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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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Tracking MRSA Evolution to Discover Important Biomarkers to Quickly Characterize Unique MRSA Clones in Hospital Bloodstream Infections

Agnes FigueiredoUniversidade Federal do Rio de JaneiroRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

The project will use molecular approaches, including genomics and phylogenomics, to find biomarkers that could indicate the location in the genetic code driving bacterial adaptation. In addition, these biomarkers could be used as a rapid method for screening predominant and high-virulency MRSA clones in hospitals, and thus quickly provide infection control committees with key data on MRSA spread and its antimicrobial resistance profile.

An Artificial Intelligence System to Strengthen Antimicrobial Prescription in a Children's Hospital: SMART-EP

Marcelo PillonettoPontifícia Universidade Católica do ParanáCuritiba, Paraná, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

The idea is to develop an artificial intelligence model capable of simultaneously analyzing data from the Laboratory Information System and from the Hospital Information System. This technology aims to enable the delivery to hospital physicians of a ranked list of antimicrobials that are more suitable to treat infection by multi-resistant microorganism with a focus on newborn and young children.

Applying the Metagenomic Approach for the Detection of EsβL- and Carbapenemase-Producing Enteric Pathogens Recovered from Different Hosts

Ana GalesUniversidade Federal de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

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.

OneBR: Integrated Genomic Database for Surveillance, Diagnosis, Management and Treatment of Antimicrobial Resistance in the Human-Animal-Environment Interface

Nilton LincopanUniversidade de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

This project proposes the development of the One Health Brazilian Resistance (OneBR), a curated and integrated genomic database. OneBR will use algorithms based on artificial intelligence to conduct surveillance, diagnosis, management and treatment of antimicrobial resistance (AMR) in the human-animal-environment interface. The goal is for this platform to be used by Brazilian health professionals in diverse settings, particularly within the Unified Healthcare System (SUS).

Data Science on Drug-Resistant Tuberculosis in Brazil

Rejane PinheiroUniversidade Federal do Rio de JaneiroRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

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.

The Dynamics of Antibiotic-Resistant Microorganism Flow Between Animal Farming and Medical Hospital Assistance

Thaís SinceroUniversidade Federal de Santa CatarinaFlorianópolis, Santa Catarina, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

The project proposes to characterize the resistant determinants of microbial communities from key sources in hospitals, environment and farms to model the dynamics of the flow of antibiotic resistant microorganisms. The goal is to understand how the hospital environment and animal farming affect the ecology of antibiotic resistance movement. The project will rely on a methodology that allows the analysis of genes related to antibiotic resistance in a complex microbial community derived from specific samples instead of culture based methods for AMR identification.

Plasmid Curing by an Ethiopian Barley: A Natural Food Approach to Reduce Plasmid Mediated Antibiotic Resistance

Bruno PennaUniversidade Federal FluminenseRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

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.

Application of Low-Cost and Sustainable Solar Oxidation Treatment to Prevent Microbial Resistance in Effluents in Brazil

Camila AmaralUniversidade Federal de Minas GeraisBelo Horizonte, Minas Gerais, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

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.

Monitor AMR in Community Uropathogens and Correlate Them with the Determinants of Resistance in Animal Enterobacteria Isolates

Eliana Carolina VesperoUniversidade Estadual de LondrinaLondrina, Paraná, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

The project aims to monitor AMR in microorganisms of the urinary tract and correlate it with the genetic determinants of resistance in animal enterobacteria. The study results will be disseminated in order to inform potential changes to guidelines regarding selection of the appropriate antimicrobials first-line treatment for urinary tract infections (UTI).

Engineers, Pharmacists and Chemists Collaborating on the Development of an Aerobic Granular Sludge (AGS) to Remove Antibiotics from Hospital Wastewater

Leonardo MouraUniversidade Federal do Rio de JaneiroRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

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.

The Use of Low-Cost Immobilized DNA Aptamers on a Cellulose Filter to Remove Antibiotic Residues from Effluents

Tiago MendesUniversidade Federal de ViçosaViçosa, Minas Gerais, Brazil
Grand Challenges Brazil
Drug Resistance Burden
1 Nov 2018

The project will develop a cellulose filter containing immobilized DNA aptamers, molecules that bind to a specific target molecule, that act as specific and high affinity probes for the uptake and retention of antibiotic molecules present in effluents. Nowadays, the removal of antibiotic residues from effluents is mainly based on chemical processes and physical methods that require expensive technologies and costly maintenance. The success of this project will represent a wastewater treatment option that is low-cost and environment-friendly.

