ARRA IMPACT REPORT:
Global Health Innovations


Role of Innovation in Global Public Health
Innovative scientific, technical, and business-based products and processes are rapidly becoming available in the public health domain for disease surveillance and control, environmental monitoring, health behavior change, and disease prevention.1 To be effective, these innovations must be rigorously evaluated, the end user must be engaged, and the intervention customized to the context of the public health problem that is being addressed.2 Fostering innovation may require training the next generation of innovators in the process of innovation, from conception through implementation and creation of an enabling environment at academic institutions to assemble experts in different disciplines to jointly address public health problems with fresh approaches. ARRA awards supported the development of innovation training programs at 12 universities and the development of global health consortia to work on new technologies for global public health needs.

Innovative Pediatric Interventions
Early childhood diarrhea (ECD) can lead to high rates of morbidity (stunting and cognitive deficits) and mortality, which may be alleviated with improvement of water and sanitation practices.3

  • Water Sanitation and Early Childhood Diarrhea: ARRA funds supported the development of a training program in modeling complex environments and their health impacts. A team of post-doctoral fellows from the University of Venda in South African and the University of Virginia used agent- based modeling (ABM), to study the interplay between water sanitation and health, specifically ECD.3
  • Malnutrition and Diarrhea: ABMs are software tools that input environmental and health variables and use algorithms to predict the resulting health outcomes. For this project, they utilized data collected by the malnutrition and enteric disease network (MAL-ED), a five year prospective study on childhood diarrhea and malnutrition supported by the Bill and Melinda Gates Foundation. Variables such as maps of household locations, water collection sites, water quality and frequency measures and anthropometric data were then linked to the development of diarrhea and the reduction in child height.3
  • Evaluating Public Health Programs: This work has also illustrated the utility of the ABM tool in evaluating public health programs outside of the U.S.3
Pneumonia is the primary cause of mortality for children under the age of five and medical technologies devoted to decreasing this disease are needed.4
  • C-IDEA – A Multi-Disciplinary Global Health Consortium: Under an ARRA award, researchers at Stanford University have established a multi-disciplinary global health consortium, C-IDEA, to speed up the development of affordable drugs, diagnostics, and devices for global health.6 Their purpose is to deliver products that are affordable, scalable, implementable, and can be commercialized.6 This consortium has strengthened the global health research enterprise at Stanford by enhancing the cross-talk between academic disciplines.4
  • Adapt-Air – Improving the Treatment of Respiratory Crises: One of many student team projects supported under this award is Adapt-Air, a device to treat acute respiratory distress in infants with pneumonia or other respiratory crises. Adapt Air is an interface made of silicon that transforms the standard respirators used in adults to adaptively fit the faces of infants, improving the seal and adjusting airway pressure to treat acute respiratory distress more effectively. This innovation will eliminate the problems with using a standard size, such as seepage of pressurized air.4
Hypothermia is a public health challenge for infants, particularly those infants that are born prematurely. Thermal protection can reduce neonatal morbidity and mortality.5
  • Embrace: The low-cost infant warmer, Embrace, a sleeping bag which uses an innovative wax and heated design, was developed by Stanford graduate students in an Entrepreneurial Design for Extreme Affordability class a few years ago. Under C-IDEA – an ARRA-funded global health consortium – students are developing a plan for implementation and sale in India under C-IDEA funding.5,6

Point-of-Care (POC) Diagnostics
New POC technologies have the potential to revolutionize telemedicine and infectious disease diagnosis by providing rapid results at cost-effective prices to underserved populations with poor access to health care.7

Under ARRA support, a team at UCLA, with collaborators in Brazil, Malawi, and Mozambique, has developed a training program in innovation around new POC technologies.7

  • Improving Remote Healthcare: Based on a lens-free microscope attached to a cell phone developed at UCLA, post-doctorates are adapting and field testing this device to use in low resource settings for surveillance, diagnosis and treatment of infectious diseases such as TB, malaria, and water-borne diarrheal diseases.7
  • LUCAS: Referred to as the Lenseless ultra-wide field cell monitoring array platform or LUCAS, this tool relies on digital holography, a technique that generates images from the shadows of cells. LUCAS can count or identify pathogens or specific cell types within blood samples and perform surveillance of water supplies for bacterial pathogens. Captured images are transmitted to a distant computer equipped with software that interprets the image. Results are then returned to the POC by cell phone.7 For example, these researchers have shown that LUCAS can identify giardia lamblia, a waterborne parasite in stool samples and differentiate it from other stool sediments.7,8

Engineering Controls to Prevent TB Transmission
Tuberculosis (TB) is the second highest infectious killer of adults globally with drug resistance being the greatest threat to TB control. WHO estimates that half of the multiple drug- resistant TB cases result from person-to-person transmission of resistant organisms. In congregate settings (hospitals, prisons, and homeless shelters) drug-resistance poses an even greater public health threat due to high transmission rates in enclosed spaces.9

  • Air Disinfection Technology: Airborne spread of infection in buildings can be contained via air disinfection technology that uses germicidal ultraviolet irradiation. Using ARRA support, a team of scientists in the U.S. and South Africa developed the first new international standard germicidal fixture design for low resource settings, based on an analysis of current fixtures and research on 50 novel prototypes.9
  • International Guidelines for Air Disinfection Technologies: They also convened the first conference on the application of upper room germicidal (UVGI) and developed international implementation guidelines for air disinfection technologies. An accompanying electronic casebook of implementation solutions has also been made freely available.9

Contributing NIH Institutes & Centers

  • Fogarty International Center (FIC)

  1. http://www.ncbi.nlm.nih.gov/pubmed/15026105
  2. http://www.ncbi.nlm.nih.gov/pubmed/22780442
  3. 1R24TW008798-01 - GUERRANT, RICHARD L - UNIVERSITY OF VIRGINIA - CHARLOTTESVILLE - VA
  4. 1RC4TW008781-01 - BARRY, MICHELE - STANFORD UNIVERSITY - STANFORD - CA
  5. http://www.ncbi.nlm.nih.gov/pubmed/22382859
  6. http://www.fic.nih.gov/News/GlobalHealthMatters/Oct2010/Pages/recovery-stanford.aspx
  7. 1R24TW008811-01 - NIELSEN, KARIN - UNIVERSITY OF CALIFORNIA LOS ANGELES - LOS ANGELES - CA
  8. https://idsa.confex.com/idsa/2011/webprogram/Paper30943.html
    1R24TW008821-01 - NARDELL, EDWARD A. - BRIGHAM AND WOMEN'S HOSPITAL - BOSTON - MA