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

• Published in: African health sciences Vol. 13; no. 2; pp. 183 - 204
• Main Authors: Spencer, P S, Vandemaele, K, Richer, M, Palmer, V S, Chungong, S, Anker, M, Ayana, Y, Opoka, M L, Klaucke, B N, Quarello, A, Tumwine, J K
• Format: Journal Article
• Language: English
• Published: Uganda Makerere University Medical School 01-06-2013; Makerere Medical School
• Subjects: Animals; Children & youth; Communicable Diseases; Confidence Intervals; Dinka; Environmental Exposure; Epilepsy; filariasis; Food Contamination; Health and Medicine; Health Surveys; Humans; Infection rates; Medical disorders; Moru; neurotoxins; Nodding syndrome; Nodding Syndrome - epidemiology; Nodding Syndrome - etiology; Nutrition; Odds Ratio; Original; Qualitative Research; Sorghum; Sudan - epidemiology; Toxins; Zoonoses; Sudan; South Sudan; Dinka; Moru; neurotoxins; sorghum; Epilepsy; filariasis
• ISSN: 1680-6905; 1729-0503; 1680-6905
• DOI: 10.4314/ahs.v13i2.2

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.