Could Nodding Syndrome (NS) in Northern Uganda be an environmentally induced alteration of ancestral microbiota?

Abstract

Hippocrates stated in 460-C.370 BC that, “All diseases begin in the Gut.” This statement may be beginning to have meanings in the advent of new diseases such as Nodding Syndrome (NS) and Autism Spectrum Disorder (ASD). Interestingly, a recent publication from China in the journal of microbiology in 2017 suggests that high grain diet had dynamically shifted the composition of mucosa-associated microbiota and induced mucosal Injuries in the colon of Sheep. NS is a devastating childhood neurological disorder characterized by atonic seizure, cognitive impairment, head nodding, wasting and stunted growth. In addition, NS in Northern Uganda is clustered in time (those who were in IDPs), in space (discretely observed on either sides of the two rivers of Aswa and Pager) and in person (onset mainly between the ages of 5-15 years) and therefore exhibits spatial temporality. The first case of NS was noticed in Kitgum district in 1997, one year after the reported displacement of that community into IDP. Prior to that internal displacement, there were no reported cases of NS. The same scenario occurred in the IDPs of Odek, Gulu district where the population was displaced into IDPs in 2001 and approximately a year later in 2002, cases of NS began to appear. In the IDPs, children that eventually developed NS fed nearly exclusively on food ration provided by relief agencies and roughly a year later, cases of NS began to appear. In the other East African countries, there were no reported cases of NS prior to internal displacement and dependence on food ration. The observed common factors in the three East African regions where NS occurs at endemic proportion are perhaps: Internal displacement and feeding on relief food. These researchers suggest that NS may have perhaps resulted from dietary and environmental factors during IDPs which may have been foreign to their GIT and links this observation to the concept of microbiota-gut-brain axis.

Nodding Syndrome and Autism Spectrum Disorder

“…This was similarly observed in Awere in Gulu where the 2001-2002 influxes were followed with increased incidences of NS, 7 years later in 2008-2009 [3]. The peaks of reported NS onset correlated with peaks of household displacement and food insecurity, where residents were heavily dependent on food aid from relief agencies [2,3,29,[31][32][33][34]. The IDP camps were exceptionally poor, insecure, unsanitary, with overcrowding, violence, food insecurity and squalid, and morbidity and mortality rates were high [2,35].…”

“…In the period before displacement into IDPs, there were no reported cases of NS [2]. Similarly in 2001, another community of Aromowanglobo in Awere sub county, Gulu District were moved into IDPs where many of them became dependent on food rations supplied by the relief agencies [3,33]. IDP camps became associated with malnutrition, social norm breakdown, rising incidence of alcoholism, mental health disorders, suicidal tendencies, increasing prevalence of HIV, Cholera, Hepatitis B & E and other infectious diseases, neglect and waste of the youths [2][3][4]29].…”

“…Nodding syndrome were seen only in children who were born normal, lived in the IDP camps, were from poor families, all ate food ration from relief agencies foreign to their GIT and that all the children who developed NS were IDP resident at some stage in their lives [2][3][4][5]. The relief agencies distributed various forms of cereals (Plumpy nuts, Beans, soya, red sorghum, yellow posho, and maize) and cooking oil which were perhaps foreign to their GI microbiome of the affected communities and the communities ate them, they provided cooking oil whose constituents were foreign to the population and they consumed them [2,3,33,34]. In addition, NS children have been found to have deficiency of Vitamin B6, Vitamin D, Acetyl carnitine and biotinidase [5].…”