Mosquito borne diseases such as malaria, dengue, chikungunya and zika cause huge suffering in tropical regions of the world. One of the main approaches to controlling these diseases is to use insecticides to kill mosquitoes and prevent them from transmitting the infection from person to person. Millions of pounds are spent on mosquito control each year though surprisingly there is no simple method for evaluating the ability of these interventions to kill mosquitoes or prevent them from transmitting disease. The number of biting mosquitoes in an area fluctuates substantially from day to day due to local weather patterns so the number of mosquitoes caught in traps is a poor predictor of the size of the population. More importantly the number of mosquitoes in itself is not a good predictor of risk as many diseases take several days to develop inside the mosquito and find their way to the mouthparts. This means that only older mosquitoes can pass on the infection. Mosquito age is therefore very important for assessing the effectiveness of anti-mosquito interventions but currently, there is no easy, accurate way of assessing the age of a mosquito population. Near-Infrared Spectroscopy (NIRS) is a new age-grading and species identification technique that has been developed in the laboratory. It predicts the age of the mosquito by measuring how a beam of light is reflected differently from the bodies of mosquitoes as they get older. Unlike other methods NIRS doesn't require costly chemicals or procedures and it can be carried out by anybody with minimal training. This makes it feasible for use as a routine method for monitoring mosquito age in the field. Currently NIRS cannot predict the age of an individual mosquito very accurately and tests have only been done on mosquitoes reared in the laboratory which are likely to be more uniform (and therefore give more accurate results) than those caught in the wild. However, for disease control it is more important to know the average age of the mosquito population than the age of individuals. Our preliminary work suggests that if we change the way we analyse NIRS outputs we can generate highly precise predictions of the average age of the mosquito population. The project intends to take NIRS from the laboratory to the field and test whether it is good enough to be able to be used in the routine monitoring of mosquito populations. The project will use semi-field and field data to operationalise the technique and outline how many mosquitoes need to be caught (and over how many days) to generate estimates accurate enough to guide the deployment of mosquito control. The work will concentrate on the two most important mosquito borne infections: malaria (which kills 438,000 people in 2015) and dengue (which infects 400 million people annually). However the technique developed here can be applied to other diseases and mosquito species. NIRS can also be used to differentiate closely-related mosquito species that are indistinguishable by eye. That is important, as not all of these mosquitoes have the same ability to transmit disease and are affected by control interventions differently. Similarly to age-grading, the capacity of NIRS to differentiate species needs to be more rigorously tested in the field. There is also evidence to suggest that NIRS might be able to detect whether a mosquito is infected with the virus that causes dengue disease. This will be tested for malaria, first in the laboratory in Burkina Faso and then in the field. Currently mosquito species, age and infection status are estimated using a variety of laborious and costly procedures that preclude their use as routine monitoring tools in poorer parts of the world. A single, inexpensive method for doing all three tests simultaneously would have significant public health impact: we could describe the risks of disease transmission and evaluate the efficacy of control programs far more cheaply and quickly.

The massive scale up of long-lasting insecticidal nets (LN) from 2% in 2000 to 55% in 2015 has made the major contribution to the decline of malaria in Africa. LN effectiveness is entirely dependent on the pyrethroids, and with high LN coverage resistance has increased in distribution and strength. Leading LN brands are giving less protection than before and in North West Tanzania are failing to control malaria despite high coverage and usage rates. This problem was anticipated, and WHO has long encouraged industry to develop new types of 'combination' LN treated with new chemical compounds to overcome resistance and restore effectiveness. The strongest resistance is mediated by cytochrome P450s, enzymes that metabolise the pyrethroid to inactive compounds. One solution is the synergist PBO which inhibits the P450 system in insects. LN products combining pyrethroid and PBO are available but due to limited evidence of additional impact against malaria these nets have not been widely deployed. This situation is changing as we showed in a randomised controlled trial in Tanzania that LN with PBO (Olyset Plus) was able to control malaria transmission where standard LN failed due to resistance. Presently there are two types of PBO-LN available that differ in distribution of PBO on the net and it is not clear how they would compare making it difficult for malaria control agencies to make an informed choice. 