Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, southern Sudan

Abstract

Background: Nodding syndrome (repetitive nodding and progressive generalized seizures) is assuming epidemic proportions in South Sudan, Tanzania and Uganda.

Nodding syndrome in Mundri county, South Sudan: Environmental, nutritional and infectious factors

“…7 To detect and measure infection with O. volvulus, respectively, skin snips were taken by Lui Hospital staff from the iliac crest of cases and controls and read by multiple observers who scored microfilarial loads semi-quantitatively (trace, 1+, 2+, 3+).…”

“…Body temperature may be elevated, but there is an attenuated blood flow to the extremities, of note because some children with Nodding Syndrome tend to have arms and legs that feel cold on examination. 7 Affected animals develop tremors, stiff gait, loss of control of direction of movement, and convulsions. Cessation of exposure early in the disease may lead to recovery, but prolonged exposure induces permanent neurological damage.…”

“…16 While Nodding Syndrome is thus not a new seizure disorder, outbreaks have been reported de novo in populations such as those in Mundri County, South Sudan, the subject of this paper and its companion clinical study 7 . Common factors in communities with Nodding Syndrome in South Sudan, Tanzania and Uganda include: a marginalized, impoverished and poorly nourished population previously subjected to internal displacement, periodic food shortages, endemic onchocerciasis, and absence or interruption of insect vector control, vaccine administration, and drug prophylaxis/treatment.…”

“…Nodding Syndrome is a progressive generalized seizure disorder of children that has been described exclusively in African countries, with particular reference to Tanzania, 1-4 South Sudan [5][6][7] and, most recently, northern Uganda. 8 The signature sign, repetitive dropping of the head resulting from an atonic seizure events, has also been described in Liberia.…”

“…17 The reader is referred to the companion paper 7 for a description of the clinical and electrophysiological characteristics of Nodding Syndrome in Lui and Amadi, and the design and analysis of the case-control studies. This paper reports the multi-factorial exposures associated with Nodding Syndrome and examines how they may relate to etiology, with the goal of identifying those that merit detailed research study.…”