New Gestational Weight Gain Recommendations for the Brazilian Unified Health System (SUS)

Gilberto KacUniversidade Federal do Rio de JaneiroRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

Potential Pregnancy Days Lost (PPDL): An Innovative Gestational Age Measure to Assess Maternal and Child Health Interventions and Outcomes

Carmen DinizUniversidade de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

The main goal of the project is to develop and explore an innovative measure of gestational age - "potential pregnancy days lost" (PPDL) - to produce evidence of its association with maternal and child health, morbidity and mortality in the short, medium and long term. The indicator also aims to convince women and policy makers about the need to promote less interventions and "harm-free care" during pregnancy.

Early Childhood Development Friendly Index: Assessing the Enabling Environment for Nurturing Care in Brazilian Municipalities

Muriel GubertUniversidade de BrasíliaBrasília, Distrito Federal, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

How and When: Disentangling Cash and Care Effects of Conditional Cash Transfers on Birth Outcomes

Cecilia MachadoFundação Getúlio VargasRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

Seeks to understand the impacts of the Bolsa Família conditional cash transfer on birth outcomes (e.g., birth weight, gestational weeks, etc). The proposed design will disentangle the measured effects into two components: one that is associated to the cash transfer; and another related to prenatal care assistance. Moreover, this strategy will allow the researchers to determine the window of opportunity where CCT interventions exhibit highest impacts on birth outcomes, recognizing heterogeneous impacts according to how early in the pregnancy the CCT intervention starts.

Decision-Making Support Platform Based on Visual Analytics and Machine Learning to Subsidize Public Politics Focused on Gestational Health

Tiago CarvalhoInstituto Federal de São PauloCampinas, São Paulo, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

Assessing the Impact of Hospital-Based Breastfeeding Interventions on Infant Health

Cristiano BoccoliniFiocruzRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

Aims to access all 68.3 million living births certificates from Brazil, from 1994 to 2016, and compare them with breastfeeding policies in all Brazilian hospitals to assess the impact of the initiatives on infant health. The study also plans to estimate the number of avoidable deaths during this time period, if those initiatives were adopted in Brazil.

Spatial Analysis of Child Vaccination Coverage and its Relation to Socioeconomic and Health Characteristics in Brazil

Carolina BarbieriUniversidade Católica de SantosSantos, São Paulo, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

Data Science to Inform the Design and Evaluation of Interventions to Improve Perinatal Outcomes: Lessons from the Mãe Coruja Program

Jailson CorreiaMunicipal Health SecretariatRecife, Pernambuco, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

The study is aimed at evaluating the effectiveness of Mãe Coruja intervention in reducing low birthweight and preterm birth. By using appropriate statistical methods, the study will use the Cidacs dataset combined with the data from Mãe Coruja program to carry out the quasi-experimental study. With the support of machine learning techniques, the project will also Identify social, economic, geographic and environmental conditions that are associated with the outcomes. The researchers will also build an index of perinatal health risk to inform improvements in targeting populations and the deployment of similar strategies and programs elsewhere in Brazil.

Influenza in Pregnancy and Birth Outcomes in the Brazilian Semi-Arid Region: the INFLUEN-SA Study

Aldo LimaUniversidade Federal do CearáFortaleza, Ceará, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

Using the 100M Cohort to Establish Critical Air Pollution Thresholds for Safe Childbirth in Brazil

Alexandra BrentaniUniversidade de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

Does air pollution affect the rates of stillbirths, congenital malformations and neonatal mortality? This study aims to answer this question by merging the child health data collected within the 100 Million Brazilian Cohort from Cidacs with high-resolved satellite-derived data on air pollution to establish critical ambient air pollution thresholds for preventing adverse birth outcomes and malformations based on concentrations of fine particles, PM 2.5.

Use of Interactive Infographic in the PMCP - Analysis of Indicators to Improve the Quality of Maternal and Child Health

Judith KelnerUniversidade Federal de PernambucoCaruaru, Pernambuco, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

Data-Driven Risk Stratification for Preterm Birth in Brazil: Development of a Machine Learning-Based Innovation for Health Care

Erika ThomazUniversidade Federal do MaranhãoSão Luiz, Maranhão, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

Identifying the preventable causes and performing early risk stratification of pregnant women are instrumental to develop strategies to prevent and reduce preterm birth (PTB). The ability to identify at-risk pregnancies and to enroll women in prevention strategies has been difficult due to complexity of associated risk factors. The study aims to combine different national level data sources to understand the main predictors of PTB and develop a machine-learning-based predictive model to conduct automated risk stratification at the point of care level, integrated with advanced data visualization for clinical decision support.