'Mosaic LN' restrict the PBO to the roof panel where mosquitoes may first contact the net due to convection of CO2 from the sleeper inside. Others like Olyset Plus have all panels treated with PBO. Bi-treated nets incorporating new types of insecticide have also become available. A leading product mixes pyrethroid with an insect growth regulator pyriproxifen (PPF) that sterilises mosquitoes that contact the net. Another type mixes pyrethroid with the pyrrole chlorfenapyr (CFP), whose unique mode of action is unlikely to confer cross resistance with other public health insecticides. LSHTM has helped develop both types of mixture LN and has evaluated them entomologically in laboratory and experimental huts. With its in depth knowledge LSHTM is in a unique position to continue evaluation at community level for malaria control. Earlier experience provides insight on how to measure the characteristics of these unusual compounds on nets when used by communities. It is important to monitor effectiveness over 3 years lifespan because effectiveness is likely to change over time. It is important to decide how, where and when the main categories of bi-treated LN should be deployed to maximize effectiveness and resistance management potential. Insecticide combinations, as with drug combinations in the example of antimalarial therapy, are considered the best way to reduce selection pressure for resistance but the LN may differ in this capability. To address these issues we propose a four-arm randomized non-inferiority trial in 56 villages comparing the two PBO-LN types 1/ reference PBO-LN (Olyset Plus) and 2/ mosaic PBO-LN (PermaNet 3.0), and the two mixture-LN 3/ PPF-LN (Olyset Duo) and 4/ CFP-LN (Interceptor G2). The trial will demonstrate whether the mixture PPF-LN and CFP-LN provide similar or greater protection against malaria transmission than the reference PBO-LN. It will show whether mosaic PBO-LN provides equivalent protection to the reference PBO-LN. It will show whether bi-treated LN will reduce or prevent the selection of resistance. Health economic analysis will define which interventions are cost effective. The trial findings will guide national malaria control and international agencies (Global Fund, President's Malaria Initiative, WHO) on malaria control strategy, effectiveness of different types of bi-treated LN, cost effectiveness and deployment options to maximize impact against resistance.

The COVID-19 Parenting project will reach 57 million families in DAC countries during the COVID epidemic, with evidence-based resources to prevent violence against children and reduce parenting stress. DAC countries are facing far-reaching COVID epidemics, with cyclical periods of lockdowns and school closures (Mahler, 2020). Parents and caregivers globally are caring for children under exceptionally stressful conditions. Even the most secure families are struggling to manage children within extended lockdowns. Shouting and physical violence are worsened by stress, poverty, alcohol use, confined and crowded conditions (Meinck, 2017), all heightened under COVID-19. UNICEF reports global escalation in child abuse, with severe health, social and economic impacts. We will work with the World Health Organisation, UNICEF, the Global Partnership to End Violence, UNODC, USAID, the US Centers for Disease Control and other NGOs including the Special Olympics, World Without Orphans and local DAC country community organisations to: 1. Adapt parenting programs with demonstrated effectiveness into scalable resources for DAC countries, using the best evidence. This will include text message-based systems and low-data ir or offline app support for families. 2. Deliver parenting support programs and resources to 57 million families in an initial 14 DAC countries, through partnerships with UN agencies, NGOs and faith-based organisations. Translate resources into relevant DAC country languages to facilitate uptake. 3. Evaluate mechanisms of delivery, costs and their impact on reduction in violence, parenting and stress through online pre-post repeated surveys and in-depth qualitative research with families in DAC settings. We will achieve a rare outcome for research translation: direct delivery of support to 57 million families in DAC countries. It is exceptional value for money, with a cost to UKRI of less than one penny (£0.008) per DAC family receiving evidence-based violence prevention support during COVID-19.

