Clinical, neurological, and electrophysiological features of nodding syndrome in Kitgum, Uganda: an observational case series.
An epidemiologic investigation of potential risk factors for nodding syndrome in Kitgum District, Uganda.
Clinical and epidemiologic characteristics of nodding syndrome in Mundri County, southern Sudan.
International Scientific Meeting on Nodding Syndrome, Kampala, Uganda, 30 July-1 August 2012: meeting report.
On the basis of reports for Uganda and probably for South Sudan, the incidence of nodding syndrome appears to be increasing (Figure 2).
Although onchocerciasis is endemic to all 3 areas, the distribution of this parasitic disease is much wider, extending to across much of eastern and western Africa (19,20) and Central and South America (21), which are huge areas with populations apparently unaffected by nodding syndrome (Figure 3).
Most of the populations affected by nodding syndrome were internally displaced; in Uganda and Sudan, the conflict with the Lord's Resistance Army during the 1990s resulted in dependence on refugee camps and in widespread food shortages during the years preceding nodding syndrome.
The distinctive age distribution (tight clustering among persons 5-15 years of age) is a consistent feature of nodding syndrome (Figure 4).
In-depth analysis of these clinical features and comparison with other nodding syndrome reports is under way.
Persons with suspected cases of nodding syndrome were then brought to the study site by caregivers, along with potential neighbor controls, and after screening by investigators, the first 38 pairs that fulfilled the case definition were enrolled in the study.
In preliminary analyses, no association with nodding syndrome was found with other risk factors, including exposure to munitions, parents' occupations and demographic characteristics.
Although the cause of nodding syndrome remains unknown, based on these preliminary findings, reinforcing mass ivermectin treatment for onchocerciasis and conducting seizure management using antiepileptic medications were recommended by CDC to the South Sudan Ministry of Health.