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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Brazil and Pakistan Data-Driven Ecosystem for COVID-19 Preparedness, Equity and Vaccine Surveillance
Vinicius de Araujo Oliveira of Fiocruz in Brazil will develop a framework for the re-use of large clinical and administrative datasets to enable comparative analysis of COVID-19 vaccine safety and effectiveness in Brazil and in Pakistan, with colleagues at Shaukat Khanum Memorial Cancer Hospital and Research Centre there, to improve pandemic responses and promote data-driven evidence generation in the Global South. Monitoring vaccinations across different settings is crucial for containing pandemics. However, comparative analysis of large health datasets in different scenarios is challenging due to concerns around safety and reproducibility and the loss of the context in which the data was collected, which can affect research results. They will adapt data science standards and tools to different local health system scenarios and run individual and joint vaccine effectiveness analyses for the two countries to assess compatibility and reproducibility of the findings. They will also build a public data visualization dashboard for health managers and policymakers to monitor the pandemic, particularly in vulnerable populations.
FAIR and CARE Principles for a Multi-Country Electronic Medical Record Cohort
Vincent Cubaka of Partners In Health in the U.S. will build robust data governance structures to enable the utilization of electronic medical records from multiple countries for research purposes to improve health. So-called FAIR (Findable, Accessible, Interoperable, Reusable) data principles enhance the value of personal medical records for research, and CARE principles were developed to protect the owners of these data. However, the rigidity of these principles can create conflicts, which can make it difficult, for example, to open access to datasets across different countries. To address this, for their current project studying the impact of COVID-19 on chronic care patients across four low- and middle-income countries, they will develop data governance structures and set-up a multi-country community oversight committee to enable full access by researchers to appropriately de-identified individual-level data on a suitable platform.
Integrated Surveillance of NTDs Through the Blood Donation Program in Kenya
Wyckliff Omondi from the Ministry of Health in Kenya will integrate a neglected tropical disease (NTD) surveillance program into the national blood donation program as a more cost-effective mechanism to monitor lymphatic filariasis and other endemic NTDs in Kenya. Kenya is on course to eliminate lymphatic filariasis using mass drug administration programs. Certifying regions as disease-free requires careful post-treatment assessments. To support this, they will work with the Kenya National Blood Transfusion Service, which collects, tests, and distributes blood across the country, to collect small, normally discarded blood samples from regional centers and test them for lymphatic filariasis, dengue and chikungunya in their central laboratory. As well as supporting eradication efforts, this routine testing will provide an early warning system by identifying distribution patterns and prevalence of dengue and chikungunya, which have histories of outbreaks in coastal regions.
Implementing Metagenomic Next Generation Sequencing for the Management of Lung Infections in a High-Risk Population
Ida Viktoria Kolte of Fiocruz in Brazil will employ metagenomic next generation sequencing (mNGS) for the analysis of sputum and blood samples from Indigenous patients to identify the causes of severe lung infection in the rural Amambai district. Brazil's one million Indigenous people suffer a disproportionate burden of infectious and respiratory diseases. Lung infections are challenging to diagnose because they can be caused by viral, bacterial and fungal pathogens and are often associated with co-infections. They will collect samples from 170 patients aged over 18 years presenting with symptoms of severe lung infection from five locations and subject them to next generation sequencing to identify the microorganisms present. They will also use implementation research to identify any cultural barriers that have restricted current diagnostic and therapeutic practices to help more effectively implement the new metagenomic next generation sequencing technology into clinical practice.
Leveraging Patient Engagement and Electronic Medical Records for Antenatal Risk Stratification
Ifeoluwa Olokode of Helium Health in Nigeria will develop a digital antenatal risk stratification tool to determine the risk of maternal mortality for pregnant women in Nigeria and link them to appropriate care services to reduce maternal death rates. Nigeria has one of the highest burdens of maternal mortality, with the biggest driver being a delay in the decision to seek health care. They will develop the stratification tool to incorporate patient demographic, behavioral, and obstetric clinical information into existing models to predict antenatal risk levels and communicate them to patients to aid earlier decision making. The tool will be adapted to different demographics, such as women with no education, and integrated into an existing digital patient healthcare platform. It will also connect women with financial support services. They will implement their tool across Lagos, Kano, and Akwa Ibom states over twelve months to demonstrate proof of concept.
