The project will study the genetic material from environmental samples from humans (healthy and ill), cattle and their meat to estimate the proportion of E. coli and K. pneumoniae in the microbiome. The main objective is to better understand the distribution of bacteria and its resistance genes, Escherichia coli and Klebsiella pneumoniae bacteria and extended spectrum beta-lactamase (EsβL) and carbapenemases encoding genes in distinct ecological sources.

The researcher will use machine learning techniques and a linked database to analyze mortality from drug-resistant tuberculosis. The goal is to better understand how the flow of patients through the health services network have influenced, or not, the occurrence of resistance.

Bacterial plasmids are genetic elements that can carry genes for antibiotic resistance from one bacteria to another acting as "messengers". Plasmid transfers contribute to the appearance of multidrug resistant bacteria. This project aims to use a "kill the messenger, not the bacteria" approach to tackle the problem of increasing antibiotic resistance. The goal is to test the elimination of plasmids carrying genes for antimicrobial resistance.

The project proposes to use an aerobic granular sludge (AGS) - a technology based on microbial community - to remove antibiotics and antimicrobial resistant genes from hospital wastewater. AGS is one of the latest innovations and it has not yet been applied for the treatment of hospital wastewater.

Aims to validate the International Fetal and Newborn Growth Consortium for the 21st century (Intergrowth-21st) standards for gestational weight gain (GWG) and create new recommendations of GWG based on those standards for first trimester normal and overweight women to be used in the Brazilian Unified Health System (SUS). GWG recommendations currently used in SUS have not been properly tested or validated, thus the project might improve prenatal nutritional care and reduce post gestational weight retention.

The study aims to develop an Early Childhood Development friendly index (ECD-FI) based on a core set of evidence-based nurturing care indicators to assess the factors contributing to enabling environments and promote ECD at the municipal level by monitoring and identifying opportunities to scale up ECD programs. The index will be created through machine learning and will run analytical models considering demographic information and risk factors at the municipal level. This disaggregated data is not available in Brazil.

The project will develop a platform to provide services for decision-making support for neonatal death preventive actions by using data from CIDACS cohort. The platform will offer three services: cohort data visualization for decision-making support by comparative human visual analysis, prediction of risk of neonatal death based on machine learning models, and simulator of public policies impact influencing on the risk of neonatal death.

By analyzing national children vaccination coverage from spatial perspectives, the study aims to uncover insights into the traditional surveillance. This will help to identify coverage rates, regions of greater vulnerability by providing a differentiated look at the logic of equity in health. Understanding the low childhood vaccination coverage will help to guide public policies for the purpose of interventions.

Studies show that seasonal influenza in Ceará, in the Northeast region of Brazil, occurs 2 to 3 months earlier than in the South and Southeast, which guides the national calendar of vaccination. By using data science approaches, the study will test if Brazil's current national policy targeting vaccination only during the months of April and May inadequately protects against the harmful maternal-fetal effects of influenza in the Semi-Arid and northern regions of Brazil. If the hypothesis confirms, the study has the potential to change policy and modify the vaccination calendar.

The proposal will develop a platform for the analysis and visualization of data that will allow managers, public servants and other stakeholders involved in the Mãe Coruja Program at Pernambuco state (PMCP) to extract strategic information to improve the intervention. The focus will be on the implementation and actual enforcement of public policies, considering the high gestational risk and sexually transmitted infections (STI). Currently, health databases are for consultations only. The innovation of this proposal is to create an intelligent cloud platform for the analysis and distribution of health information to improve health care of women enrolled in PMCP.

Infectious diseases may have only transitory impacts on pregnant mothers, but they can have lasting impacts on children. Can public interventions mitigate these impacts? This project aims to identify how exposure to localized epidemiological risk factors in the fetal period influences developmental outcomes for children through the early years of life. The researchers propose to evaluate in what extent the access to primary health care and social welfare programs mitigate negative impacts in child development.

This project will test a sustainable solar oxidation system as a way to remove antibiotic resistant bacteria from wastewater. The hypothesis is that this technology can enable the inactivation of antibiotic resistant bacteria and the elimination of antibiotic resistant genes from effluents in Brazil.

