and maintain a cloud-based registry, and test their approach in two large community hospitals in India and Nigeria.

Tapash Roy, Subhash Chandir and Toufiq Rahman of IRD Global in Singapore will improve child immunization coverage among the homeless, or floating, populations in urban slums in Bangladesh by offering vaccines during evening sessions at existing shelters. The mortality rate for children under five in Bangladesh is high, and many deaths would be preventable with better vaccination coverage. The lack of an integrated public healthcare delivery system in urban areas has resulted in a large inequity between the rich and poor, and the vaccination rate among the floating population of approximately 25,000 is well below the national average. They will develop and test a plan to provide vaccination services using an unconventional gathering place of the floating populations (called Pavement Dweller Centers) during convenient hours. PDCs have been established on city property to provide temporary shelter, safe drinking water, and sanitation services to the homeless. They will use this infrastructure to provide free, mobile phone-based digital immunization registry vaccinations during extended hour clinics with evening shifts, so visitors don't need to miss work to spend time traveling to a healthcare center. The program will be executed by personnel trained in communication to pre-empt any apprehensions by caregivers, and will involve educating visitors on the importance of vaccination. They will evaluate the feasibility and cost-effectiveness of the program in three PDCs in Dhaka and assess community response by a post-intervention survey.

Andrew Seal of the Institute for Global Health and Development in the United Kingdom will test whether traditional female social groups in Somalia can adopt a participatory learning and action (PLA) approach to improve vaccine knowledge and coverage in humanitarian settings. Vaccine-preventable diseases are prevalent in Somalia; measles is the leading cause of death in children under five, yet less than 40% of children are immunized. This is due in part to lack of knowledge about the benefits of vaccination. The PLA approach is based on the idea that sustainable social change is possible if teachers and learners engage in meaningful dialogue and share ideas and experiences. Abbay-Abbay groups, common throughout Somalia, are social groups of 10-20 women, led by an elected Khalifada (lead woman). They meet regularly and have a core interest in the challenges of child rearing, with most women having direct or indirect experience with losing a child to measles. They will recruit coordinators to support Abbay-Abbay leaders, providing information and facilitating learning around vaccinations. They will evaluate their approach for improving attitudes to vaccination and reducing the incidence of measles via a randomized cluster study.

Dilip Abraham of Christian Medical College in India will analyze water samples from peri-urban and rural areas in India to study whether and how the typhoid fever-causing bacterium S. Typhi survives by living inside the common amoebae, Acanthamoeba. Acanthamoeba spp. are known to internalize S. Typhi, and may provide an intracellular environmental niche and extend survival of the bacteria. They will collect samples from drinking water sources and sewage lines in peri-urban and rural sites in Southern India. From these samples, they will recover Acanthamoeba and detect any internalized S. Typhi by culture and PCR. Whole genome sequencing will be used to conduct comparative genomic analysis of intracellular S. Typhi to identify any major virulence markers that promote its ability to be internalized by and remain viable within Acanthamoeba. This would help explain why persistence of S. Typhi in the environment can lead to sporadic outbreaks, and allow officials to plan preventative strategies beyond vaccines for the control and elimination of typhoid.

Joseph Tucker of the London School of Hygiene and Tropical Medicine in the United Kingdom will hold a national crowdsourcing contest to develop a social media-based intervention to improve confidence in childhood vaccines and boost coverage in China. Expert-driven strategies have been launched to promote vaccination coverage in China, but have had limited effect. As an alternative approach, they will apply crowdsourcing to tap into the knowledge of individuals to design a more effective, online intervention. They will open the contest with a call for new ideas that use text, images, and videos to promote vaccinations; enable online evaluation of those ideas by crowd and expert judges; and assemble a steering committee of health experts to produce the finalists. The final content of the intervention will be developed by the finalists in an intensive 'designathon' event. They will test the new intervention in select community health centers in three cities in China and analyze its ability to improve confidence in vaccinations.

Windy Tanner and Jim VanDerslice of the University of Utah in the U.S., together with colleagues from Mehran University of Engineering and Technology in Pakistan, will analyze water samples to determine the conditions that promote the survival of the typhoid fever causing bacterium Salmonella Typhi, and they will use metagenomic deconvolution to identify any gene exchange from other microbial species that may produce drug-resistant strains. S. Typhi is responsible for over 100,000 deaths each year, mostly in the developing world where fecal contamination of food and drinking water is common. The emergence of drug-resistant strains has limited the available treatment options. Biofilms are environmental niches with complex microbial communities and are ubiquitous in the environments where S. Typhi is commonly found. They will sample water and biofilms from a variety of these environments along the fecal-drinking water transmission route in the Sindh province of Pakistan and test for the presence of S. Typhi using qPCR and culture methods. They will also evaluate whether specific organisms stabilize and protect S. Typhi in these biofilms and could cause resistance gene exchange.

Itoro Ata of the Solina Center for International Development and Research in Nigeria will implement a program to support unemployed mothers in Nigeria by linking education on the importance of vaccinations with vocational skills education and training to improve immunization coverage. Many rural areas in Nigeria have consistently low rates of routine immunization and large populations of unemployed, stay-at-home mothers whose children are at risk of vaccine-preventable disease. They will create a direct link between community health systems and economic empowerment programs focused on vocational skill development by creating the Routine Immunization Buddy System (RIBS). Mothers in the program will be placed in small support groups and paired with another woman within the group. The lead woman of each group will be trained by community health workers to provide practical information on vaccines using a teaching tool called Hannun Rigakafi (the immunization hand). Women in the RIBS groups will also be taught about possible work options, such as farming, and offered associated tools and training. Pairing education on vaccines with vocational training should help boost the confidence of the mothers and better motivate them to complete the five routine childhood immunizations for their children. The program will be piloted in the Kaduna state of Nigeria and evaluated for improving vaccination knowledge and demand.

Gemma Langridge of Quadram Institute Bioscience in the United Kingdom, along with co-investigators Aaron Jenkins of the University of Sydney in Australia and France Daigle of the University of Montreal in Canada, will collect different isolates of S. Typhi, which causes typhoid fever, to analyze genomic structure, growth, and gene expression to better understand how it can survive at low levels in water, and determine how it can be reactivated for monitoring. Typhoid fever is a potentially fatal disease associated with exposure to contaminated water. S. Typhi, the bacteria causing the disease, exist in water in a so-called viable-but-non-culturable (VBNC) state, which makes it difficult to monitor for control efforts. Their previous analyses have shown that the VBNC bacteria undergo structural rearrangements of their genomes and changes in gene expression, which may explain the reduced growth. They will analyze the correlation between genome structure and growth of different S. Typhi isolates using samples isolated from around 25 typhoid fever cases, and a further 75 stored isolates across the endemic region. Of these, a selection will be tested for their ability to enter a VBNC state and survive in water from areas of high and low typhoid incidence. One isolate that has entered VBNC with a defined structural genotype will be tested to establish the conditions most suitable for resuscitation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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