Projects

ONGOING PROJECTS

COVID-19

Dr. Smith is the founder and editor-in-chief of COVID-101.org. She launched this project on March 15, 2020, in response to the need for COVID information that is accessible and rooted in science. The project workflow looks like this: readers ask COVID-19 questions, our doctors rapidly review the scientific evidence, and the team delivers simple answers to an array of platforms (Facebook, Twitter, Instagram, and the web). More than 25 volunteers contribute to COVID-101, including epidemiologists and infectious disease physicians from a dozen colleges and universities (University of Washington, Columbia, Johns Hopkins, Harvard, George Washington University, and more).

Dr. Smith, in collaboration with colleagues at UCSF and UCLA, is leading efforts to harmonize data collection across global pregnancy and perinatal COVID registrie

Comprehensive Multivitamins in Pregnancy

Dr. Smith led the pooling and analysis for an individual patient data meta-analysis intended to inform policy surrounding multiple micronutrient supplementation (MMS) in pregnancy (Smith et al Lancet Global Health 2017). Despite concerns about potential health risks raised in the World Health Organization (WHO) 2016 Antenatal Care Guidlines, the meta-analysis and a second study published in the Journal of Nutrition (Smith and Sudfeld 2019) finds clear evidence that MMS containing iron and folic acid is safe and superior to iron and folic acid alone. MMS in pregnancy reduces the risk of low birth weight, preterm birth, and being born small-for-gestational-age. Further, MMS reduces the risk of neonatal and infant mortality for girls, and there was no evidence of increased risk among the 26 subgroups examined. Dr. Smith has participated in the Taskforce on Maternal Micronutrient Supplementation in Pregnancy hosted by the New York Academy of Sciences and is an advocate for improving evidence-based maternal nutrition services during pregnancy.

The Effect of Neonatal Vitamin A Supplementation on Infant Mortality

Dr. Smith led field operations for implementation of a large, neonatal vitamin A supplementation (NVAS) randomized control trial in Tanzania funded by the Bill & Melinda Gates Foundation, in collaboration with colleagues at the Harvard T.H. Chan School of Public Health (HSPH), Ifakara Health Institute (IHI), and the World Health Organization (WHO). This was the largest NVAS trial ever conducted in sub-Saharan Africa; the team enrolled 32,000 neonates and tracked them throughout their first year of life. To inform global policy, other teams conducted parallel trials in India and Ghana; the three trials found conflicting results. The India trial—consistent with previous trials in the region—found that supplementation reduced the risk of infant death. But the trials in Tanzania and Ghana found no effect of supplementation (Masanja and Smith et al Lancet 2015). Dr. Smith published a study that explored potential reasons for these conflicting results; this work provided the first evidence—based on individual data—that indicated maternal micronutrient status may explain the heterogenous effects of NVAS (Smith et al International Journal of Epidemiology 2016). Dr. Smith was part of the WHO working group that pooled and analyzed individual pateitn data from all prior NVAS trials.This work has informed WHO guidelines for NVAS; those guidelines are expected to be released this year.

The Effect of Early Breastfeeding Initiation on Infant Morbidity and Mortality

Dr. Smith has published several papers showing a link between breastfeeding initiation time and infant morbidity and mortality (Smith et al The Journal of Pediatrics 2107; Smith et al PloS one 2017; Neovita Study Group Lancet Global Health 2016). However, the mechanism through which early newborn nutrition has a long-term health impact is not known. Some have hypothesized that early breastfeeding may decrease the risk of microbial translocation, accelerate intestinal maturation, promote resistance to and epithelial recovery from infection, and protect against environmental enteric dysfunction (EED). But there is limited data about these potential mechanisms. Dr. Smith and colleagues recently completed a study among a cohort of children enrolled in a micronutrient trial in Tanzania; both delayed breastfeeding initiation and prelacteal feeding were associated with elevated biomarkers of poor gut function later in infancy.

PAST PROJECTS - NEWBORN MORBIDITY & MORTALITY

Systematic Review: Barriers and Enablers of health system adoption of kangaroo mother care implementation: A systematic review of mother, father, and family perspectives, 2015

PI: Grace Chan, Harvard T.H. Chan School of Public Health

Dr. Smith is the lead author responsible for preparing the manuscript for publication.

Harmonization of ongoing cohorts of newborn intervention trials to obtain additional information critical for maternal, fetal and newborn health (AMANHI Project) , 2013-2015

PI: Wafaie Fawzi, Harvard T.H. Chan School of Public Health

PI: Honorati Masanja, Ifakara Health Institute

Dr. Smith was an co-investigator of this project. The objective of this research was to collect information to determine the burden, timing and causes of maternal deaths and stillbirths in rural Tanzania, in collaboration with ten other sites around the world. This will produce the largest set of reliable epidemiological information on maternal and fetal survival using a multi-country cohort approach.

PAST PROJECTS - INFECTIOUS DISEASE

The effect of standard dose multivitamin supplementation on disease progression in HIV-infected adults initiating HAART: a randomized double blind placebo-controlled trial in Uganda, 2012-2013

PI: Wafaie Fawzi, Harvard T.H. Chan School of Public Health

PI: David Guwatudde, Makerere University

Ms. Smith was a research assistant on this project, providing data and statistical support while investigators prepared DSMB reports and scientific papers to disseminate the trial results.

Quantifying the Economic Burden of Rotavirus in Bolivia, 2008-2009

PI: Juan Leon, Rollins School of Public Health, Emory University

PI: Volga Iniguez, Universidad Mayor de San Andres

Ms. Smith was a co-investigator of this project. She designed and implemented the national study including: selection of study sites, creation of survey instruments, hiring and training of field staff, management of data from more than 400 surveys, and management of Bolivian research assistants from US. She collaborated with the surveillance program and Ministry of Health to analyze epidemiologic data and utilize preliminary study results for publication and public service announcements in preparation for release of the Rotavirus Vaccine in Bolivia.

Randomized, Double-Blinded Clinical Trial for Human Norovirus Inactivation in Oysters by High Hydrostatic Pressure Processing, 2007-2009