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. 2012 Sep;12(3):242-8.
doi: 10.4314/ahs.v12i3.1.

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

J K Tumwine  1 , K Vandemaele, S Chungong, M Richer, M Anker, Y Ayana, M L Opoka, D N Klaucke, A Quarello, P S Spencer
Affiliations

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

J K Tumwine et al. Afr Health Sci. 2012 Sep.

Abstract

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

Objective: To describe clinical and epidemiological features of nodding syndrome in southern Sudan based on preliminary investigations conducted in 2001 and 2002.

Method: Household surveys, clinical, electrophysiological (EEG) assessments, informant interviews and case-control studies were conducted in the town of Lui and the village of Amadi in southern Sudan.

Results: Nodding syndrome is characterized by involuntary repetitive nodding of the head, progressing to generalized seizures; mental and physical deterioration. The EEGs were consistent with progressive epileptic encephalopathy. Prevalence of Nodding syndrome in Lui and Amadi was 2.3% and 6.7% respectively. All case control studies showed a positive association between cases and Onchocerca volvulus. A history of measles was negatively associated with being a case: 2/13 of cases and 11/19 of controls had had measles: odds ratio 0.13 (95% CI 0.02, 0.76). Environmental assessment did not reveal any naturally occurring or manmade neurotoxic factors to explain Nodding Syndrome, although fungal contamination of food could not be ruled out.

Conclusion: Nodding Syndrome was strongly associated with Onchocerca volvulus. There was no evidence to suggest an environmental pollutant, chemical agent, or other toxic factor.

Keywords: South Sudan; clinical; epidemiology; nodding; syndrome.

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Figures

Figure 1
Figure 1
Age distribution of cases examined (n=139) with ever had nodding (n=134)
Figure 2
Figure 2
The smaller patient has Nodding syndrome and is the same age as the taller adolescent who is of the same age, but does not have nodding syndrome. (Photograph by courtesy of Stella Chungong)
Figure 3a
Figure 3a
Distribution on Nodding syndrome patients by clinical finding, Lui, Mundri county, south Sudan
Figure 3b
Figure 3b
More symptoms of children with Nodding syndrome, Lui, Mundri county, south Sudan
See this image and copyright information in PMC

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