UGANDA/SOUTH SUDAN: Nodding Syndrome - Hundreds of children infected

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Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Commentary

Nodding Disease: What do the Acholi and New Yorkers share?

By Vivian E. Asedri
Posted Tuesday, February 7 2012 at 00:00

The anguish, misery, frustration and hopelessness that has gripped the Acholi community in Pader, Kitgum and Lamwo and Ugandans of goodwill over the mysterious ‘nodding disease’ afflicting over 4,000 children and killed at least 200 according to local media reports, is now being shared thousands of miles away by people of New York in United States.
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Unlike in Uganda where the government and Ministry of Health officials have been virtually impotent to identify or at least medically control the suffering of the victims, officials here have jumped into action.
...
Researchers from Dent Neurological Institute of Buffalo, New York, who had suspected the children might be suffering from Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) tested all the children for PANS and ruled it out. One of the Dent specialists, Dr Rosario Trifiletti, told the NBC News that walking pneumonia might cause the symptoms.

However, a huge cloud now hangs over the environmental and poisonous chemical intake factor as cause of the disease outbreak. A renowned environmental campaigner and lawyer, Ms. Erin Brockovich, has argued that a train derailment near Le Roy High School in the 1970s that spilled huge amounts of poisonous chemicals could be the cause of the children’s suffering.
...
As the US researchers continue with their frantic effort to get to the bottom of the ‘nodding disease’ mystery, including possibility of bacterial or virus infections to the brain, if the poisonous chemical spill and eventual intake by the children has any validity, it may raise some soul-searching questions to the health officials in Uganda.

For instance, since the Acholi sub-region is emerging out of nearly 20 years of Lords Resistance Army (LRA) armed insurgency, could some of the weapons used over the years be a factor to cause the ‘nodding disease’?
...
The question I have for President Museveni and his Cabinet is: how many more of our children must die before the Acholi sub-region is declared a disaster area warranting emergency release of funds to ameliorate the devastating effects of this mysterious illness to the local community? And, why haven’t the Members of Parliament collected signatures to convene an emergency session to address this outbreak? If we cannot fight for the healthcare and welfare of our children, what justifies our national priorities?

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Mr Asedri is a medical information technologist, San Diego, California, USA.

Full text:
http://www.monitor.co.ug/OpEd/Commentary/-/689364/1321424/-/1292e61z/-/

 

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Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://www.promedmail.org/eafr

Published Date: 2012-02-11 15:02:37
Subject: PRO/EAFR> Nodding disease - Uganda: (Pader, Kitgum, & Lamwo)
Archive Number: 20120211.242990

NODDING DISEASE - UGANDA: (PADER, KITGUM,& LAMWO)
**********************************************


A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 10 Feb 2012Source: The Monitor [edited]http://www.monitor.co.ug/News/National/-/688334/1323756/-/b0tehwz/-/index.html


Govt announces Shs7b plan to fight nodding disease
----------------------------------------------------
The government has finalised a Shs7 billion plan to fight nodding
disease, an illness mostly affecting children in Acholi sub-region.
Addressing Parliament yesterday [9th February 2012], the State
Minister for Health, Dr Richard Nduhura, said the Shs7 billion plan
has already been shared with development partners and members of the
Acholi Parliamentary Group.

"The initial funding of Shs100 million to initiate the response has
been obtained from reallocations within the Ministry of Health budget
and other funds will be mobilised from other government and partner
agencies", Dr Nduhura said. For more than six months now, the disease
has tormented children in Acholi sub-region, killing scores of them.
About 1,500 children in Acholi sub-region are reported to have dropped
out of school as a result of the disease.

Dr Nduhura said the disease has so far killed, 170 people out of the
3,094 cases officially recorded. The ministry will this month set up
centres for screening and treating cases. Padibe Health Centre IV has
been designated for Lamwo District, Kitgum Hospital for Kitgum
District and Pajule Health Centre IV for Pader District.

Dr Nduhura said outreach services will be offered on a weekly basis to
the affected communities by staff from the designated treatment centres.

[Byline: Isaac Imaka]

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[The government of Uganda has rolled out a plan for offering
supportive care to the children affected by nodding disease as
investigations into the aetiology and cure for this emerging epileptic
syndrome are currently inconclusive.

 

[Emily]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://allafrica.com/stories/201202130012.html

Uganda: Nodding Mystery - Do More Research
13 February 2012

editorial
[snip]
The centres for screening and treatment that the ministry will set up alongside outreach services to the affected communities are crucial. It is important, however, to also carry out more research and engage scientists to study similar cases reported in Le Roy, New York, and compare them with the ones in Uganda to determine if there is any connection. It is also vital to find out how those cases are being managed and what we could learn from them.

 

[Emily]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960126-3/fulltext

The Lancet, Volume 379, Issue 9813, Page 299, 28 January 2012
<Previous Article|Next Article>
doi:10.1016/S0140-6736(12)60126-3Cite or Link Using DOI
CDC planning trial for mysterious nodding syndrome
John Donnelly
While the cause of nodding syndrome in Africa continues to perplex scientists, they are hoping to soon unravel one mystery: which treatments the disease might respond to. John Donnelly reports.
[snip]
Fred Hartman, Management Sciences for Health's Country Lead for South Sudan and supervisor for the USAID-funded Sudan Health Transformation Project II, has worked for 30 years in Africa, but when he first saw children with nodding syndrome in 2010 he was shocked. ?I've been all over the world, and I've never seen anything like it?, he said. ?All the children look like they have cerebral palsy. So many of the kids are malnourished. You bring them food and they can't eat it. And by the time you make the diagnosis, it's too late for the children. It's really sad.?
Dowell called the CDC's upcoming investigation important. ?We are in the business of detecting outbreaks. For the most part, when we investigate an outbreak, the cause becomes clear, but periodically we get these ones where the cause isn't clear?, he said. Asked where nodding syndrome stood on the list of mystery outbreaks, Dowell said: ?It's right there at the top of the list.?

 

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Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://outcomemag.com/health/2012/02/18/nodding-disease-confounds-experts-kills-children/

?Nodding disease? confounds experts, kills children
February 18, 2012 | Filed under: Health | Posted by: OM Team 02/19/2012 Patrick Anywar, 14, lies curled up naked in the dust and midday heat of a Ugandan village, struggling to look up at his younger brother and sister playing in front of the family home.
After a minute?s effort to face his siblings, Anywar?s head slumps onto his chest and his emaciated body is gripped by convulsions.

