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.

Alain Labrique of Johns Hopkins Bloomberg School of Public Health in the U.S. and Meghan Azad of the University of Manitoba in Canada will study the impact of prelacteals - fluids or solids given before breastfeeding is established - on the populations of bacteria in the newborn gut (the microbiome), and how it may affect development. Immediate and exclusive breastfeeding helps maintain healthy growth in infants and protects them against infections, which are also influenced by their gut microbiome. However, in Bangladesh and many other low-resource countries, it is common practice to give newborns ritual foods, like honey or sugar water, before breastfeeding begins, which may impede development. They hypothesize a link between prelacteal use and newborn development mediated by the gut microbiome. To test this, they will use an ongoing population-based study in rural Bangladesh and compare the types and amounts of bacteria in the gut using stool samples of 300 prelacteal-fed and exclusively breastfed infants at 7 days, 28 days and 3 months of life. They will also analyze the composition of the prelacteals being used, including the presence of any toxic contaminants, and of the breastmilk of the mothers, for correlating with any changes in gut microbial populations. The study will enable them to quantify the potentially negative impact of this widespread cultural practice, common to over a billion people across the Gangetic floodplain.

Ruth Müller of the Institute of Tropical Medicine in Belgium and Meghnath Dhimal of the Nepal Health Research Council will provide entomological training for health science students and medical professionals and increase community awareness of vector-borne diseases (VBDs) in Nepal to better equip the population to deal with disease outbreaks. VBDs like those caused by the dengue, zika, or chikungunya viruses cause more than 700,000 deaths annually, mostly in poor countries with limited public health resources and tropical climates. Climate change has expanded the affected areas as warmer temperatures facilitate survival of the insect vectors. They will establish the EntoCAP team to enhance entomological capacity to fight these diseases. The team will hold five-day workshops for 300 health science students and health care professionals on surveillance and control of vector populations, and monitoring of disease outbreaks. They will also increase community interest in VBDs by hosting science labs for children to teach them how to recognize mosquitoes at various developmental stages and understand the dangers of VBDs. In addition, they will begin building a reference collection using DNA barcoding technology to catalog insect vectors by species for studying biodiversity and microevolution of disease vectors.

Eric Ochomo of the Kenya Medical Research Institute (KEMRI) in Kenya and Luc Djogbenou of the University of Abomey (UAC) in Benin will develop a curriculum to teach African scientists how to use genetic approaches to combat insecticide resistance in the fight against malaria. Malaria is a disease that kills almost 500,000 people annually, most in sub-Saharan Africa. People become infected when bitten by mosquitoes that transmit the disease-causing parasites. Insecticide treatment of bed nets and indoor areas are effective methods of disease control, but mosquitoes are becoming resistant. Varying the types of insecticides used and applying them in different combinations can help fight resistance, but it's difficult to know the most effective approach before resistance develops without the help of genetic markers. They will teach African scientists techniques to identify genetic resistance markers including sample collection and preservation, transcriptomic and whole-genome sequencing, and bioinformatics using online and hands-on approaches. This will ensure timely changes to insecticide application to better combat resistance. They will also encourage local scientists to establish industry partnerships to ensure that resistance monitoring can continue long-term.