Marcos Augusto Bastos Dias from Fiocruz in Brazil in collaboration with the Global Pregnancy Collaboration (CoLab) will test a new approach for managing women in Brazil with preeclampsia in order to reduce unnecessary preterm births. Preeclampsia is characterized by high blood pressure and impaired organ function during pregnancy and can cause severe complications or even death for mother and child. The only cure is delivery, but preterm births are also high risk. In Brazil preeclampsia accounts for far more preterm deliveries than in higher income countries who more readily choose medication to reduce the severity of the disease, and help delay delivery. The study includes seven geographically diverse hospitals with 23 satellite community health centres over four years. They will train staff to adopt the WHO guidelines for preventing preeclampsia and introduce a method for identifying low-risk women whose pregnancies can be safely prolonged. The study will also generate data and biological samples that can be used to help better stratify risk and understand the disease, which could further improve clinical management and lead to new treatments.

Ricardo Tavares Pinheiro from the Universidade Católica de Pelotas in Brazil will identify factors that are associated with gestational depression, and determine whether they influence their response to treatment and ultimately the healthy development of the child. Gestational and postpartum anxiety and depression affect 15-25% of mothers and can alter the emotional, social and cognitive development of the child. They are likely caused by a complex combination of genetic, hormonal, psychological and social/environmental factors. Only a handful of risk factors, including the levels of proinflammatory molecules, have been identified. The study will involve around 1250 pregnant women who will be evaluated by psychologists to ascertain their mental state. Blood and buccal cell samples will be collected to analyze the presence of candidate risk markers (specific proteins and microRNAs) and genetic polymorphisms (specific DNA sequences) to identify those associated with depression. They will also determine the relationship between these psychological and physiological factors and the subsequent motor and neurocognitive development of the born children. Clinical studies will also evaluate the efficacy of several modified therapeutic approaches centered on cognitive behavioral therapy, which involves guiding the patient to modify any distorted thinking and can be effective in depressed mothers.

Iná da Silva dos Santos from the Universidade Federal de Pelotas in Brazil will develop a simple, low-cost strategy targeting mothers to ensure young children get enough sleep. Inadequate sleep is more common in children from low-resource households, and can negatively impact their physical and mental health, including their cognitive development. Children can be encouraged to sleep well by creating a restful environment and helping them learn to get to sleep by themselves. They will perform a randomized controlled study with around 500 mothers of infants aged three months. One group of mothers will be taught about normal sleep behavior during the first year of life and how to encourage their child to sleep. The effect of this intervention on sleep duration, growth and neurodevelopment will be analyzed over a 24-month period. Sleep duration will be monitored by actigraphy to ensure accuracy.

Guilherme Vanoni Polanczyk from Universidade de São Paulo in Brazil will test their new method Pixel Averages for Auxological Assessment (PIXA3) that enables parents at home to frequently and precisely measure height during early childhood to help better detect and monitor growth defects in low-resource settings. The current standard for accurately measuring height requires specialized equipment and trained staff, and is thus unsuitable for frequent application. Their new method involves using a smartphone to take multiple photographs of an individual next to an internal standard of known size, and doesn’t require cross-sectional population norms, which have complicated current methods of longitudinally assessing growth. They will perform a randomized controlled trial in São Paulo to test the feasibility of their method and determine how accurate it is compared to traditional growth measures taken at a health clinic.

Antonio Fernandes Moron from the Universidade Federal de São Paulo in Brazil will investigate whether the presence of specific bacterial populations in the vagina can predict preterm birth, which could form part of an inexpensive test suitable for low resource settings. Preterm birth leads to major short- and long-term health problems for the child. The causes are largely unknown, making it hard to identify pregnant women at increased risk who need monitoring and might benefit from treatment. They hypothesize that bacterial infections in the vagina during pregnancy can alter the length, elasticity and/or thickness of the cervix, thereby triggering preterm birth. To test this, they will analyze vaginal samples from 400 pregnant women located at four urban care centers throughout Brazil to identify bacteria and selected proteins that associate with specific cervical alterations detectable by ultrasound, and determine their association with preterm birth.