Anywar is one of more than 3,000 children in northern Uganda who are suffering from a debilitating mystery ailment known as nodding disease, which has touched almost every family in the village of Tumangu.

For several years, scientists have tried and failed to determine the cause of the illness, which locals say has killed hundreds of youngsters.

What they do know is that the disease affects only children and gradually devastates its victims through debilitating seizures, stunted growth, wasted limbs, mental disabilities and sometimes starvation.

[snip]

 

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Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

It is probably a reference to Uganda not Angola.

http://www.promedmail.org/fr

Published Date: 2012-02-25 7:36:45
Subject: PRO / EDR> mysterious disease - Angola, (ICR)
Archive Number: 20120225.244143

MYSTERIOUS ILLNESS - ANGOLA,
(ADDITIONAL INFORMATION REQUIRED)
************************************************** ********************

A ProMED-mail
http://www.promedmail.org
ProMED-mail is a program of
International Society for Infectious Diseases
http://www.isid.org

Date: Tues, Feb. 21 2012Source: The Rise, National Daily [edited] http://www.essor.ml/international/article/ouganda-mysterieuse-maladie-du


Mysterious "disease of the head nodding ..."
In this country, it kills especially children
---------------------------------------
Nobody knows why a young boy of 14
years lies curled up, naked in the dust and
under the midday sun, in northern
Uganda, struggling to raise their heads and
see his brother and s? heart cadets
playing outside the family home. After
few minutes of effort, his head falls on his
chest and her emaciated body is seized of
convulsions. This child is one of 3000 children
northern Uganda suffering from a sore
mysterious, known as the "disease
nod "or" trembling disease "
("Nodding disease"). Scientists
study it for several years are lost in
conjectures about the origin of this disease which has
already killed at least 200 children in the region. The
little they know is that it only affects
Children. It results in crises
convulsion that prevent them from feeding,
causing stunting, members
diminished, mental disabilities, until
Sometimes they starve.
The disease has already taken a son, the mother of
young boy who said he could do nothing
other than helplessly to the ravages of
it on its other son. "Before, he walked
and run like other children, but
Now, someone has to watch over him
permanently, "she says." The disease is
terrible, it prevents him from eating and drinking
alone. "On a trail in an open field
sorghum, a volunteer paramedic of 54
years, says that the disease has ravaged her
Tumangu village in Kitgum District, to
about 450 km north of Kampala. "In the
village live 780 people and we have 97
case. Almost all families were
affected, "he says. An incurable disease.
When the local clinic, several
km, receives one of its episodic
deliveries of medicines, the medic
volunteer gets on his bike to get
purchase. But these treatments are only
second best. "We give drugs against
epilepsy, such as carbamazepine, but this
disease is different from epilepsy, "
says he. Faced with this incurable disease, the
population has increased from fear to fatalism,
he said: "We're starting to say that patients who
died were cured, because eventually, they
no longer suffer from this painful disease. "

Since 2010, scientists from all
disciplines - epidemiologists, biologists,
neurologists, toxicologists, psychiatrists - led
all kinds of tests to try to discover
the origins of the disease. Several assumptions
were studied: a parasite such as
causing onchocerciasis (blindness or
rivers) for possible side effects of
civil war in northern Uganda, where there
the very brutal rebellion Force
Lord's Resistance Army (LRA). "We looked
all this, but unfortunately we could not
identify any real factor or
risk (...) research of the pathogen
continue, "says Miriam Nanyunja, service
prevention and control of diseases
the World Health Organization (WHO) to
Kampala. The same results have often led
more questions than answers. The
Scientists do not know if the disease is
linked to similar outbreaks in Southern Sudan
and Tanzania, trying to understand if
continues to expand and began to decline,
and why it is limited to some
communities. In late January, under pressure from
Ugandan MPs, the Ministry of Health has
a plan for emergency response
attempt to identify and delimit the
illness. Ms. Nanyunja, WHO estimates that
Until the discovery of the origin of
affection and a possible treatment,
Physicians should focus on trying to
relief to patients. "There are many
diseases that we continue to treat
symptoms without knowing the exact cause, "
she says.

-
Communicated by:
ProMED-
<promed-fra@promedmail.org>

[Any information that can inform public opinion
national and international welcome.

The interactive map of HealthMap / ProMED-mail
Uganda is available at:
http://healthmap.org/r/00_B.- Mod.BM]

 

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Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://www.promedmail.org/eafr

Published Date: 2012-02-27 13:48:40
Subject: PRO/EAFR> Nodding disease - Uganda (02): (Northern) Ministry of Health
Archive Number: 20120227.244406

NODDING DISEASE - UGANDA (02): (NORTHERN) MINISTRY OF HEALTH
************************************************************


A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Wed 8 Feb 2012Source: Ministry of Health, Republic of Uganda [edited]http://www.health.go.ug/docs/STATEMENT.pdf


Statement by the Hon Minister of Health to Parliament on nodding
disease in Northern Uganda
----------------------------------------------------------------------
Introduction
------------
In August 2009, the Ministry of Health received reports of a
progressive disease characterized by nodding of the head, mental
retardation, and stunted growth mainly affecting children 5-15 years.
The Ministry of Health together with the WHO, CDC, and other partners
thereafter initiated investigations to determine the cause of the
illness.

The investigations revealed that the disease was a new type of
epilepsy that has affected at least 3000 children in the districts of
Kitgum, Lamwo, and Pader in Northern Uganda. In addition, most of the
affected children are malnourished, live in areas where
onchocerciasis (river blindness) is prevalent, and have dropped out
of school. It is also important to note that this crippling disease
has aroused a huge public outcry justifying the need for urgent
response.

Background
----------
The disease presentation suggests that this is possibly a new type of
epilepsy that is manifested by head nodding episodes that consist of
repetitive dropping forward of the head. The nodding is sometimes
precipitated by food or cold weather and is often accompanied by
other seizure-like activity such as convulsions or staring spells.
During the episodes, the child stops feeding and appears non
responsive, with or without loss of consciousness. There is
deterioration of brain function in some of the victims and
malnutrition with growth retardation in the majority of cases. It
seems to primarily affect children between the ages of 5 and 15
years. The disease was first described in Tanzania in 1962, later in
Liberia (1983), and Southern Sudan (2003). It is important to note
that no definite cause and cure have been found in all these
countries.

