Grand Challenges Canada, Toronto
23 October 2013
4 projects nominated for grants up to $2 million;
10 projects awarded $270,000
Grand Challenges Canada, funded by the Government of Canada, today extended a total of $10.1 million to 14 bold, creative projects aimed at improving the early brain development of kids in low-resource countries.
Projects in Jamaica, Colombia, Bangladesh and Indonesia are scale-up award nominees (board-approved grants up to CDN $2 million, pending successful contract negotiations).
Seed grants of CDN $270,000 each are given to seven organizations overseas — in Vietnam (2 grants), Bangladesh, India, Kenya, Zambia and Peru. And three seed grants are given to Canadian organizations: the Hospital for Sick Kids, Toronto (two grants), and the University Health Network, Toronto.
All 14 projects will be implemented in developing countries: five in Africa, six in Asia and three in Latin America and the Caribbean.
“Impoverished brains result in impoverished countries,” says Dr. Peter A. Singer, CEO of Grand Challenges Canada. “For a wide range of sad, all-too-familiar and preventable reasons, an estimated 200 million children under 5 years old in the world’s 112 low- and middle-income countries will fail to reach their brain’s full development potential.”
“These projects illustrate well the success of our search for ‘bold ideas with big impact,’ pioneering new approaches worldwide to maximize the number of kids in low-resource countries who achieve and contribute to their fullest capabilities,” Dr. Singer added.
Says Mrs. Laureen Harper, honourary chairperson of the program: “The Grand Challenges Canada Saving Brains program is designed to help millions of children in developing countries who fail to reach their full development potential due to such factors as malnutrition, infection, birth complications, or a lack of nurturing and stimulation at an early age.”
Says the Honourable Christian Paradis, Canadian Minister of International Development and Minister for La Francophonie: “Our Government, under the leadership of Prime Minister Harper, is committed to advancing the health of the world’s most vulnerable mothers, newborns and children. We are proud to partner with Grand Challenges Canada to find innovative solutions to the most pressing global health challenges. The Saving Brains program is just one example of how innovation can help improve the lives of children in their earliest days. ”
Seed grant awards
Hospital procedures: mitigating harm of pain to brain development of a tiny preterm baby
The Centre for Global Child Health, Hospital for Sick Children (Toronto, Canada)
Working in Ghana, this project will introduce ways of alleviating pain for infants born prematurely and treated in special neonatal intensive care units (NICU)s — the tiniest of kids who experience moderate to severe pain several times daily due to diagnostic and therapeutic procedures such as blood sample collections and medicine injections.
Project leader Dr. Bonnie Stevens of Toronto’s Hospital for Sick Children says the severity of brain defects found later among children born preterm can be linked to the number of painful procedures experienced in the NICU.
“Higher volumes of painful procedures with inadequately managed pain have also been associated with cognitive, language and motor problems, and low academic achievement,” says Dr. Stevens. “Although the consequences of pain are known, procedural pain is frequently under-managed and under-prioritized.”
Worldwide, about 13 million infants are born preterm each year — a number growing steadily thanks to modern technologies. And even in North America, Europe and Australia, surveys show “neonates” are exposed to an average of 4 to 14 painful procedures daily, with only about 1 in 3 receiving pain relief.
Less is known about neonatal pain management in low- and middle-income countries, where the incidence of neonatal sickness and death is highest. However, a survey in Kenya showed that infants in seven special care newborn nurseries experienced, on average, four painful procedures daily, half of them injections and blood sample withdrawals. No form of analgesia was documented.
The project will introduce Ghanaian caregivers and parents to an integrated “Toolkit for Minimizing the Impact of Pain in Infants,” adapted from successful practices in Canada. Videos and other educational materials will detail simple, universally affordable, proven ways to mitigate procedural pain for an infant, such as:
- Sweet solutions (e.g., sucrose or glucose) administered orally prior to a painful procedure;
- Kangaroo care, where infants are held in skin-to-skin contact with a parent;
- Facilitated tucking, where infants are held in a fetal-like position to provide support and boundaries;
- Breastfeeding.
Combined, these interventions have a demonstrated cumulative pain-relieving effect.
“Inadequate resources are cited as the major impediment to pain management in infants as well as a lack of knowledge, severe staff shortages and formal training about pain. The proposed Toolkit intervention will address these issues,” says Dr. Stevens.
The project draws on existing partnerships between the University of Ghana School of Nursing, Korle Bu Teaching Hospital in Accra and Toronto’s Hospital for Sick Children, together training 1,000 pediatric nurses in Ghana over the next 10-15 years, supported by a Canadian government grant. Plans calls for the toolkit’s integration into the curriculum at the School of Nursing (where there is limited pain content) and its use scaled up to reach additional countries.
Says Dr. Stevens: “Decreasing the intensity of painful procedures in hospitalized infants using simple, inexpensive, evidence-based strategies has the potential to minimize both immediate stress and suffering, and the known longer-term impact of pain on the developing neonatal brain and cognitive deficits.”
Malaria in the womb: New malaria policies to protect early brain development in Malawi
University Health Network (Canada)
Each year, about 125 million pregnant women are at risk of placental malaria (PM) and about 25% of all pregnancies in sub-Saharan Africa are complicated by PM at delivery.