The DIRTS project will use a randomized controlled trial to measure the impact of improved flows of extension information, access to agricultural input packages, and rainfall index insurance on agricultural intensification, specifically the use of fertilizers and improved seeds. To further examine the importance of weather-related risk to farm investment, all farmers in our study will be able to purchase a commercial rainfall index insurance product, developed by the Ghana Insurers Association (GIA). In 2014 we will offer free insurance to a randomly-selected subset of our sample, and actuarially-fair insurance to everyone else. Based on past experience, we expect take-up to be at or near 100% for the free insurance, and low for actuarially-fair insurance. We anticipate a strong investment response to the free insurance. In year 2, given that communities now have experience with the insurance, we expect that there will be strong demand at actuarially fair and higher prices. We will also experiment with marketing by local notables, to see if this increases demand. Second, to test the importance of unsure, untimely and costly access to agricultural inputs, DIRTS will make commercial fertilizer and improved seeds available to selected communities at different points during the year instead of just prior to land preparation. These inputs will be sold at market price by existing agro-input dealers, who are based in the districts. The project will facilitate linkages between these suppliers and the communities and subsidize transport. Third, to test the importance of imperfect farmer knowledge of farming best practices, randomly selected communities will be provided with more intensive extension through a Community Extension Agent (CEA). CEAs will be based in their own communities and will use Android phones to deliver standardized weekly extension messages, and will use mobile technology (pre-loaded database) to offer appropriate and time-sensitive advice to the farmers. For this study, 3240 households in 162 communities will be randomized into one of four treatment groups: insurance and extension; insurance and agricultural inputs; insurance, extension, and agricultural inputs, and insurance only. Two main evaluation tools will be used to study DIRTS households: comprehensive annual surveys to collect household and plot level data, and weekly tracking of household labor surveys during the agricultural season. Field work for DIRTS will run from January 2014 to March 2016 in 9 districts in northern Ghana. During the study period, project staff will use social media outlets and meetings with key stakeholders in the insurance and agricultural sectors to disseminate technical knowledge, focus group discussion results, and preliminary findings. At the end of the study period, local and international dissemination conferences will be held to publicize results.

In thirty years' time there will be half a billion adolescents in Africa. Like youth everywhere, they possess huge potential to thrive. But more than half are trapped in cycles of poor nutrition, poverty, low education, violence and unemployment. They also have the world's highest rates of early fertility, with adverse long-term outcomes for adolescent parents and their children. Such inter-generational disadvantage creates risks not only in the region but also to global stability. The SDGs and African Union's Agenda 2063 challenge us to take a radical new approach. The UK's Global Challenges Research Fund provides a unique opportunity to do this. The Accelerating Advantage Hub will find the combinations of services with the greatest positive impacts for Africa's adolescents and their children. We need to move beyond services focused on single outcomes, towards 'super-accelerator' impacts across multiple SDGs of health, education, violence prevention, gender equality and economic stability. With our government partners we will test combination services - for example of cash transfers, malaria prophylaxis, parenting programs, business skills and violence prevention - to identify the leanest and most effective policy packages. The Hub has been planned with African governments and international agencies including the UN Development Program, African Union, UNICEF and the World Health Organisation. They have told us that 'evidence as usual' is not enough. When we make a personal investment, like buying a computer, we want to know not only whether it is the most efficient, but also whether it is good value for money and whether we will like to use it. Governments need the same information about services: their effectiveness, their cost-effectiveness, whether they can be delivered through existing health, education and welfare systems, and whether they will be accepted by service providers and by adolescents. The Hub will conduct large-scale studies and use existing data in Angola, Cote D'Ivoire, DRC, Ethiopia, Gambia, Ghana, Guinea, Kenya, Lesotho, Liberia, Malawi, Mali, Mozambique, Nigeria, Senegal, Sierra Leone, South Africa, Somalia, South Sudan, Tanzania, Uganda, Zambia & Zimbabwe. All projects will include cost-effectiveness to assist budget decisions. In short, we will provide African policy-makers with the evidence they need and want to do the best for adolescents. The Hub will also train and support frontline workers to improve services for adolescents across Africa. We will turn evidence into training modules, freely accessible manuals and support materials. We will deliver practitioner training in 34 African countries by working with NGO partners selected for wide regional coverage, for example Paediatric Adolescent Treatment for Africa, the International Rescue Committee, Clowns without Borders and the International AIDS Alliance. Skills-building for young researchers in Africa and the UK is built into the Hub's work. We will support 45 promising young academics and dedicated African policymakers to focus their careers on improving the lives of adolescents and their children. The Hub's work is planned with adolescents themselves. Too many services have failed because they do not appeal to teenagers' aspirations and immediate goals. The Hub will work directly with adolescent advisory groups in Eastern, Western and Southern Africa to co-develop approaches that are not only effective, but also meaningful and fun for those who will use them. We aim to reach 20 million adolescents and their children with effective combinations of services to meet their needs. Between our direct countries of research and our NGO partners, the Hub will actively engage with policymakers, practitioners and adolescents across East, West, Southern and Central Africa and including fragile and war-torn states. We have a common goal: to transform the potential of Africa's adolescents into a thriving future for the continent.