Current situation of nodding disease in the country
---------------------------------------------------
Currently documented cases total to 3094 out of which 170 have died.
The distribution by district is as follows:
District / No. of Cases / No. of Deaths / Affected Sub-counties
Pader / 1488 / 66 / Awere, Puranga, Angagura, Atanga, and Pajule
Kitgum / 1278 / 98 / Akwang, Kitgum Matidi, Labong Amida, and Namokora
Lamwo / 328 / 6 / Palabek Gem, Padibe East, Padibe West, Palabek Kal,
and Palabek Ogil, and Lokum

The most affected sub-counties are Awere, Puranga, Angagura, Atanga,
and Pajule, in Pader district; Palabek Gem, Padibe East, Padibe West,
Palabek Kal, and Palabek Ogil, and Lokum in Lamwo district; and
Akwang, Kitgum Matidi, Labong Amida, and Namokora in Kitgum district.

Currently the disease is affecting children aged 5 to 15 years with
54 percent of the affected children being males. All the affected
sub-counties are traversed by the fast flowing rivers of Pager and
Aswa, which favor the breeding of river blindness vectors. Similar
observations have been made in the other countries like Tanzania,
Liberia, and Sudan where cases have been identified.

Response by the Ministry of Health
----------------------------------
Investigations
--------------
The Ministry of Health together with WHO, CDC, and Partners conducted
epidemiological investigations in 2009 and continue with
investigations in the affected districts.

Investigations have been able to exclude a number of possible
infectious, toxic, and nutritional factors, but the cause of the
illness remains unclear. The association between onchocerciasis and
nodding syndrome is weak and requires further investigations.

Other findings include: a modest deficiency of vitamin B6 in most of
the cases and deficiencies in other micronutrients (vitamin A,
selenium, and zinc). However these findings still warrant further
investigations.

The investigations to date reveal that patients with nodding disease
cannot pass it on to others. The investigations have also revealed
that patients can effectively be treated with the anti-epileptic
drugs that are currently available in the country and they can live a
normal life provided the treatment is taken as prescribed by the
doctor. The investigations will eventually lead to the
characterization of the disease, its distribution in the population
and possible cause(s).

Measures
--------
Following the investigations, the following measures have been instituted:
1. Quantification of the required medicines was finalized and
submitted to the National Medical Stores. The medicines
(carbamazepine, phenytoin, and sodium valproate) have been delivered
to the affected districts of Kitgum, Pader, and Lamwo.

2. The nodding disease response plan costing [UGX] 7 billion [USD 3
million] has been finalized and shared with Partners including the
representatives of the Acholi Parliamentary Group. The initial
funding of [UGX] 100 million [USD 42 000] to initiate the response
has been obtained from reallocations within the Ministry of Health
budget. However, additional funds need to be mobilized from other
Government and partner agencies.

3. Centers for screening and treating cases will be opened effective
this month (February 2012) and staffed with psychiatric clinical
officers and psychiatric nurses in each of the affected districts. In
the affected districts, Padibe HCIV [Health Centre 4, a small
community hospital] has been designated for Lamwo district, Kitgum
hospital for Kitgum district, and Pajule HCIV for Pader district.

4. Outreach services will be offered on a weekly basis to the
affected communities and the lower health facilities by staff from
the designated treatment centers.

5. Lira and Gulu Regional Referral Hospitals will receive and treat
severely ill cases that cannot be managed in the screening and
treatment centers.

6. Cases that require highly specialized treatment will be referred
to the National Referral Hospitals (Mulago and Butabika) by the
Regional Referral Hospitals.

7. Psychiatry experts from Mulago hospital, Butabika National
Referral Hospital, and from the regional referral hospitals of Gulu
and Lira have been identified to train and supervise the screening
teams at the designated centres. This will facilitate screening and
treatment of cases.

8. Treatment guidelines have been developed to help guide the
clinicians on the ground. This will be rolled out to all the
treatment centers.

9. Talking points for district leaders and local politicians have
also been developed and will be availed to the affected districts for
the leaders to use for sensitization and mobilization purposes.

10. The Ministry of Health has requested the Office of the Prime
Minister to supply food to the designated screening and treatment
sites for the affected families.

11. Request for a supplementary budget to handle phase 1 of the
response plan (Emergency Phase) amounting to UGX 3.875 billion [USD
1.7 million] has been submitted to Ministry of Finance Planning and
Economic Development.

Challenges
----------
1. Despite the investigations conducted over the past years, the
cause and cure for the disease remain unknown.

2. The initial supplementary budget request that was presented to the
Ministry of Finance Planning and Economic Development (MoFPED) last
financial year was unsuccessful. The MoH made re-allocations from the
approved sector budget but the funds mobilized were inadequate to
support a comprehensive response.

3. Since the disease has no definite cure, parents of affected
children have been hesitant to bring their children to the health
facilities for ongoing supportive treatment.

4. There is a misconception that nodding disease is linked to
"witchcraft" and this has resulted in poor health seeking behaviors.

Way forward
-----------
1. A multisectoral nodding disease response plan has been prepared.
The overall national and district response is being coordinated by
the National and District Taskforce and district disaster management
committees with priority activities being implemented in 2 phases as
highlighted below.

2. The initial intensive and emergency phases starting from January
to December 2012 will prioritize resource mobilization, establishment
of screening, and treatment centers and mobile clinics in affected
districts to screen and offer comprehensive treatment including
anti-epileptics, nutritional rehabilitation, psycho-social
counseling, physiotherapy, and bi-annual mass treatment for river
blindness with ivermectin.

3. The subsequent post-emergency phase starting from January 2013
will prioritize consolidation and institutionalization of phase 1
activities, in addition to addressing the special education needs of
affected children, initiating livelihood projects for affected
families, intensification of river blindness control to include mass
treatment and vector control measures, and conducting research to
identify the cause and cure for the disease.

4. The funds for initiating the interventions above are in the
process of being mobilized from government and partner agencies.

5. There is need for the Ministries of Water, Education, and Sports
and Gender, Labour, and Social Development to support districts to
deal with water requirements, educational, and social consequences.

Appeal
------
1. The Ministry of Health therefore appeals to Parliament to support
the supplementary budget request to implement the response plan.

