African Mothers on Diarrhea
Study by Kalamazoo resident aims to save lives of
Ethiopian mothers' beliefs about diarrhea can lead to
inappropriate treatment for their children's life-
threatening condition, a 20-year-old Johns Hopkins
University undergraduate from Kalamazoo, Mich., concluded
after field research in Africa.
Rishi Mediratta's data — interviews, stool samples and medical records — revealed that a "large proportion" of the mothers in one Ethiopian community did not have even a rudimentary understanding of how best to either prevent diarrheal disease or manage it.
Diarrheal diseases are a leading cause of mortality in developing African nations.
"Many of them withheld food, fluids and breast milk from their children during diarrheal episodes, which is contrary to the accepted guidelines for the management of diarrhea," said Mediratta, a Johns Hopkins junior who graduated from Portage Central High School and Kalamazoo Area Math and Science Center in 2004. "Mothers may have the misconception that providing fluids to their children can exacerbate the condition. However, rehydrating children is the most effective treatment for children with diarrhea and should be the first treatment administered."
Mediratta's research, focusing on how best to educate Ethiopian mothers so that they can prevent — and manage — diarrheal diseases in their children, was funded by a Johns Hopkins Provost's Undergraduate Research Award. One of 45 PURA winners this academic year, Mediratta, a junior, will present the results of his research at an awards ceremony at Johns Hopkins on March 8.
Since 1993, about 40 students a year have received PURA grants of up to $3,000 to conduct original research. Some have published their results in professional journals. The awards, funded through donations from the Hodson Trust, are an important part of the university's commitment to undergraduate research.
A public health studies major, Mediratta witnessed the terrible toll that diarrheal diseases take among the East African country's children while volunteering at a mission in Addis Ababa and at clinics in the small rural town of Gondar during his sophomore year January intersession.
"I was extremely shocked at the severity of the conditions of the children I saw there," he said. "It was not uncommon to find them experiencing diarrhea for two weeks continuously. They came to the clinic with sunken eyes, poor skin turgor and poor thirst, all signs of severe dehydration. They were malnourished, were not receiving adequate fluids, and their mothers were not taking the steps to prevent diarrhea in their children. I wanted to do something about this problem."
Mediratta decided that the best way to ascertain how a successful public health initiative might be launched against diarrhea in Ethiopia was to study how Ethiopian mothers handled the disease, and then compare their habits and methods to those of moms in Bangladesh, home of the International Center for Diarrheal Disease Research.
"I chose Bangladesh because the International Center is the 'gold standard' for treatment of diarrheal diseases in developing countries, so it can be considered a model for how diarrhea might best be managed in Ethiopia, too," Mediratta said.
Mediratta decided that the clinic in Gondar — a small, rural town in northwestern Ethiopia — was the ideal setting for his study, because "my research would have greater value in an area where diarrhea is a major community health problem." The town has become a temporary home to about 10,000 displaced Ethiopians.
With approval from the university committee that oversees research on human subjects, he carefully designed a survey that assessed risk factors known to contribute to diarrheal disease in children, including socio-economic level, child nutrition, maternal hand-washing hygiene and latrine and water use. The goal, he said, was to "identify those determinants that could be modified by mothers to reduce morbidity associated with diarrhea."
Mediratta then trained 13 health facilitators at a local clinic to administer the survey to mothers who sought care there. Several other members of the community were selected to question approximately 500 mother-child pairs.
Mediratta hopes that his study's results will help public health workers to develop a curriculum to help Ethiopian mothers understand the risks associated with diarrhea and the very simple measures they can take to prevent and manage the illness in their children.
"In a country where there is, on average, one physician per 40,000 people, it is unlikely that everyone in Ethiopia will have access to health centers," he said. "Equipping mothers with the knowledge and skills to manage diarrheal disease is a critical means through which to mitigate the potential harmful effects of diarrhea."
Mediratta's faculty mentor, R. Bradley Sack, professor of international health and medicine at the Johns Hopkins Bloomberg School of Public Health, credits his student with designing an "important" study that could have meaningful repercussions for Ethiopian child health.
"Rishi has done a remarkable job in designing and carrying out a study determining risk factors for Ethiopian children, all in a few months time," Sack said. "The data will be important in suggesting interventions for the prevention of childhood diarrhea in this population."
Mediratta hopes to continue his involvement in that cause.
"I am strongly committed to this research because diarrheal disease can be cured," he said. "Eradicating one of the most nefarious and preventable public health crises — one that afflicts 2 million children every year worldwide — is within our reach."
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