Breakthroughs Blog: Child health

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Rohit Ramchandani, who we met at the American Society of Tropical Medicine and Hygiene Annual Conferenc. Dr. Ramchandani does research to innovate global treatment options for childhood diarrhea at the Johns Hopkins School of Public Health in Baltimore, Maryland and the University of Waterloo. My name: Rohit Ramchandani, DrPHWhere I work: Johns Hopkins School of Public Health in Baltimore, Maryland and the University of WaterlooI’m funded by: US Agency for International DevelopmentMy research: My research focuses on diarrhea in children…the second-leading cause of death in children under five globally…These are close to 500,000 deaths that are happening every year, most of which are preventable, and treatable. They’re treatable with medicines, oral rehydration salts [ORS] and zinc. That’s the globally recommended treatment for diarrhea. But the problem is, in many low- and middle-income countries, access to these medicines is not where it should be, particularly in rural communities. So we looked at that issue of access. We did it by leveraging human-centered design approach. And we really focused on the details and the challenges that mothers face treating their children with diarrhea…Our research showed that 40% of the time, mothers are preparing ORS in the wrong concentration: either too diluted, or too concentrated. That can lead to hypernatremia, that can make the diarrhea even worse, or the efficacy gets reduced if it’s too diluted. So we actually worked with a local pharmaceutical company in Zambia to shrink down then size of the ORS sachets—the standard all over the world is a one-liter sachet—we shrunk those down to make 200-mililiter sachets, and then we made the packaging double as a measurement vessel for the right amount of water…One of our key funders during our scale-up phase was USAID—their Discover Health Program. They played a fundamental role in some of the social marketing we were doing as we were scaling up the development of our diarrhea treatment kit.Motivation: There’s just a fundamental issue of justice in the world…We often think of innovation being new product development, high technology, but things like ORS and zinc—innovation can happen really in the delivery side of things. And that’s really where our innovation focused.Why federal support is critical: I think this is low-hanging fruit. Diarrhea, as one of the leading causes of death in the world for children—we have the solutions, we know what to do, and these kinds of innovations can really make a huge difference in saving lives.…[And] there’s a health security argument [to do this work]. The world is getting smaller and smaller every day. We are inextricably linked to one another. When I’m not in the lab: I’m a dad! I’m a dad of two amazing young girls. They inspire me every day. It makes my work in child health that much more meaningful—the inspiration I get from them. I want all parents to have that.

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Vinayak Joshi, who we met at the American Society of Tropical Medicine and Hygiene Annual Conference. Dr. Joshi is working on a diagnostic for cerebral malaria with support from the National Institute of Allergy and Infectious Diseases.My name: Vinayak Joshi, PhDWhere I work: VisionQuest Biomedical Inc.I’m funded by: National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)My research: We are developing a user-friendly, fully automated, and simple-to-use diagnostic for cerebral malaria. Today, cerebral malaria misdiagnosis causes hundreds of thousands of deaths in African children. With improved diagnostic accuracy, we can prevent many of those deaths and associated disabilities. Motivation: My background is in machine learning software development for medical diagnosis. In my PhD research, I developed an algorithm for detecting malarial biomarkers in eyes. Later, I got a chance to visit one of the malaria clinics—and I learned that this particular kind of malaria, cerebral malaria, is one of the largest killers of children in Africa—and I actually witnessed a child’s death which left an impression on my mind. Rather than just focusing on developing an algorithm, I reasoned that developing a tool that would lead to greater accessibility and was affordable to the target population in Africa, would make a significant humanitarian contribution.Why US federal support is critical: One of the major goals of this work is to prevent deaths in young children. For such two- to three-year-old kids—it is one of the biggest global health problems. After a child is affected with cerebral malaria, one needs to take action in 24 to 48 hours, otherwise it results in death. It may not be always reported in the news media, but hundreds of thousands of deaths occur every year from this issue. The death toll and neurological disability in children caused by this disease are important problems, often overlooked by the world outside of sub-Saharan Africa. The United States does a lot of noble work in different countries, in health care, development, other infrastructure, and I think this is one of the problems that should receive more attention. There are many technologies being developed, but developers can’t find the channels to commercialize them, because the African market is not where you make money—you do it for humanitarian purposes. But to develop any product you need money, and I think the US government should look into it. They should support the institutions that produce the tools but have to find sources of funding to commercialize these technologies and make them accessible to the target population.When I’m not in the lab: I like a lot of traveling—it’s one of my hobbies. I don’t particularly like to go to top tourist destinations. I like to explore new, unexplored parts of the country. 