2. The Ministry of Health calls upon all political, civic, cultural,
and religious leaders to sensitize and mobilize the public on the
need to control nodding disease.

3. I also appeal to:
- Parents/guardians to take affected children to the nearest health
facilities at the earliest opportunity.
- Communities in the affected districts to attend the bi-annual mass
treatment for river blindness.
- Families to provide adequate care to the affected children.
- Local leaders to mobilize communities to cooperate with the ongoing
investigations and interventions to identify the cause.

Hon Dr Richard Nduhuura
Minister of State for Health (General Duties)

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[This official report from the Ugandan Ministry of Health highlights
the current status of nodding disease investigations and response in
the country.

The HealthMap/ProMED-mail interactive map of Uganda can be seen at
http://healthmap.org/r/1RZv. Pader, Lamwo, and Kitgum districts in
northern Uganda can be located on the map at
http://en.wikipedia.org/wiki/Districts_of_Uganda. - Mod.JFW]

 

[alert]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Post #26 above has been amended and now includes the text:

[In a previous article on this disease
mysterious, we mentioned Angola as
countries affected by this disease
(ProMED-confers, archive number:
20120225.244143 of 25 February 2012). this article
comes in correcting this error because it
was well in Uganda instead of Angola.
ProMED-apologizes for this error that
slipped into communication. - Mod.SC]

 

[Pathfinder]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Each child?s nodding head eats at Ocitti?s pride

By Harriet Anena
Posted Saturday, March 3 2012 at 00:00

Excerpt:

The drama that comes with meal time can only be handled by two or more adults. When food is finally served, the children stare at the dish of pigeon peas and millet bread with expressionless faces. Their hands are already washed but none makes an effort to eat except for Milly Adyero, 12. She takes the first bite, chews it with slow and restrained effort. When it comes to swallowing, she stretches her neck and makes a painful effort of taking the food down her sore throat.

That continues for about five minutes before she starts to nod. Some of her siblings had started nodding before even tasting the food, while Kabila gets his third seizure of the day.

Ocitti and Aya hold the children and feed them one after another, when the nodding subsides. ?We have to feed them, lest they become even more malnourished,? says Aya, who gets teary every time she recalls how her daughter Labol died. ?She was my eldest daughter, only 13 but the disease took her life away. She had started behaving like a mad person,? she says.

Labol would urinate on herself, would not respond when talked and as getting more frequent seizures. ?When she starts nodding and you speak to her, she does not respond, even if you pinch her, she does not show any sign of pain,? says Aya of her daughter?s last days. ?If you are not used to witnessing the seizure attacks, you can flee in fear, but we are now used?,? she adds, explaining the condition of her two sick children.

Mr Ocitti, however, says, on top of the nodding disease, Labol could have been possessed by spirits of those killed during the war by the LRA.

?Sometimes she would speak to herself and say ?wait for me, I am coming? or ?am I the one who killed you, am I?? he narrates, adding that even in her sleep, Labol would sometimes scream, saying some people want to take her away.

Mystery

The mystery surrounding the cause of the disease is not peculiar to Ocitti and his family. Families of over 3,000 children affected by nodding disease in northern Uganda are in the dark, asking themselves unanswered questions of what the disease is.

Some think it is contagious and have stopped sending their children to school or to church, while others say it could be a curse by spirits of those killed during the war.


Full text:
http://www.monitor.co.ug/SpecialReports/-/688342/1357980/-/item/1/-/w4lf1hz/-/index.html

 

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Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://www.promedmail.org/

Published Date: 2012-03-09 14:09:17
Subject: PRO/EDR> Undiagnosed cerebral disease - Uganda (03): nodding disease
Archive Number: 20120309.1065524

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (03): NODDING DISEASE
***********************************************************
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Date: Wed 7 Mar 2012
Source: Daily Monitor (Uganda) [edited]
http://www.monitor.co.ug/News/National/-/688334/1361002/-/axes6qz/-/


Experts link nodding to black flies
-----------------------------------
President Museveni [Uganda] pledged helicopters for aerial spraying of black flies believed to be a cause of the disease.

Experts have said they are getting clues that the black fly associated with river blindness could be the cause of nodding disease. Prof James Tumwine, a pediatrics and child health expert at Mulago Hospital, said 80 per cent of children studied in southern Sudan had onchocerciasis parasites in their bodies, which cause an abnormal electric flow in the brain.

He said CT scans also revealed structural damage to the brain of the victims, which in turn increases brain activity in form of epileptic seizures.

"As a child nods, you can see that the child electric brain activity is very high, consequently causing seizures and convulsions in the rest of the body parts, and we have absolutely no doubt that river blindness is connected to this condition," Prof Tumwine said during president Museveni's visit to the 24 nodding victims at Mulago Hospital yesterday [6 Mar 2012].

However, the ministry of health officials accompanying the president said the new revelation is not conclusive and that there could be other factors, or combination of factors which they will continue investigating until they get to the root of the problem.

The president, who commended Kitgum Woman MP Beatrice Anywar's support to the affected children, directed the health ministry to carry out mass treatment for onchocerca parasites in the victims and spraying of black flies in affected districts.

The disease is said to have taken toll in the villages along River Pader, through Agago, crossing over to Kitgum, South Sudan, and areas around River Aswa.

The president also suggested killing the fly that is specifically found along very fast flowing rivers, but health minister Christine Ondoa said the exercise could be difficult, due to the nature of the fly and its movement.

Mr Museveni said helicopters could be availed for aerial spraying of the flies. The children are currently being treated using sodium valproate -- an anticonvulsant used in the treatment of epilepsy, anorexia nervosa, panic attack, posttraumatic stress disorder, as well as other psychiatric conditions.

Meanwhile, the attendants of the children at Mulago are said to have refused posho [east African dish of maize flour] and beans saying since the government considered their plea, they should have a diet change. When asked whether the children were improving, in unison, the attendants said that the condition of the children was still the same.

At least 3000 children are affected by nodding and 200 have since died of it.