Using Geocoded Big Data to Identify Causal Links Between Infectious Diseases and Child Developmental Outcomes

Rudi RochaFundação Getúlio VargasRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

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.

The Intergenerational Impact of Conditional Cash Transfers on Newborn Health

Andreza LucasUniversidade Federal de PernambucoCaruaru, Pernambuco, Brazil
Grand Challenges Brazil
Data Science Approaches
1 Nov 2018

This research aims to analyze the relationship between a conditional cash transfer program and the child's health, considering two generations of the families and using two different approaches: econometric analysis and data mining algorithms. By analyzing the long term impacts of Bolsa Familia program on future generations' health performance, the project will investigate if a child who was born in a family whose grandparents received the cash transfer is in better health conditions than a similar child born in a family whose grandparents did not receive the same benefit.

Healthy Birth: A Prospective Study to Evaluate the Implementation and Effects of an Intervention to Improve the Quality of Maternal and Neonatal Care in Brazilian Hospitals

Maria do Carmo LealFiocruzRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

Maria do Carmo Leal from Fiocruz in Brazil will undertake a pilot “Parto Adequado” (Adequate Birth) project to evaluate whether different health care models offered by medical institutions during pregnancy and childbirth can promote healthier births, particularly by reducing the rate of unnecessary medical procedures. These include caesarean section without clinical indication, which occur frequently in Brazil and can have negative consequences. They have selected 23 geographically dispersed hospitals for the pilot study, which will involve around 16,000 mothers. To promote good practices, they have developed three health care models that combine different numbers and types of medical staff (i.e., Doctors and nurses-midwives) to be involved at specific stages from pregnancy to birth. These will be offered to hospitals for implementation over 18 months. They will then analyse the degree of implementation of the models, and their effects on the type of birth, adoption of good practices, and hospital costs after two and three years. They will also interview the mothers and health care workers to evaluate acceptability of the different models.

PrePARE - Preterm Birth Reduction by Improvements in the Quality of Care to Patients with Preeclampsia

Marcos Augusto Bastos DiasFiocruzRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

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.

Monitoring Child Development Indicators in Vaccination Campaigns: A Tool for Planning and Evaluating Intersectoral Actions

Sonya Isoyama VenancioInstituto de SaúdeSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

Sonia Isoyama Venancio from the Instituto de Saúde in Brazil will implement a program for monitoring the development of children less than five years of age during vaccination campaigns in the municipalities, to help identify risk factors, raise awareness, and support healthy development. They will design and pilot test a questionnaire that can be easily applied during a vaccination procedure to carefully query the health and behavior of the child, as well as their family environment and access to health services and education. To promote implementation of the program, they will recruit and train interviewers, and partner with Universities to recruit health-care students for collecting the data and entering them into a custom built web application. They will validate their approach for identifying children with developmental problems, and analyze the data for potential causes such as socioeconomic conditions and quality of health care.

Maternal Neuropsychiatric Disorders During Pregnancy and Postpartum Period: Early Detection and Intervention, and its Impact on Family Triads

Ricardo Tavares PinheiroUniversidade Católica de PelotasPelotas, Rio Grande do Sul, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

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.

Continuous Global Early Intervention Program for Preterm Infants Performed by their Families

Rita de Cássia SilveiraHospital de Clínicas de Porto AlegrePorto Alegre, Rio Grande do Sul, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

Rita de Cássia Silveira from Hospital de Clínicas de Porto Alegre in Brazil will develop and test a program for families with preterm infants to follow at home to improve the child’s cognitive, motor and social development. Preterm infants (those born with less than 37 weeks of gestation) can suffer a variety of complications due to incomplete brain, lung and eye development, which can cause long-term problems. They have shown that careful baby massage, alongside the standard skin-to-skin care by the mother, in the hospital after birth can improve the child’s neurological development at two years of age. Here they will perform a randomized study of around 80 mothers of preterm infants, and teach one group to perform the massage technique and instruct them to administer it at home for the child’s first 12 months of life, which will be carefully monitored. The effects on motor and neurodevelopment will be assessed at regular intervals up to 24 months of age and compared to a control group performing only skin-to-skin care.

Infant Sleep Hygiene Counseling: A Randomized Controlled Trial

Iná da Silva dos SantosUniversidade Federal de PelotasPelotas, Rio Grande do Sul, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

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.