Joao Guilherme Bezerra Alves from the Instituto de Medicina Integral Professor Fernando Figueira in Brazil will perform a randomized controlled trial to assess whether a daily oral supplement of magnesium citrate can prevent placental vascular disease, which can lead to preterm birth. Placental vascular disease restricts the flow of nutrients to the fetus and can cause growth restriction and maternal hypertensive disorders. Magnesium is known to promote placental vascular flow, and magnesium citrate is safe, inexpensive and easily absorbed in the body. They will perform a clinical trial in two large hospitals in Brazil in which 3,000 pregnant women will be offered a daily magnesium supplement or a placebo control starting from up to 20 weeks of gestation and continuing until birth. The effect on various outcomes including placental function, preterm labor, and mother and child health will be evaluated.

Jose Simon Camelo Junior from the Universidade Federal de São Paulo in Brazil will test a method for producing a lyophilized human milk concentrate for feeding very low birth weight newborns that can be implemented in developing countries. Very small premature babies of less than 1,500 grams require large quantities of proteins, calories, minerals, micronutrients and electrolytes to survive and thrive. However, breast milk alone is not concentrated enough. Supplements derived from cow’s milk have been used but appear to inhibit particularly the immunological quality of human breast milk, which helps block infection. Human milk additives have now also been tested and show promising results, but they are prohibitively expensive to produce in developing countries. They will use a simple method involving evaporation, centrifugation and lyophilization to produce a concentrated form of human milk that can be implemented in Brazilian milk banks. The milk product will be evaluated for stability and safety and for nutritional content to ensure it contains adequate concentrations of essential nutrients within manageable volumes to support very low weight newborns.

Silvia Regina Dias Medici Saldiva from the Instituto de Saúde in Brazil will determine whether and which physical, social and cultural aspects of urban environments can increase the incidence of preterm birth. Prematurity is a major cause of childhood mortality and disability, and levels are high in Brazil. Preterm birth is likely caused by combinations of factors that, particularly in urban locales, might include environmental factors such as the quality of housing, proximity to health facilities and pollution levels, which then interact with social and cultural factors. They will identify spatial clusters of premature births from 2012 in the city of São Paulo to define suitable regions for performing case-control studies. The studies will involve face-to-face interviews at selected households by trained interviewers to assess environmental and social factors such as income, education, health and sanitation. These data will be supplemented with available or modeled meterological and pollutant data, and data from tree rings, which can provide climate information as well as levels of toxins. They will then perform hierarchical modeling to identify environmental factors associated with preterm births.

Renato Soibelmann Procianoy from the Universidade Federal do Rio Grande do Sul in Brazil will analyze the association between bacterial populations in the vagina and gut of mothers in their third trimester and in the meconium of very preterm newborns, with risk of preterm delivery. It was previously assumed that microbes from the mother are first transferred to the fetus during delivery. However, it was recently shown that this could happen already in the uterus, triggering a possible immune response by the fetus that may lead to premature birth, which is a leading cause of infant morbidity and mortality. They will use 16S rRNA-based bacterial sequencing technology on around 600 samples to compare the types of bacteria present in preterm infants with that in healthy term infants in a neonatal unit in the Clinicas Hospital in Porto Alegre. They will also track the changes in bacterial composition in healthy and sick newborns during their hospital stay, to identify types of bacteria associated with specific diseases such as diarrhea. All samples will be stored in a repository for future case-controlled studies.

José Guilherme Cecatti from the Universidade Estadual de Campinas in Brazil will develop a predictive algorithm to identify early in pregnancy those at increased risk of preterm birth so that if possible they can be treated. There are likely to be many causes of preterm birth, and it is a major cause of both short and long term life-threatening complications for infants. They will use existing data from 6,000 pregnancies that resulted in both term and preterm births, and perform three complementary mass spectrometry-based methods on blood taken early (around 15 weeks) in those pregnancies to identify a panel of biomarkers that can predict preterm birth. This will be combined with sociodemographic and physical data including economic status and age to generate a predictive algorithm. They will then evaluate this algorithm in a cohort of 1,150 low risk pregnant Brazilian women for its ability to identify those that go on to give birth prematurely.