[byline: Agatha Ayebazibwe]

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ProMED-mail
<promed@promedmail.org>

[ProMED-mail reviewed the literature on nodding disease (ND) in our posting from 15 Dec 2011 (archive no 20111215.3605). It was first described in 1962 and the link to onchocerciasis (transmitted by black flies) suggested in 1994. The electrical brain activity referred to here is probably an EEG (electroencephalography), which is pathological in most diseases of the central nervous system. Nodding disease is perceived as a variant of epilepsy and it is not surprising that the EEG is abnormal, but it provides little clue to the cause of the disease. MRI scans are usually better to pick up changes in the brain than CT scans and a study that performed MRI on 7 patients with ND found that 4 had normal scans (Winkler AS, et al. The head nodding syndrome -- clinical classification and possible causes. Epilepsia. 2008; 49(12): 2008-15; available at http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.01671.x/full). Thus the cause of ND remains elusive. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1Yil.]

 

[Shiloh]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Source: http://www.bbc.co.uk/news/world-africa-17319434

10 March 2012 Last updated at 10:02 ET
Written by Andrew Harding Africa correspondent

The syndrome stealing Uganda and South Sudan's children

It is deadly and indiscriminate. And it is killing children across northern Uganda and South Sudan.

But I'm not talking about Joseph Kony's Lord's Resistance Army which, despite its sudden brush with global infamy, has not been seriously active inside Uganda for some six years.

I'm referring instead to a mysterious disease that I first encountered in the region in 2003. It is called Nodding Syndrome, and I was shocked to discover this week that nearly a decade since it was first detected, almost no progress has been made in identifying, treating or containing the disease...

 

[Pathfinder]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Nodding disease centres open

By Agatha Ayebazibwe (email the author)
Posted Tuesday, March 13 2012 at 00:00

Screening and treatment centres for nodding disease syndrome have opened today with Padibe Health Centre in Lamwo District registering more than 200 children amidst transport challenges.

<!--Ads and Related Buttons--><!-- Ads minus related Buttons -->
At least 30 children had by 2pm been registered at Kitgum Hospital, 50 at Palabek Health Centre in Lamwo District and 200 in Pader.
...
According to Dr Benard Opar, the national coordinator for the nodding syndrome response, the centres will for the start provide outpatient services as they wait for more equipment to enable them admit patients for treatment that requires overnight stay.

<!--Ads and Related Buttons--><!-- Ads minus related Buttons -->
?We expect the numbers to increase but most of them are being hindered by transport problem since the ambulances in the area are down,? he told Daily Monitor yesterday.

More...
http://www.monitor.co.ug/News/National/-/688334/1365204/-/axbyc3z/-/

 

[Tonka]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://noticias.lainformacion.com/m...ene-en-jaque-a-uganda_LUc3sZDRnm9GmrCLkxId15/
Spanish-English translation

A mysterious disease kills 200 children and kept in check in Uganda

14.03.2012 12:53 | Jocelyn Edward, Pader District (Uganda) | GlobalPost
The disease, which has been termed " disease pitching "provokes attacks in children who have their heads constantly shake up and down.

PHOTO: Pitching Syndrome


A mysterious disease that has already killed 200 children in rural areas of Uganda and hundreds more have weakened in check the medical community, which tries to find the source and remedy for evil. The condition of the pitch or "nodding disease" is called as a disease that causes seizures in children who have their heads constantly shake up and down, preventing them from eating properly. Many of those affected just with physical and mental. Okwonga Morrish, 9, Akun and Agnes, 15, pitching the syndrome. Conspicuously silent and indifferent, sit under a tree near his family's hut in northern Uganda. "I do not see them as happy as normal children," says his father, John Anywar. "They've changed a lot. Sometimes it seems like they are going crazy . " Dirty Clothes Morrish Agnes and fall loosely by their skeletal bodies . Agnes caught the disease in 2007, and his brother in 2009. As often suffer seizures that prevent them from eating, are malnourished and are small for their age. His father says that has led them to the doctor countless times, but given the mysterious nature of the disease has not achieved much. "It's very frustrating because we always go with them to the centers of health and the doctors will take blood samples, but unfortunately did not get to help us. They say they are still looking for the medicines to cure them, "he explains. pitching disease is estimated to affect about 4,000 children in northern Uganda and other thousands in Sudan 's south, according to World Health Organization . The disease has killed at least 200 children in Uganda since it was first detected by the Ministry of Health of the country in 2009. Although investigations are ongoing national and international researchers, experts remain puzzled by the disease . The cause remains unknown , and there is not a treatment that relieves it. Children with the disease show a surprising range of symptoms. Since attacks usually coincide with food intake, those who suffer have trouble eating, what causes are malnourished and have mental and physical malformations. The disease may even provoke blindness. Often children with the disease end up developing serious mental disabilities and are prone to accidents such as burns, drowning and car accidents. Most of the deaths related to this disease are linked to secondary causes. " The clinical picture is rather strange , "says Dr. Emmanuel Tenywa, WHO. "This is a new disease that we have not yet fully understand." experts handle some clues. In particular, believe that the pitch may be related to the parasitic worm that causes onchocerciasis or river blindness . "In areas where these syndromes are reported is also where a high proportion of river blindness," said Tenywa. Researchers have also identified a number of vitamin B6 deficiency in populations where abundant syndrome. "We do not know how they can be connected but there is a rare disorder that causes attacks can be cured with large doses of vitamin B6, "says Dr. Scott Dowell, the Center for Control of Diseases of the U.S. ( CDC for its acronym in English). "It makes us think that with large doses of vitamin B6 may help these children, "he says. The CDC is working with the Uganda Ministry of Health for testing with different types of medication to control the incidents of attacks and the distribution of vitamin B6 entered the sick. While experts work to find effective treatment, the disease continues to rage in Uganda, with villages where almost every family has an affected child. "We will not say it's a disaster, but the situation is bad and have to take action, "said Rukia Nakamatte Ministry spokesman Ugandan Health. Jupa In elementary school in the district of Pader, 59 of his 250 students have contracted the syndrome , according to its director, Saidi Pacotoo. Four of them have had to stop attending classes because of illness. Students who have the syndrome do not perform well and sometimes are attacked in the middle of class. "Children vomit . can see how it goes much saliva in your mouth and they change eyes, "says Saidi." It's as if they were fighting against death. You can not do anything, just ensure no harm. " The principal called the girl Nancy Layet of 7 years in office. As shown Morrish Agnes and silent and expressionless. "This child has the disease," he says. "You can see in his eyes, in your mouth. You can see that does not look normal . " Agnes and Morrish had to stop attend school last year. Anywar, his father said he wished they could keep going, but had to leave because they suffered too many episodes of seizures.

