Health System Design

Joshua Warren and Daniel Weinberger of Yale University in the U.S. will develop an analytical framework to improve local estimates of vaccine coverage in low- to middle-income countries. Current estimates can be unreliable, due to errors and biases in record-keeping and difficulties in estimating local population sizes, and are further complicated when children are vaccinated outside of their home administrative district.

The primary objective of this project is to develop a platform that comprehensively screens for substandard medicines, expand implementation from a central testing facility to regional and community health centers and create demand through stakeholder education workshops. This project is expected to impact quality of MCH medicines on the market. Existing methods of substandard drug detection are bulky, require technical expertise, time-consuming, qualitative, error-prone and do not measure drug release kinetics.

We propose a comprehensive integrated program to address the comprehensive interrelated factors leading to poor maternal and child health. We combine service delivery improvements with demand-side innovations and multiple mobile phone applications. These include safe delivery kits, insurance for transport and treatment of obstetric emergencies, safe water and hygiene products, and small incentives for women to start antenatal care (ANC) early.

Kris Ansin of the Mali Health Organizing Project in the U.S. will work to improve the use of primary health clinics in Mali by identifying shortcomings in patients' experiences at the clinics and working with staff to address them. They have already discovered that poor patient reception and hospitality strongly deter individuals from using these clinics. They will identify more specific patient concerns and help overcome them by training staff. They will evaluate their approach by measuring patient satisfaction, clinic usage, and health outcomes.

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.

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.

Alexander Green of Arizona State University in the U.S. and Keith Pardee of the University of Toronto in Canada will develop molecular technologies, hosted by cell-free systems embedded into paper, to create point-of-care diagnostics for multiple diseases at low-costs. These sensitive and specific diagnostics will remain active without refrigeration for one year, and have been demonstrated in proof-of-concept tests with the Zika virus.

Rebecca Traub of the University of Melbourne in Australia will develop a method to preserve fresh stool so that it can be transported over longer distances to central laboratories and used to diagnose intestinal parasites and monitor the different types. They will test two types of preservation, a 5% weight/volume potassium dichromate solution and 10% formalin, on the accuracy of identifying three different types of helminth eggs in fecal samples from infected individuals in Thailand over 120 days.

Kenneth Stedman of Portland State University in the U.S. will test a low-cost and simple method for simultaneously collecting and stabilizing stool samples that can be used for diagnosing helminth infections in remote locations. The samples allow quantification of eggs from the helminth parasite, which causes intestinal infections that are endemic in many developing regions, and will help monitor large-scale treatment efforts. The method is based on his vaccine-stabilization technology, which was developed along with James Laidler at Portland State University.

Thomas Egwang of Med Biotech Laboratories in Uganda will develop a reformulated medium derived from mammalian cell culture medium that is optimized for storage and preservation of stool-derived helminth eggs. Diagnosis of soil-transmitted helminth infections, which cause considerable morbidity in developing countries, involves microscopic examination of fecal samples. The accuracy of these methods depends on how well the sample has been preserved since collection.