PM has profound maternal and fetal health consequences, including increased risk of anemia, preterm birth, fetal growth restriction and delivery of low birth weight infants. The impact of in-utero malaria exposure on fetal neurodevelopment is unknown, however researchers with the project team recently linked malaria-exposure in animals with persistent and long-term deficits in memory and behaviour.
Dr. Kevin Kain of the Toronto-based University Health Network, leader of this project in Malawi, says malaria exposure in the womb “may derail the developmental trajectory of generations of children.” And a shift in understanding — that malaria exposure may result not just in infant mortality and low birth weight but affects also long-term neurodevelopment “represents a change in paradigm that will initiate a re-evaluation of public health policies designed to protect women and children from the deleterious consequences of PM.”
Today’s approach to this problem — intermittent preventive treatment of pregnant women with sulfadoxine-pyrimethamine — is losing effectiveness due to rising drug resistance, resulting in persistent infections.
The new project involves a novel antenatal care policy that focuses resources on accurate point-of-care malaria diagnosis and effective case- management of infection to reduce the burden of malaria in pregnancy and protect early brain development.
The work is expected to provide “compelling evidence that will directly impact national and international policies on the prevention of malaria in pregnancy. If our findings support an intervention that leads to improved neurocognitive outcome for exposed infants, it will refocus public health policies towards protecting fetal brain development.”
Project collaborators include the University of Malawi, and the University of Liverpool, UK.
An Integrated Toolkit to Save Newborns’ Brains in Kenya
The Centre for Global Child Health, Hospital for Sick Children (Toronto, Canada)
The first month of life is a critical period in brain growth and development that can be affected in many ways, including from hypothermia and infection.
Reducing the number of these impediments to young brain growth is the aim of a toolkit created by Toronto’s Hospital for Sick Kids for use initially by mothers in Kenya.
Contents of the tool kit (which costs less than $5) include:
- A clean delivery kit to minimize infection at time of delivery
- A sterilizing gel that, applied to the umbilical stump, reduces certain severe infections by 75% and mortality from all causes by 25 to 40%;
- An emollient to promote skin integrity, helping to reduce infection and prevent hypothermia (and shown to reduce mortality in hospitalized preterm infants)
- A handheld scale to spot early warnings signaled by an infant’s weight, and a ThermoSpot to identify hypothermia and fever
- A mylar infant sleeve and reusable heating device to treat hypothermia
Information on infant stimulation, involving play and communication strategies proven beneficial to neurodevelopment in low birth weight newborns.
If any danger signals are found, community health workers will refer cases to appropriate health care.
“We believe that improved neurodevelopment outcomes at age 1 will translate into sustainable longer term gains in academic performance, employment, productivity, and ultimately more human capital,” says project leader Dr. Shaun Morris of the Hospital for Sick Kids.
Project collaborators include the Aga Khan University, Kenya.
Iron-fortified biscuits to reduce maternal and child anemia
St John’s Research Institute, Unit ofCBCI Society for Medical Education, Bangalore, (India)
Anemia — a low level of red blood cells causing a body’s reduced capacity to carry oxygen — results from micronutrient deficiencies, most often iron.
India has one of the highest rates of anemia globally: over 79% of children aged 6 to 8 months and 58% of the 26 million pregnant women each year. Some 17 million of these women have access to iron pills yet 11 million do not take them for the recommend time (adherence rate: 35%). Why? The pill is big and tastes metallic.
Yet iron deficiency anemia dramatically affects the health of a pregnant woman and her unborn baby, increasing risks of death and sickness during childbirth, including hemorrhage and low-birth weight. Long-term, iron deficiency anemia delays psychomotor development and impairs cognitive development in infants, preschool and school-aged children around the world.
Moreover, researchers say, the effects of anemia are, “not likely to be corrected by subsequent iron therapy… anemic children will have impaired performance in tests of language skills, motor skills, and coordination, reportedly equivalent to a 5 to 10 point deficit in IQ.”
Part of the answer may be an iron-fortified biscuit for use by pregnant women, indistinguishable in taste from popular Indian biscuits.
Coupled with marketing, project leaders say their new biscuit is more likely to be used by previously non-adherent pregnant women, and increase iron stores in newborns, “which translates to more sustainable and protected early brain development.”
“After extensive consumer research, the nutrition team led by Dr A.V. Kurpad and the project collaborators, Violet Health Inc have developed several prototypes specifically designed with the tastes and preferences of pregnant women in India,” says project leader Dr. Pratibha Dwarkanath of St John’s Research Institute, unit of CBCI Society for Medical Education.
“We estimate our solution to be more cost-effective than the iron pill, while reaching more anemic women and their children”
“After proof of concept, we anticipate a scaled trial in Karnataka within three years and reducing anemia in women and infants.”
Project collaborators include Violet Health, Inc., NY, and the Indian Institute of Management, India Bangalore.
And many others: News release in full: here
Example coverage:
The Hindu, click here
New Indian Express, click here
Africa Science News Service, click here
Agencia EFE, click here