 

[alert]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://www.promedmail.org/

Published Date: 2012-03-17 22:45:57
Subject: PRO/EDR> Undiagnosed cerebral disease - Uganda (04): nodding disease
Archive Number: 20120317.1073307

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (04): NODDING DISEASE
***********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Sat, Mar 17, 2012
Source: Observer, Uganda
http://www.observer.ug/index.php?option=3Dcom_content&view=3Darticle&id=3D=
17720:-govt-turns-to-choppers-to-fight-nodding-disease&catid=3D34:news&It=
emid=3D114 [Edited]


Nodding disease update: Uganda Government considering spraying
-------------------------------------------------------------
Government [Uganda] is considering using helicopters to spray areas affected bythe nodding disease, the minister of Health, Dr Catherine Ondoa, has said.

Ondoa also told journalists during a press briefing yesterday that her ministry has dispatched a team of doctors and researchers to northern Uganda to tackle the syndrome that is killing children in droves in Kitgum, Pader and Lamwo districts. Families in these districts have been forced to watch their children present with nodding, seizures, malnutrition and disability. Often, these symptoms have culminated in death.

World health bodies like the World Health Organisation and Centres for Disease Control and Prevention have researched but failed to find the exact cause and cure of Nodding Disease Syndrome. Dr Ondoa told journalists that government trained and dispatched some 99 health workers to Pader, Kitgum and Lamwo to manage the estimated 3000 or so cases.

"This syndrome involves a multitude of problems and we are managing it in a multi-sector way. We are giving patients anti-epileptic drugs as well as vitamins because most of the children suffer from vitamin deficiency," Dr Ondoa said.

She added that 3 specialised screening centres have been opened up in Katanga Health Centre III at Kitgum general hospital and Para Bekan specifically to handle Nodding Disease. Patients who go to these health facilities undergo physical checkups, blood tests, and brain and heart scans. They receive medical treatment as well as psychological and occupational therapy.

"Nodding Disease right now is being handled as a medical, nutritional, psychiatric, behavioural and cognitive disorder," Dr Anthony Mbonye, the Commissioner Health Services, told journalists at the media briefing. Mbonye added that government is also planning outreach programmes for patients who are unable to [get] to the health centres.

Researchers who have been deployed will carry out environmental and ecological
studies in Pader, the worst hit district. Dr Ondoa noted that since the disease is associated with river blindness (onchocerciasis), government has decided to give preventative medicine to the people in the areas affected by that ailment.

Every 6 months, government will give people medication to kill off the microfilariae in their bodies and cut the cycle of spreading the disease from one infected person to another, she said. Government also plans to spray the affected areas using helicopters to kill off the blackflies [_Simulium_ sp.]that pass on the disease from person to person.

"We urge communities to swallow the medicine and cooperate with us during the spraying so that we prevent the cycle," Dr Ondoa said.

Nodding Disease facts
. More than 3000 children diagnosed with Nodding Disease.
. 200 reported to have died from the disease.
. In 4 days alone, government has registered 437 cases at one health centre of Katanga. Of these, 38 have been admitted.
. Pader is worst hit with 1700 cases.
. In one day, 40 patients were diagnosed and 5 admitted at Kitgum general hospital.
. 9 patients admitted at Para Bekan in Lamwo.
. All 25 patients admitted at Mulago hospital [Kampala] are stable. One, though, was diagnosed with a brain tumour and underwent surgery.
. 2 of the patients at Mulago have epilepsy, 12 are ready to be discharged.
. Of the Shs 3.6bn [USD 1.4m] needed for research and management, Shs 1.1bn
[USD 438 000] has been released.
. Ministry of Finance has promised another Shs 2.7bn [USD 1.1m].


[Byline: Shifa Mwesigye
smwesigye@observer.ug]

[Communicated by:
ProMED-mail from HealthMap Alerts
promed@promedmail.org]

[ProMED reviewed the literature on Nodding Disease, ND, in our post of 15 Dec 2011 (see below). The decision to start aerial spraying and 6-monthly drug administration [with ivermectin we suppose] imply that the Government of Uganda has decided that onchocerciasis is a likely cause of the disease. ProMED will be happy to post further information as it becomes available.

HealthMap location: http://healthmap.org/r/1xMp - Mod.EP]

[Photos of afflicted children, some tethered to prevent straying:
http://cdn.radionetherlands.nl/data...ad/article/2012/03/nodding-disease-teaser.jpg
http://www.ghfn.org/Topics/NoddingDisease/PhotoGallery/Nodding7.jpg
http://www.goddiscussion.com/wp-content/uploads/2012/02/NoddingDisease.jpg
- Mod.JW]

 

[Pathfinder]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Mysterious disease devastating families

<IFRAME height=315 src="http://www.youtube.com/embed/brl-GRo434Q" frameBorder=0 width=560 allowfullscreen></IFRAME>

Published on Mar 19, 2012 by CNN

An outbreak of nodding disease is devastating families in northern Uganda. CNN's David McKenzie reports.

http://www.youtube.com/watch?v=brl-GRo434Q

 

[alert]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://scienceblogs.com/aetiology/2012/03/the_emergence_of_nodding_disea.php

The emergence of "nodding disease"
Category: General Epidemiology • Infectious causes of chronic disease • Infectious disease • Outbreak • Public health
Posted on: March 27, 2012 9:30 AM, by Tara C. Smith

The emergence of "new" diseases is a complicated issue. "New" diseases often just means "new to biomedical science." Viruses like Ebola and HIV were certainly circulating in Africa in animal reservoirs for decades, and probably millenia, before they came to the attention of physicians via human infections. Hantavirus in the American southwest has likely infected many people, causing pneumonia of unknown origin, before the Four Corners outbreak led to the eventual identification of the Sin Nombre virus. Encroachment of humans into new areas can bring them into contact with novel infectious agents acquired via their food or water, or by exposure to new disease vectors such as mosquitoes or ticks. Occasionally, emerging diseases may be truly "new"--such as recombinant influenza viruses that resulted from a mixture of viruses from different host species to form a unique variant, different from either parent virus.

