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 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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.