Evaluating the Impact of Social Factors and Interventions on Healthy Growth and Development: the 80 Million Brazilian Cohort

Mauricio Lima BarretoFiocruzRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

Mauricio Lima Barreto from Fiocruz in Brazil will evaluate the impact of social and economic inequalities, and the national family allowance program (Bolsa Familia), on healthy births and early childhood health and development. They will setup a cohort, which will be derived from a central database of named households created to support Brazil’s social programs, and a data center for the analysis. They will use a variety of demographic, economic and social data on families, as well as information on births and childhood deaths, and child growth. The impact of receiving family allowance, and the effect of its value and duration, on outcomes such as birth weight, prematurity, fetal death, and early childhood growth will also be measured. This approach will generate evidence to help maximize the value of the social program and inform future related policies.

Testing PIXA(3): An Innovative Way to Measure Growth Easily, Frequently and Precisely

Guilherme Vanoni PolanczykUniversidade de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

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.

Mother and Teacher Support Programs to Improve Cognitive, Social and Communication Skills of Pre-School Children, to Improve the Mother's Quality of Life and to Decrease Domestic Violence Levels

Maria Conceicao do RosárioUniversidade Federal de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
All Children Thriving
20 Oct 2015

Maria Conceicao do Rosário from Universidade Federal de São Paulo in Brazil will assess the effect of mother and teacher support programs in pre-schools in poor districts of São Paulo on the physical and emotional well-being of families, and on early childhood development. Many poor communities in Brazil suffer from high levels of urban violence and adult mental illness that affect the healthy development and well-being of children. Brazil has pledged that all children aged 4-6 will be in pre-school by 2016, presenting an opportunity to improve the quality of pre-school teaching to impact childhood development. They will recruit around 900 mothers to evaluate a mother support program, which will involve weekly group meetings for around 12 weeks to discuss issues including parenting methods and healthy child development. They will also implement a teacher support program to increase their knowledge on childhood health and development, and assess the impact on their attitudes and practices.

Use of Metabolomics for the Identification and Validation of Clinical Biomarkers for Preterm Birth

José Guilherme CecattiUniversidade Estadual de CampinasCampinas, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

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.

Pessary Plus Progesterone to Prevent Preterm Delivery in Women With Short Cervical Length

Rodolfo de Carvalho PacagnellaUniversidade Estadual de CampinasCampinas, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Rodolfo de Carvalho Pacagnella from the Universidade Estadual de Campinas in Brazil will perform two randomized clinical trials across 15 obstetric clinics in Brazil to evaluate treatment with progesterone in the presence or absence of a cervical pessary for preventing spontaneous preterm birth. Both cervical pessary and progesterone are individually considered to be effective preventative treatments for preterm birth, which is one of the most common complications seen in pregnancy and can cause severe complications for the premature infant. The causes of preterm birth are mostly unknown, although incidence does increase with cervical shortening during the mid stages of pregnancy. They will also analyze the prevalence of a short cervix in Brazilian pregnant women, and determine how well it predicts preterm birth. Their approach to screen for cervix length and then treat high-risk individuals with the combination therapy will also be evaluated for cost-effectiveness.

Influence of the Vaginal Microbiome and Vaginal Metabolites on Cervical Remodeling and Preterm Parturition

Antonio Fernandes MoronUniversidade Federal de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

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.

Senses of Birth: Effects of an Interactive Exhibit in Changing the Perception About Labor and Birth With Community Mobilization for Reducing Excessive Caesarean Sections and Iatrogenic Prematurity In Brazil

Bernardo Jefferson de OliveiraUniversidade Federal de Minas GeraisBelo Horizonte, Minas Gerais, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Bernardo Jefferson de Oliveira from the Universidade Federal de Minas Gerais in Brazil will develop an interactive exhibit including images, audio, games, and theatre to encourage natural childbirth and perform a pilot study to evaluate its effect on changing public perception of labor and birth. They aim to reduce unnecessary cesarean sections in Brazil where the incidence of preterm births, which can cause severe disabilities, has been increasing. This is thought to be due in part to the negative perception of normal birth and the assumption that cesarean sections are safer and more convenient. The exhibit will focus on producing sensations and emotions to teach participants about the experience, risks and benefits of both cesarean section and natural childbirth. They will present the exhibit over 12 months in three major cities, which should reach around 30,000 people, and use interviews and questionnaires before and after participants visit the exhibit to measure its effect on knowledge and attitudes.