Nodding disease is one of those that has only recently appeared on the radar of those of us in public health, although it is not truly a "new" disease. It was first described 40 years ago, but this syndrome has been sufficiently rare as to not merit significant medical attention until 2010. Outbreaks of nodding disease have now occurred in South Sudan, Tanzania, and Uganda, affecting thousands of children. The disease first presents as cognitive difficulties; then the nodding starts, especially when children are provided food. They experience further cognitive decline, and ultimately regress to an almost infantile stage, where parents cannot leave them unattended for fear they may wander off or injure themselves by accident. Death appears to often be a result of such accidents: (drowning, falling into a cookfire) or starvation, as the seizures in the late stages of the disease seem to make it virtually impossible for the child to eat. No one is known to have recovered from the disease.

While the cause(s) still remain mysterious, studies have been done trying to determine risk factors for disease development. A recent CDC-assisted study, for example, was carried out in the new country of South Sudan. This examined 38 matched cases and controls and examined dietary as well as infectious disease factors, looking at issues such as vitamin deficiencies, a history of hunger, and current infection with the parasite Onchocerca volvulus.

This particular agent is interesting, as the nematode already causes a well-known disease, river blindness. Like many parasites, the life cycle of O. volvulus is fascinating and complicated. Humans are the main host, who are initially infected via the bite of the black fly, which was herself infected with O. volvulus from a previous human meal. After inoculation, the nematode larvae migrate to the subcutaneous tissue of their human host, where they multiply and mature over the course of 6-12 months, eventually mating and producing microfilariae--little baby worms, up to 3000 per day per female nematode. It's this life stage that are then ingested by black flies during a daytime meal, when the microfilariae migrate to the host's skin. Within the fly, they will mature through three larval stages, ready to infect another human host.

How then do these worms cause blindness, if they live mainly in the subcutaneous tissues and, sporadically, the skin? The microfilariae also migrate to the surface of the cornea, and when these organisms die, they cause an intense immune response. Interestingly, this response seems to be due not to the worms themselves, but to their Wolbachia symbionts--bacteria species notorious for infecting parasites (and insects) and causing all sorts of weird things to happen. Repeated episodes of this inflammation can lead to keratitis, and the cornea eventually becomes opaque. O. volvulus can also cause intense skin itching, leaving dead and discolored patches of skin in addition to the characteristic blindness. In all, it's a nasty disease but one that is relatively simple to treat if caught early, either with antiparasitic drugs or even with antibiotics such as tetracycline to kill the Wolbachia. The disease can also be prevented by fly mitigation and preventative doses of anti-parasitic medicines.

Testing for O. volvulus is relatively simple. The MMWR study used a "skin snip"--just as it sounds, taking a small piece of skin from the patient and examining it for microfilariae. However, this has the limitation that it may miss early infections (where microfilariae have not yet developed and spread) or mild infections (where there are fewer organisms per square millimeter of skin sample). They note that they also took blood samples to examine antibody responses, but those data were not yet available.

What they found was interesting. In one village, Maridi, they found a matched odds ratio of 9.3 (with the cases being more likely to be currently infected with O. volvulus than the controls), which agrees with an earlier study done in Tanzania which found high levels of infections in cases. However, no healthy controls were tested for comparison in that publication. Furthermore, in the South Sudan study, no statistically significant difference in parasite infection was found between cases and controls in the second village, Witto. Why the dramatic difference between the two locations in the same country? Don't know. It could simply be related to small sizes (only 25 pairs were examined in Maridi, a "semi-urban" area, and 13 in Witto, described as rural). We also don't know anything about temporality--were the patients affected before they developed nodding disease, or subsequent to the start of symptoms? Even though many questions remain, the Ugandan government is taking steps that look as if they believe a cause of nodding disease has been found, and that O. volvulus is that cause. While additional measures to stop the spread of the parasite are probably a good idea in any case (reducing river blindness is also good), I certainly wouldn't call this case closed, and neither did the individuals speaking on this issue recently at ICEID, where this outbreak was discussed in at least two sessions I attended.

There is biologic plausibility for O. volvulus to cause a seizure disorder. Several other types of parasites can cause epileptic conditions, including the tapeworm Taenia solium, which can originate in beef or pork products. Could it be that O. volvulus is getting into the brain and causing pathology, leading to seizures? The 2008 Tanzanian study suggests no, as the cerebral spinal fluid was tested in 42 patients and found to be negative for O. volvulus DNA in all patients.

With some emerging diseases, there is the risk that the incidence of a disease is increasing due only to awareness of an illness--the more doctors that recognize it, the more cases they will diagnose. However, there is anecdotal evidence that this isn't the case with nodding disease:

Dr. Abubakar said in an interview that while the syndrome is known to have existed for some time in South Sudan, the recent spike in reported cases could only partially be explained by wider awareness and better surveillance. "It's not only local authorities but local NGOs saying more children have been affected," he said. Particularly striking, he said, is that in South Sudan "there are a number of displaced people from another location who did not have nodding. But after the displacement, when they moved to affected areas, after 2 years the children started developing the syndrome."
Additional studies and more thorough surveillance are needed to confirm that this is true, which would suggest a localized focus of disease in multiple different areas (which does seem to be the case at this point in time).

The migration aspect is intriguing, suggesting some sort of environmental exposure--if it was simple genetics, where the children were living shouldn't matter. However, this puts us back almost as square one, examining what is present in the local environment--both infectious and non-infectious agents including heavy metals and various toxins.

The work investigating nodding disease is still in its infancy, but already "nodding disease" has affected more individuals than all of the recorded cases of Ebola. Now that there is recognition of the disease, and some international support for research into its causes, hopefully better treatment and prevention efforts will follow.

Works cited

WInkler et al, 2008. The head nodding syndrome--clinical classification and possible causes. Epilepsia. 49(12):2008-15. Link.

CDC. 2012. Nodding Syndrome -- South Sudan, 2011. MMWR. 61(03);52-54. Link.

 

[Ronan Kelly]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Last group of nodding disease children discharged
Publish Date: Mar 29, 2012
.
By Violet Nabatanzi

The last group of children suffering from nodding disease has been discharged from Mulago national referral hospital.

"They are expected to report to the treatment centres for follow up documents before returning to their homes," the hospital's spokesperson Dan Kimosho said.

