To improve the health outcomes of its citizens, Ethiopia must take steps to meet SDG3.4 and decrease the number of premature deaths caused by non-communicable diseases (NCDs). NCD deaths are preventable by tackling their risk factors: unhealthy diets, physical inactivity, and air pollution. These risk factors are becoming increasingly prevalent in urban sites and have their origins in fetal life, and focusing prevention policies on pregnancy can yield significant benefits. Pregnancy is a unique opportunity for lifestyle interventions and antenatal care (ANC) has long been a key strategy for health promotion, disease prevention, early diagnosis, and treatment. The high ANC coverage in urban Ethiopia makes it an ideal program to support access and utilization of quality NCD services for prevention and risk reduction in urban populations. Guided by the immediate need for high-quality implementation research and evaluations in real-word settings to tackle the multisectoral and complex challenges of NCD prevention, we will fill the implementation knowledge gaps by developing, implementing, and assessing the impact of a novel prevention program in four diverse urban sites. We will apply user-centered approaches to adapt effective evidence-based WHO guidelines and implementation strategies with beneficiaries and stakeholders. Our approach for achieving behavior change in pregnant women is twofold: i) thorough assessments of women’s environments and environmental risks, as wider determinants of health; ii) integration of implementation strategies into the National Health Information system of Ethiopia. We will provide real-word evidence for the impact of implementation for behavior change, NCD risk reduction and better maternal and child health. ENABLE will support care providers for continuity and quality of overall healthcare and of NCD care and surveillance, and ultimately strengthen the Ethiopian public health system towards better health for all.

The main aim of the proposed project is to use genomic epidemiology of tuberculosis, malaria and emerging and re-emerging pathogens in Africa as to better understand disease etiology, dynamics of disease transmission, and evolution of drug-resistant pathogens. The study also aims to increase Africa's capacity in bioinformatics, genomics, genomics data management, biobanking, and promote data sharing. Our goal is to improve the health of Africans with innovations in disease surveillance, equip the next generation of African scientists with cutting edge skills and strengthening south-south research collaborations. We propose the following hypotheses: 1. Increased capacity in genomic epidemiology will enable more effective disease surveillance in Africa. 2. Increased capacity in biobanking and genomics data management and analysis in Africa will enhance regional surveillance of infectious diseases and encourage timely and effective responses to emerging pathogens. 3. Regional whole genome sequence-based surveillance will improve the detection of DR-TB and inform the development of more sensitive and specific rapid diagnostics for the detection and surveillance of DR-TB in Africa and elsewhere. 4. Regional genomic surveillance of malaria parasites will inform a pre-emptive detection of emerging DR parasites and measure the impact of programmatic interventions for a data driven decision making by policy makers. 5. Implementation of harmonized genomic data analysis tools will allow the creation of continent-wide surveillance networks able to identify cross-border spread of DR variants and emerging pathogens. To achieve this, PANGenS will develop genomic epidemiology capacity across Africa by establishing a collaborative framework that brings together all expertise to perform trainings and implementation in all relevant components ranging from wet lab to bioinformatics, and establish proof-of-concept studies for TB and malaria in in selected partner countries