Breastfeeding in Premature Infants: Impact of Bfhi in Neonatal Units

Carmen Gracinda Silvan ScochiUniversidade de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Carmen Gracinda Silvan Scochi from the Universidade de São Paulo in Brazil will encourage mothers of preterm infants in Brazil to exclusively breastfeed them for the first six months to better protect them against infections and optimize their growth and neurodevelopment. The incidence of preterm births in Brazil is increasing, and causes multiple short and long-term complications. Exclusive breastfeeding can limit some of these complications but is particularly challenging with preterm infants due to their incomplete development and the need for hospitalization, as well as there being practical and emotional difficulties for the mother. The existing WHO/UNICEF global program for promoting exclusive breastfeeding has been adapted specifically for preterm infants and involves better educating medical staff so that they provide the practical and emotional support to encourage exclusive breastfeeding. They will establish the program in 10 hospitals/maternity units across Brazil and evaluate its effect on the numbers of preterm infants being exclusively breastfed.

A Randomized Clinical Trial With Oral Magnesium Supplementation in Pregnancy

Joao Guilherme Bezerra AlvesInstituto de Medicina Integral Professor Fernando FigueiraRecife, Pernambuco, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

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.

Quarenta Semana: Innovative Intervention in the Prenatal Care for Reduction of Prematurity

Jose Maria de Andrade LopesInstituto Fernandes Figueira - FiocruzRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Jose Maria de Andrade Lopes of the Instituto Fernandes Figueira - Fiocruz in Brazil will conduct a randomized study to evaluate “Quarenta Semana,” which is a program designed to remove risk factors associated with preterm births in Rio de Janeiro. The preterm birth rate in Brazil is amongst the highest globally. Some known risk factors for preterm birth include limited access to healthcare services, maternal social and health factors such as diabetes, and the quality of prenatal care. They will train pregnant women to act as health advocates who encourage women to seek prenatal care in their first trimester. They will also establish social support groups to help reduce stress and offer support throughout pregnancy, and implement a checklist for providers and patients to increase the quality of prenatal care. The effect of these approaches on preterm birth rates will be evaluated.

Elaboration of a Lyophilized Human Milk Concentrate To Be Used To Feed Very Low Birth Weight Preterm Newborns

José Simon CameloUniversidade Federal de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

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.

Improved Method of Screening for Preeclampsia

Renato Luis da Silveira XimenesUniversidade Federal de São PauloSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Renato Luis da Silveira Ximenes of Universidade Federal de São Paulo in Brazil will conduct a randomized controlled trial to evaluate whether a daily low dose of aspirin taken from early in pregnancy can prevent preeclampsia and thereby reduce the rate of preterm birth. Preterm birth is a leading cause of neonatal morbidity and mortality, and preeclampsia is a major cause of maternal death. The combination of several biomarkers such as serum levels of placental growth factor and biophysical measurements such as mean arterial pressure can now quite well identify women at higher risk of developing preeclampsia already at 11-14 weeks gestation, providing an early window of opportunity to treat them. And a recent meta-analysis suggested that the administration of low dose aspirin before 16 weeks could reduce the rate of preeclampsia by fifty percent. They hypothesize that the earlier treatment is started, the more effective it will be. They will screen pregnant Brazilian women at 11–14 weeks to identify those at risk of developing early preeclampsia and test whether low dose aspirin can prevent it.

Premature Births in São Paulo: A Spatial Approach

Silvia Regina Dias Medici SaldivaInstituto de SaúdeSão Paulo, São Paulo, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

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.

ABC Transporters in Pregnancy and Preterm Labor

Tania Maria Ruffoni OrtigaUniversidade Federal do Rio de JaneiroRio de Janeiro, Rio de Janeiro, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

Tania Maria Ruffoni Ortiga from the Universidade Federal do Rio de Janeiro in Brazil will measure the levels of so-called ABC transporters throughout pregnancy, and during normal and preterm labor, and how they are influenced by infections such as malaria and influenza, to determine whether they might increase the risk of preterm labor. ABC transporters sit in the outer membranes of cells and actively transport drugs, toxins and immune signaling molecules out of them. In this way, they regulate the immune response, hormonal signaling and the activity of drugs such as antibiotics, which become particularly important during pregnancy and labor. They will collect human intrauterine tissue at different time points during pregnancy and during cesarean delivery from hospitals in Brazil and Canada, and investigate the distribution of ABC transporters and the association with infection. They will also use a mouse model of malaria to evaluate the effect on the levels and activity of the transporters.

Association Among Fetal Microbiota, Prematurity and Preterm Morbidities

Renato Soibelmann ProcianoyUniversidade Federal do Rio Grande do SulPorto Alegre, Rio Grande do Sul, Brazil
Grand Challenges Brazil
Preterm Birth Burden
6 Dec 2013

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.

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