Our proposed project will focus on the nutrition and health of adolescent boys and girls. Adolescence is the stage of life, from 10 to 19 years of age, when children transition into adults. It is characterized by rapid growth, sexual maturation, widespread 're-wiring' and re-organisation of the brain, and an increase in the scope and complexity of social interactions. We currently have the largest generation of 10 to 19 year olds in human history, more than 1 billion worldwide, and half of these grow up in countries characterised by high levels of poor quality nutrition and rising rates of non-communicable disease (NCDs: obesity, heart disease and diabetes). In sub-Saharan Africa and South Asia, adolescents form 20-35% of the population. It has recently become clear that adolescence is a critical phase in life for achieving human potential, and during which the physical, psychological, behavioural, social and economic foundations of adult health are consolidated. The recent Lancet commission on adolescent health points out that investment in this stage of the lifecourse has the potential to produce a 'triple dividend' benefiting adolescents now, into their future adult life, and into the lives of their children. Half of the inequality in the value of lifetime earnings is due to factors determined before the end of adolescence. Despite its significance, adolescence has been largely neglected in health and social policy terms; a phenomenon recognised by the recent UN Global strategy for women's, children's and adolescents' health. Adolescent nutrition has, in particular, been under-researched, leading to large knowledge gaps. There have been no comprehensive studies of nutritional status and physical activity across different populations and settings. Little is known about how nutrition and physical activity change through adolescence, what determines these changes, and how they influence growth, current health, future disease risk, and the health of the next generation. We do not understand the drivers of dietary and activity behaviours among adolescents, and how these could be changed to benefit health. Our application brings together a multi-disciplinary network of researchers interested in adolescent health from the UK, India and different regions of sub-Saharan Africa, with the collective expertise to carry out large-scale nutrition research. Our long-term vision is to 1) conduct in-depth studies of the dietary behaviour, nutritional status, body composition and physical activity of adolescents in vulnerable populations in these countries, and how these change through adolescence; 2) to understand, through qualitative research, the factors which determine their diet and activity behaviour at each stage of adolescence; and 3) develop and test context-specific interventions to improve adolescent health through nutrition. In preparation for this ambitious future work, the current pump-priming application is to 1) consolidate the new network by holding two workshops, one in India, one in Africa; 2) conduct training in qualitative research methods and carry out pilot qualitative data collection to explore influences on dietary and activity behaviour in adolescents across multiple settings; 3) carry out literature reviews of existing data on the nutritional status of adolescents and existing policies for adolescent nutrition in the countries represented; 4) carry out secondary analyses using data from existing cohorts within the group, to examine how nutrition in young adolescence relates to adolescent growth and adult NCD risk markers; and 5) work together to develop the design of the future project, and prepare a larger grant application in 2018. A major objective of both the pump-priming work and the future larger study is to build capacity among early-and mid-career researchers in these countries for rigorous and cutting-edge nutrition research.

A reliable and acceptable quantity and quality of water, and managing water-related risks for all is considered by the United Nations to be "the critical determinant of success in achieving most other Sustainable Development Goals (SDGs)". Water is essential for human life, but also necessary for food and energy security, health and well-being, and prosperous economies. However, some 80% of the world's population live in areas with threats to water security; the impacts of which cost $500bn a year. Progress in meeting SDG6 (Ensure availability and sustainable management of water and sanitation for all), has been slow and in May 2018 the United Nations reported that "The world is not on track to achieve SDG6". Improvements that increase access to water or sanitation are undone by pollution, extreme weather, urbanization, over-abstraction of groundwater, land degradation etc. This is caused by significant barriers that include: (1) Insufficient data to understand social, cultural, environmental, hydrological processes; (2) Existing service delivery / business models are not fit for purpose - costs are too high, and poor understanding of local priorities leads to inappropriate investments; (3) Water governance is fragmented and communities are engage with, and take responsibility for, water security; (4) Pathways to water security are not adaptable and appropriate to local context and values. These barriers are inherently systemic, and will require a significant international and interdisciplinary endeavour. The GCRF Water Security and Sustainable Development Hub brings together leading researchers from Colombia, Ethiopia, India, Malaysia and the UK. Each international partner will host a Water Collaboratory (collaboration laboratories) which will provide a participatory process, open to all stakeholders, to jointly question, discuss, and construct new ideas to resolve water security issues. Through developing and demonstrating a systems and capacity building approach to better understand water systems; value all aspects of water; and strengthen water governance we will unlock systemic barriers to achieving water security in practice.