Metagenomic Next Generation Sequencing for Female Sexual and Reproductive Health in Zambia
Jennifer Fitzpatrick of Zambart in Zambia will design and implement a one-step multiplex whole genome sequencing platform for the diagnosis of female genital schistosomiasis (FGS), sexually transmitted infections (STIs) and vaginal microbiome analysis in Zambia. FGS is caused by Schistosoma haematobium and affects around 56 million women in sub-Saharan Africa. Current diagnostic capabilities for STIs and FGS are inadequate and many patients are either incorrectly treated, overtreated or receive no treatment at all. They will use 525 self-taken vaginal swabs to develop the sequencing assay and follow-up with self-taken cervicovaginal swabs and S. haematobium eggs taken from up to 2,000 sexually active girls and women aged 15 to 50 for further development and implementation of the platform to enable the rapid identification of known and new pathogens. They will also characterize the cervicovaginal flora to gain insights into its role in sexual and reproductive health.
Metagenomic Sequencing to Find Causes of Febrile Illness in South and Southeast Asia
Elizabeth Batty of the University of Oxford in the United Kingdom will use metagenomic next generation sequencing to identify pathogens in patient samples that are negative by all other diagnostics, to better understand the causes of febrile illness in South and Southeast Asia. Although studies have identified a broad spectrum of pathogens underlying non-malarial febrile illness, the cause of fever remains unknown in more than half of patients. Febrile illness causes substantial morbidity and mortality, and correct diagnoses are needed to ensure that patients receive the appropriate treatments. They will collect samples in multiple healthcare centers in Bangladesh, Lao PDR and Thailand, and use multiplex PCR and serological tests that detect the most common causes of acute fever. Up to 300 samples that test negative using these approaches will be sent to the central Mahidol-Oxford Tropical Medicine Research Unit laboratories in Bangkok for metagenomic sequencing and bioinformatic analysis.
Using Phytase-Producing Bifidobacterium/Lactococcus Strains to Improve Iron Absorption from Iron Fortificants Added to Phytate-Rich Foods
Marion Jourdan of Danone Nutricia Research in the Netherlands together with Michael Zimmermann of ETH Zürich in Switzerland will test an approach to enhance iron absorption from food in children in Kenya by providing them with live food-grade bacteria to release phytate-bound iron from popular foods such as cereal flour. Phytates bind strongly to iron and inhibit its absorption. Their previous work identified different bacterial strains containing phytases that could grow in milk, degrade phytates, and release nutritionally-relevant levels of free iron in vitro. They will test different strain combinations for their phytate-degrading activity under different conditions, such as in specific foods and in an environment mimicking the upper GI tract, and select the best one for producing a fermented food product. This will then be tested to assess its effect on iron absorption in a cohort of 22 iron-deficient Kenyan school-aged children.
Metagenomics-Driven Discovery of Pathogens Causing Nosocomial Infection in Senegal
Aida Badiane of the Universite Cheikh Anta Diop de Dakar in Senegal will use shotgun metagenomic next generation sequencing (mNGS) to identify the pathogens causing nosocomial infections in Senegal to improve diagnosis and treatment. Nosocomial infections (i.e., hospital-acquired) cause substantial mortality in Senegal but remain poorly understood. To create a more complete profile of the causative pathogens, they will apply shotgun mNGS to different types of clinical samples from 61 patients at LeDantec hospital to identify and quantify the pathogens. They will also identify the most suitable sample types for diagnosing the most common pathogens. The sequencing data will be analyzed and shared with clinicians, stakeholders and the global research community, and will help in the development of suitable diagnostic assays. This project will help implement sequencing technologies into the national healthcare system.
Innovations to Enhance Implementation of Trachoma Intervention in Tanzania
Innocent Semali of Hubert Kairuki Memorial University in Tanzania will design a more effective strategy for eliminating trachoma in the nomadic Maasai communities in Tanzania. Trachoma is a bacterial disease and a leading cause of blindness. Globally, there are around 84 million sufferers, mostly in sub-Saharan Africa. In Tanzania, the standard control strategy, which involves mass drug administration of azithromycin, eliminated trachoma from most districts. However, the strategy has largely failed in nomadic populations for unclear reasons. To identify those reasons, they will work towards building a partnership with a Maasai community and relevant stakeholders and use interviews and surveys to document their perceptions and behaviors around the standard trachoma interventions. This information will be used to understand the failure of the previous interventions and, together with the communities and stakeholders, to develop new strategies for testing in two villages using a mixed methods approach.