Nodding Syndrome: Clinical Characteristics, Risks Factors, Access to Treatment, and Perceptions in the Greater Mundri Area, South Sudan

Abstract

We conducted a house-to-house survey in the Mundri, Western Equatoria state of South Sudan to investigate the clinical characteristics, risk factors, access to treatment and perceptions about nodding syndrome (NS). In total, 224 NS cases with median age of seizure onset of 10 years were identified. Head nodding only was reported in 50 (22.3%) cases, and head nodding plus other types of seizures in 174 (77.7%) cases. Wasting, stunted growth, delayed sexual development and speech and behavioral abnormalities were observed in 17 (23.6%), 16 (22.2%), 9 (17.3%), 14 (19.4%) and 4 (5.6%) cases, respectively. The consumption of rat meat, but not other bushmeat was associated with an increased risk of NS (OR 9.31, 95% CI 1.27–406.51). Children with NS were more likely to have taken ivermectin in the last 5 years (OR 2.40, 95% CI 1.33–4.43). NS cases were less likely to share a bedroom with other children (OR 0.06, 95% CI 0.02–0.16) or adults (OR 0.27, 95% CI 0.13–0.56). In conclusion, rat meat consumption is an unlikely risk factor for NS, and ivermectin intake was more common among NS cases than controls. Importantly, we documented that children with NS are stigmatized because of the misconception that NS is transmitted through direct contact.

Effect of Onchocerciasis Elimination Measures on the Incidence of Epilepsy in Maridi, South Sudan: A Three-Year Prospective Study

“…Living close to rivers was observed as a risk factor for epilepsy in all onchocerciasis meso-and hyper-endemic areas where this was investigated, e.g. in Mundri [7,37] and Mvolo [8] in South Sudan, and in the Mbam and Sanaga river valleys in Cameroon [38,39].…”

Effect of onchocerciasis elimination measures on the incidence of epilepsy in Maridi, South Sudan: a three-year prospective study

“…Not taking ivermectin was found to be a risk factor for epilepsy in Maridi but not in other onchocerciasis endemic areas. [7,8,37] Even a higher proportion of ivermectin intake has been reported among persons with epilepsy in Mundri in South Sudan [37,40]. The latter may be because persons with epilepsy may be more likely not to be away from home for farming during ivermectin distribution.…”

“…Living close to rivers was observed as a risk factor for epilepsy in all onchocerciasis meso-and hyper-endemic areas where this was investigated, e.g. in Mundri [7,37] and Mvolo [8] in South Sudan, and in the Mbam and Sanaga river valleys in Cameroon [38,39].…”