The World Health Organization (WHO) model of 'age-friendly cities' emphasizes the theme of supportive urban environments for older citizens. These defined as encouraging 'active ageing' by 'optimizing opportunities for health, participation and security in order to enhance quality of life as people age' (WHO, Global Age-friendly Cities, 2007). The goal of establishing age-friendly cities should be seen in the context of pressures arising from population ageing and urbanisation. By 2030, two-thirds of the world's population will reside in cities, with - for urban areas in high-income countries - at least one-quarter of their populations aged 60 and over. This development raises important issues for older people: To what extent will cities develop as age-friendly communities? Will so-called global cities integrate or segregate their ageing populations? What kind of variations might occur across different types of urban areas? How are different groups of older people affected by urban change? The 'age-friendly' city perspective has been influential in raising awareness about the impact of population ageing. Against this, the value of this approach has yet to be assessed in the context of modern cities influenced by pressures associated with global social and economic change. The IPNS has four main objectives: first, to build a collaborative research-based network focused on understanding population ageing in the context of urban environments; second to develop a research proposal for a cross-national study examining different approaches to building age-friendly cities; third to provide a systematic review of data sets and other resources of relevance to developing a research proposal on age-friendly cities; fourth, to develop training for early career resarchers working on ageing and urban issues. The network represents the first attempt to facilitate comparative research on the issue of age-friendly cities. It builds upon two meetings held at the Universities of Keele and Manchester in 2011 that sought to establish the basis for cross-national work around the 'age-friendly' theme. The IPNS represents brings together world class research groups in Europe, Hong Kong and North America, professionals concerned with urban design and architecture, and leading NGOs working in the field of ageing. A range of activities have been identified over the two-year funding period: (1) Preparation of research proposals for a cross-national study of approaches to developing age-friendly urban environments. (2) Two workshops to specify theoretical and methodological issues raised by demographic change and urbanisation. (3) A Summer School exploring links between data resources of potential relevance to the ageing and urbanisation theme and which might underpin research proposals. (4) Master classes for network members from key researchers in the field of urbanisation and ageing. (5) A workshop with a user-based theme developing older people's participation in research on building age-friendly communities. (6) Themed workshops (face-to-face and via video-link) to identify research and policy gaps drawing on inter-disciplinary perspectives The IPNS will be sustained in a variety of ways at the end of the funding period. A collaborative research proposal as well as one to maintain the network will be major outputs from the project and work with potential funding bodies will continue after 2014. Dissemination activities will continue through professional networks, symposia at major international conferences, and involvement in expert meetings. The project will continue to be advertised through the maintenance of a website maintained by the host UK HEI. The project will continue to make a contribution to policy development around the theme of age-friendly cities, notably with the main NGOs working in the field.

