Bill & Melinda Gates Foundation funds health project at the IEA

Research will use ultrasound devices connected to cell phones to guide the collection of tissue samples

A project hosted by the IEA and led by pathologist Paulo Saldiva, director of the Institute and professor of USP's School of Medicine (FM), has been contemplated with funds from the Bill & Melinda Gates Foundation through the Grand Challenges Exploration program.

The project is aimed at designing and validating methods that allow the identification of people's causes of death where there is a shortage of professionals or training for this goal. Saldiva explains that these methods will allow to determine the immediate cause and the underlying cause (main disease) of death. "Without these indicators it is not possible to define public health policies or verify their efficiency."

Entitled "Evaluation of New Alternatives to Increase Accuracy in Determining the Cause of Death: An Autopsy-Based Approach," the project has received US$ 100,000 from the Foundation for its pilot phase, in which the methods to be developed will be applied. One thousand autopsies should be carried out in São Paulo during one year.

If the methodology of this initial phase presents high reliability indicators, the project could receive another US$ 100,000 for its continuity and expansion of research areas, since the initiatives supported by the entity should be of worldwide application. Saldiva informs that in case of continuity the research will be applied in other regions of Brazil and in some African countries, possibly Angola, Mozambique and Cape Verde.

Interdisciplinarity

Under the coordination of Saldiva, the project team is made up of researchers from the Departments of Pathology and Radiology of the FM, from USP's Institute of Mathematics and Statistics (IME), and from the São Paulo Death Verification Service, where the exams will be carried out.

Given the interdisciplinary nature of the project and its intent to impact health policies in other developing countries, Saldiva believes that the IEA is the most appropriate research institution to host the work.

The results will be reported and published in the most prestigious scientific journal feasible, according to Saldiva. "The idea is that this report can subsidize the formulation of public policies, hence the importance of the participation of the Ministry of Health in the project. In addition, the work may result in a course for professionals to collect information with biopsies guided by portable ultrasound devices."

Research

According to Saldiva, the difficulties in collecting information on cause of death due to illness are due to several factors, among them the lack of a doctor to determine the cause or the lack of training of professionals.

There are also situations in which the body has been examined by a physician with no recording and collection of samples, or with the information not being concentrated in a database, or even with a non-transparent system.

One strategy is the development of ultrasound sampling methods: "A biopsy of the lung, liver or spleen and of noble organs can be performed. It would not be possible to extract samples with a living body without opening it and having the guidance of an ultrasound device connected to the cell, and with external supervision". If relevant, this biopsy may result in the dispatch of a health team to make the diagnosis and accelerate the process of identification of new pathogens.

The other utility of the project will be to allow the improvement of hospital services through the use of ultrasound: "No one else is willing to do an autopsy. If you want to know what a person has died from, you can ask the family for permission to donate knowledge in a non-invasive, immediate and non-mutilating way."

With this, it is possible to identify therapeutic targets for tumors of breast and stomach, for example. Then, with techniques of molecular biology, it is possible to clarify how the disease came about.

This line of research will be complemented by another project already underway at the FM and also coordinated by Saldiva: the Verbal Autopsy. It consists of the development and validation of questionnaires applied by health agents to family members. "The collected information will be compared for the formulation of algorithms that can more accurately determine the underlying and the immediate causes of death, using as reference standard what will be verified in real autopsies," he explains.

Foundation

Founded in 2000 and headquartered in Seattle, the Bill & Melinda Gates Foundation is the largest charitable institution in the world. It is run by the founder and former president of Microsoft and his wife, and by investor Warren Buffett.

In addition to its own initiatives, the foundation also supports projects in partnership with other charitable institutions, non-governmental organizations, development agencies, universities, research institutes and governments of several countries.

In developing countries, actions are directed toward improving the health of the population and initiatives that enable people to leave the condition of extreme poverty and food insecurity. In the USA, the foundation seeks to ensure that people - especially the poorest - have access to opportunities that enable them to achieve better schooling and better quality of life in general.

The Grand Challenges Exploration is one of the foundation's several sponsorship lines. The project coordinated by Saldiva has been selected in the 17th round of the program, called Explore New Solutions in Global Health Priority Areas. In the Brazilian case, it consists of a partnership of the Gates Foundation with 17 state foundations to support the research.

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