Faces of Innovation—a new GHTC project that features scientists on the front lines of research and development on new global health tools and technologies—profiles Dr. Mohammad Nuhu Amin, who we met at the American Society of Tropical Medicine and Hygiene Annual Conference. Dr. Amin researches sanitation and diarrheal diseases with support from the United States Agency for International Development.My name: Nuhu Amin BDS, MPH, HSCWhere I work: International Centre for Diarrhoeal Disease Research in Bangladesh (icddr,b) I’m funded by: US Agency for International Development My research: My primary goal is to do interventions to reduce diarrhea and cholera in low- and middle-income countries, particularly in the urban communities of Dhaka. I’ve worked at icddr,b for the last ten years, and I’ve had the opportunity to work with lots of US universities. Currently I’m working with Stanford University with Professor of Medicine Dr. Stephen Luby on a Rohingya distribution impact assessment. I’m also working on another project with Emory University on a fecal pathogen exposure assessment. And our team is doing a different project with Emory University in collaboration with the University of Sydney to track the sanitation chain to detect pathogens, like norovirus, salmonella, shigella, and cholera, that cause diarrhea. We have previously also collaborated with Johns Hopkins University and we have lots of colleagues who work with Oregon University and other state universities in the United States.Motivation: I am a medical graduate, and I’ve had lots of patients with different problems including diarrhea and other infectious diseases. Bangladesh is a tropical country, so infectious disease rates are really high. This motivates me to not only focus on treatment, but to do the research to remove and prevent these diseases.Why US federal support is critical: USAID is one of our four core donors. They have been funding us for more than 50 years to support the research of our institute. I think the contribution of the US government is important for this research and development. When I’m not in the lab: I’m also a dental surgeon, so I have a clinic. Every day, for two or three hours, I treat patients and particularly patients who are poor. Dental health treatment is expensive, so I aim to serve my patients at a low-price. I have two kids as well, so I spend my time with them—they’re very inspiring for me. In addition, I love to travel to different countries. This year I traveled to almost four countries including Swaziland, South Africa, and India. I love to meet with other people around the world—that’s my hobby. 

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. The National Institutes of Health has launched a large clinical trial to assess treatments for preventing people at high risk from developing multidrug-resistant tuberculosis (MDR-TB). The study is comparing the safety and efficacy of a newer TB drug delamanid—one of the first drugs available specifically to treat MDR-TB and the first to exist in a child-friendly formulation—with isoniazid, a decades-old drug for TB prevention, in preventing development of active MDR-TB among high-risk individuals exposed to household members with MDR-TB. Study participants are considered at high risk if if they have latent TB infection, suppressed immune systems from HIV or other factors, or are younger than five years old. Study investigators hypothesize that delamanid will be a better prophylactic treatment than isoniazid in reducing the likelihood that at-risk household members of individuals living with MDR-TB will develop active TB. Existing treatments for MDR-TB are often toxic, poorly tolerated, expensive, and aren’t always available. The World Health Organization (WHO) estimated 460,000 people worldwide developed MDR-TB in 2017. According the Access to Medicine Index issued last month, which ranks the world’s 20 largest pharmaceutical companies on their efforts to improve access to medications for the world’s poorest, the industry has made remarkable progress in increasing access to lifesaving medicines, through efforts like drug donation and licensing patents to generic producers. However, according to the report, most of the progress made by the industry is limited to a few companies with their efforts too reliant on donor dollars. GSK has ranked first every year since the rankings began, with its score steadily rising each year. Dr. Jayasree K. Iyer, executive director of the Access to Medicine Foundation which releases the index, stated that two billion people still lack access to the products they need, implying progress on access has just begun. A new, rapid diagnostic test that can detect yaws—a debilitating bacterial disease spread through skin-to-skin contact causing skin lesions and ulcers—may reinvigorate efforts to eradicate the disease which affects thousands of the world’s poorest children. The molecular diagnostic test costs just US$2 and can detect yaws within 30 minutes at point-of-care, eliminating the time-consuming need to transfer disease samples to expensive high-tech labs. Though WHO reported more than 80,000 suspected cases of yaws in 2018, the real number of infections is likely to be much higher. The rapid diagnostic test is one of 30 finalists of the WHO Innovation Challenge and was showcased at the Africa Health Forum earlier this year. The diagnostic has shown “impressive results” in small trials, according to its creator, who is looking to do larger scale testing.