In Sub-Saharan Africa, there has been limited attention to congenital anomalies (spina bifida, cleft palate, limb defects, Down Syndrome and many others) which has led to a large gap in knowledge and understanding about their frequency and causes, how best to prevent them happening through public health programs, or how to meet the specialist healthcare and social needs of affected children and families in order to improve survival and quality of life. Currently, congenital anomalies are estimated to account for approximately 10% of child deaths under 5 years of age. There is a new urgency to tackle this problem. The Sustainable Development Goals set out targets for reducing neonatal and childhood mortality and morbidity, for reducing health inequity where vulnerable populations (such as those with congenital anomalies) are left behind, and to make sure that all children have access to quality healthcare. In addition, two recent events have shown the need to have better information about congenital anomalies in the population. Africa has the highest HIV burden in the world, and it is important that pregnant women receive the best antiviral medication for themselves and their babies, but a concern has been raised that one of the new antiretrovirals may raise the risk of congenital anomaly - much more data and research is needed to address this and related questions urgently. Recently in Latin America, the Zika virus epidemic focused the world's attention on the potential for maternal infections to cause congenital anomalies, and this again highlights the lack of knowledge about the effect of maternal infections in Africa, and lack of preparedness for new epidemics. This one year seed project will set up a Sub-Saharan African Network for Congenital Anomalies: Surveillance, Prevention and Care. The aim of the network is to promote the prevention of Congenital Anomalies, and care for affected children and families, by building an evidence base through surveillance and research, improving capacity for collaborative research, and paving a pathway to improve policy and practice. We have gathered together multiple stakeholders (academic researchers, ministry of health, patient organisations, healthcare professionals) from 9 African countries, including all those with the most experience in this area along with key international partners. By the end of one year, we will have agreed a governance structure, data sharing mechanism, "community of practice" website, and research priorities and further funding proposals. We will also have agreed a position paper setting out the burden of congenital anomalies at the individual, family and community level based on available data, modelling and estimation, and survey of policy and practice and experience in Sub-Saharan Africa. This position paper will be the basis for making the case with national ministries of health to raise the priority of congenital anomalies in their national health agendas. We will also scope the potential of new mobile and other technologies to be used or developed to assist data gathering and healthcare. The new network will meet in Kampala, and form committees which will continue to work throughout the year. In future, the network would be expected to expand to more countries in the region, and include more stakeholders. There has been huge enthusiasm from the partners in 9 African countries for this network. This is an exciting opportunity to make a step change in congenital anomaly prevention and care in Sub-Saharan Africa at a critical time.

The study proposed here applies cutting-edge health policy and systems research to address a critical and poorly addressed global health challenge: conflict of interest (COI) hindering improvements in the quality of care delivered by private healthcare providers. We define COI as a situation whereby the impartiality of a healthcare provider's judgment may be influenced by a secondary interest, such as financial gain, leading to a decision that is not in the patient's best interest. There is strong evidence that private doctors seeking to make a profit from patient consultations often experience a COI resulting in prescription of medication or diagnostic tests that are either unnecessary or more costly than available alternatives. We focus on irrational prescribing of antibiotics by private doctors in Pakistan, the sixth most populous country in the world, where more than 80% of people first seek care at private doctors and where antibiotic usage is among the highest in the world. Studies in Pakistan and other low and middle income countries, including our own earlier research, show that private doctors prescribe multiple antibiotics when patients do not need them in order to receive benefits from pharmaceutical companies, or make profits from the medicine sales. Despite the scale and urgency of this issue, which affects millions of people and drives antimicrobial resistance which can spread across the world, there is extremely limited evidence on strategies that are effective in contexts where resources and political support for the enforcement of rules are low. Therefore, training interventions focusing on increasing knowledge and skills to affect voluntary behaviour change in private providers is the most common approach used. However, these interventions have had limited success when irrational prescribing is mainly motivated by profit-generation rather a lack of knowledge; here norms and values associated with professional ethics are critical to address with interventions. Our study has four linked objectives, which together will generate new evidence about the impact of a continuing medical education intervention with specially designed messages to sensitise doctors to professional ethics and COI, as well as critical insights about barriers that need to be overcome in order to facilitate scale-up of this intervention in the local health system. Since influential stakeholders responsible for addressing practices of private doctors may be crossing professional ethics boundaries themselves, often by having multiple income streams without disclosure, our first objective is to understand how COI and professional ethics is conceptualised by influential stakeholders in Pakistan in order to identify potential supporters and opponents of our intervention. We next focus on private doctors, investigating how they decide what is ethically unacceptable and acceptable with respect to getting personal benefits from prescribing antibiotics. Our third objective is to understand how best to present messages that sensitise private doctors to professional ethics and the role of conflict of interest driving irrational prescription of antibiotics in order to design our intervention. Our final objective is to assess the impact of our intervention on the behaviour and attitudes of private doctors with respect to unethical benefits from pharmaceutical companies for prescribing antibiotics. A key strength of the proposed study is that it has been co-designed with Pakistani researchers and policymakers, building on two previous research council funded projects in Pakistan and Cambodia. In addition to producing new evidence to inform ongoing investments in improving quality of care and tackling antimicrobial resistance, our medical education material on COI can be used for research and training in other settings, and the tools developed as part of our innovative health systems research methods will be made available for future studies.