Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jun;13(2):183-204.
doi: 10.4314/ahs.v13i2.2.

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

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

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

P S Spencer et al. Afr Health Sci. 2013 Jun.

Abstract

Background: Nodding Syndrome is a seizure disorder of children in Mundri County, Western Equatoria, South Sudan. The disorder is reported to be spreading in South Sudan and northern Uganda.

Objective: To describe environmental, nutritional, infectious, and other factors that existed before and during the de novo 1991 appearance and subsequent increase in cases through 2001.

Methods: Household surveys, informant interviews, and case-control studies conducted in Lui town and Amadi village in 2001-2002 were supplemented in 2012 by informant interviews in Lui and Juba, South Sudan.

Results: Nodding Syndrome was associated with Onchocerca volvulus and Mansonella perstans infections, with food use of a variety of sorghum (serena) introduced as part of an emergency relief program, and was inversely associated with a history of measles infection. There was no evidence to suggest exposure to a manmade neurotoxic pollutant or chemical agent, other than chemically dressed seed intended for planting but used for food. Food use of cyanogenic plants was documented, and exposure to fungal contaminants could not be excluded.

Conclusion: Nodding Syndrome in South Sudan has an unknown etiology. Further research is recommended on the association of Nodding Syndrome with onchocerciasis/mansonelliasis and neurotoxins in plant materials used for food.

Keywords: Dinka; Epilepsy; Moru; filariasis; neurotoxins; sorghum.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Southern Sudan Map circa 1991 Children with head nodding in Mundri (many) and Maridi (few) counties in Western Equatoria were reported to the WHO team in 2002. Reproduced without modification from United Nations Operation Lifeline Southern Sector. 1992 Emergency Needs Assessment and Appeal. Southern Sudan, Nairobi, December 1991.
Figure 2
Figure 2
Mundri County map showing Liu in Morokodo district and Amadi in Meza district Note that Amadi is indicated as coincident with the course of the Yei River. Reproduced from Sudan Notes and Records 1937; 20:182. www.sudanarchive.net. http://sudanarchive.net/cgi-bin/pagessoa?e=01off—vand-TXamadi—100125-%5bamadi%5d%3aTX+-1-0-SectionLevel-0-0-1amadi-1&a=d&cl=&d=SNRVol20.1.182&dl=SNRVol20.1.182
Figure 3
Figure 3
1991 Vulnerability indices for southern Sudan
Figure 4
Figure 4
1991/92 Situation Assessment map of most affected areas in southern Sudan Note that Mundri and Maridi counties are shown to be free of severe conflict, floods, epidemics and food shortages. Reproduced without modification from United Nations Operation Lifeline Southern Sector. 1992 Emergency Needs Assessment and Appeal. Southern Sudan, Nairobi, December 1991.
See this image and copyright information in PMC

References

    1. Aall L. Epilepsy in Tanganyika. Review and Newsletter. Transcultural Research in Mental Health Problems. 1962;13:54–57.
    1. Aall-Jilek LM. Epilepsy in the Wapogoro Tribe in Tanganyika. Acta Psychiat Scand. 1965;41:57–86.
    1. Winkler AS, Friedrich K, Konig R, Meindi M, Helbok R, Unterberger I, et al. The head nodding syndrome—clinical classification and possible causes. Epilepsia. 2008;49:2008–2015. - PubMed
    1. Winkler AS, Friedrich K, Meindi M, Kidunda A, Nassri A, Jilek-Aall, et al. Clinical characteristicsof people with head nodding in southern Tanzania. Trop Doct. 2010;40:173–175. - PubMed
    1. Nyungura JL, Akim T, Lako A, Gordon A, Lejeng L, William G. Investigation into the Nodding syndrome in Witto Payam, Western Equatoria, 2010. Southern Sudan Med J. 2011;4:3–6.

Publication types