The hospital will continue to work closely with the ministry of health to monitor the affected children but from the established centres.
...
So far over 3000 children, mainly boys between the ages of five and 15 have been affected with 170 reported dead. The germ which causes river blindness also causes epilepsy in children.
...
http://www.newvision.co.ug/news/629956-last-group-of-nodding-disease-children-discharged.html

 

[alert]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

This is a novel hypothesis:

http://www.promedmail.org/

ished Date: 2012-03-28 20:32:07
Subject: PRO/EDR> Undiagnosed cerebral disease - Uganda (05): nodding disease
Archive Number: 20120328.1083745

UNDIAGNOSED CEREBRAL DISEASE - UGANDA (05): NODDING DISEASE
***********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 26 Mar 2012
Source: The John Benneth Journal [edited]
http://johnbenneth.wordpress.com/2012/03/23/homeopathic-treatment-of-the-nodding-disease/


Nodding disease mostly afflicts children. It's called nodding disease because those who have it have a strange pendulous nodding of the head, especially when they are trying to eat certain foods or when they get cold. They also have an inability to eat and are affected by malnutrition. Nodding disease could be a systemic necrotizing vasculitis due to a mycosis infection.

The pathogen here specifically could be to be _Claviceps africana_, also called sorghum rot or sorghum ergot. Sorghum is a type of grain that is grown widely in the regions of Africa affected by the nodding disease.

Nodding disease in children develops from eating infected sorghum cereal and simply breathing the spores downwind from sorghum fields. Sorghum ergot fungi cause symptoms in animals that are similar to symptoms in children who have the nodding disease [see for instance: Blaney BJ et al. Sorghum ergot (_Claviceps africana_) associated with agalactia and feed refusal in pigs and dairy cattle. Aust Vet J. 2000;78:102-7].

Many children who have the nodding disease have stunted growth and mental retardation and other symptoms. These symptoms are very similar to ergot mold poisoning in rye.

Cattle and pigs that have eaten ergot-infected sorghum suffer from the same refusal to eat and from the same severe hypothermia experienced by children with the nodding disease.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Food toxins have been mentioned before, but not sorghum rot as the specific course. So far, data from analysis of mycotoxins have not been released to the public. Recent reviews of mycotoxins include: Richard JL. Some major mycotoxins and their mycotoxicoses--an overview. Int J Food Microbiol. 2007;119:3-10; and Bennett JW, Klich M. Mycotoxins. Clin Microbiol Rev. 2003;16:497-516.

The suggestion that nodding disease could be a systemic vasculitis is contradicted by the normal finding in the cerebral fluid and inconsistent changes seen on MRI. - Mod.EP]

[For information on sorghum ergot, see ProMED-mail post "Ergot, sorghum - Australia 20080125.0307," which contains pictures, information, and see also's for _C. africana_. - Mod.DH]

[For the HealthMap/ProMED map of Uganda, see http://healthmap.org/r/1wa6. - Mod.MPP]

 

[Pathfinder]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Fri, Mar 30th, 2012

Tanzania |

Kagera on full alert as mysterious disease spreads in Uganda

Kagera Regional authorities are on a full alert following outbreak of a mysterious disease in neighbouring Uganda known as ?nodding syndrome.? The cause of the disease is unknown, but it affects only children ? who suffer from seizures, stunted physical and mental growth and nodding of the head.

...Kagera Regional Medical Officer (RMO) Dr Alex Mwita, said surveillance on all entry points had been tightened.

?We are keeping a 24-hour surveillance. The Ministry of Health and Social Welfare will be sending a team of experts to Kampala, to gather more information about the strange disease,? he said. Uganda has opened its first clinics specifically set up to help thousands of children who have a mysterious fatal condition known as nodding syndrome.

The centres in the north ? where the disease is most common ? are to control the worst of the symptoms. There have also been cases of the disease in South Sudan. More than 200 sick children turned up on Monday for treatment in the centres in the districts of Kitgum, Pader and Lamwo, Uganda?s Commissioner for Health Services Dr Anthony Mbonye told the BBC.
...
By MEDDY MULISA, Tanzania Daily News

Full text:
http://in2eastafrica.net/kagera-on-full-alert-as-mysterious-disease-spreads-in-uganda/

 

[Emily]

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

Re: UGANDA: Nodding disease or "river epilepsy"? Hundreds of children infected

http://in2eastafrica.net/what-it-means-to-suffer-from-nodding-disease/

Wed, Apr 11th, 2012
Health |
What it means to suffer from Nodding Disease

By In2EastAfrica Staff

It (nodding disease) has been disturbing me for a long time. I was already in P.2 when it started. Whenever I sat down to eat, I would feel drowsy, and then I wouldn?t know what else follows.

Whenever I went to school, I would fall, and when I ?wake up? (gain consciousness), I would find pupils crowded around me.

I can?t know that I am going to fall. It just happens. And when I fall (get seizures) and ?wake up?, my head is usually very very heavy, so I would prefer to just lie down, or be in the same position for a while.
[snip]
When Arach took Oweka to the health centre, his condition was diagnosed as epilepsy. He was given a combination of Coartem, Paracetamol, Folic Acid but the effects were bad.

?Oweka would get seizures every time he took the medicine. His eyes become big as if they are going to pop out,? Arach explains.

They had to stop the medication. When he started taking a drug labelled ?Phenobarb and F. A? , in November last year, his condition started stabilising.

He now goes to the health centre to get his medicine. The seizures and nodding have reduced too and he only gets them when he misses his medication.

?I didn?t think he would make it up to today. I had lost hope especially when I went to Gulu hospital and said I was lying. When I told them the symptoms, they just laughed at me and said I was lying,? says Arach.

Nodding disease in numbers

3,000
The number of children suffering from nodding disease in Gulu, Kitgum, Pader, Lamwo districts.

200
The number of children who have died of nodding disease in Acholi sub-region.

11
The number of children suffering from nodding disease in Palaro Sub-county, Gulu District.

By Harriet Anena, Daily Monitor

http://angeloizama.com/2012/03/01/invisible-children-response-to-nodding-disease-echoes-the-northern-uganda-war-and-more/

Invisible Children. Response to Nodding Disease echoes the Northern Uganda war and more
March 1, 2012 By Angelo Izama in The Ugandan Reader

One of the theories now ?dismissed? in explaining the relationship between the neurological disorder known as ?nodding disease? and its prevalence in the northern part of the country- is that it had anything to do with the war. One expert said it had nothing to do with war era ordinances. No bombs or other weapons of destruction could have caused these side-effects of seizures and involuntary spasms- a constant ?epilepsy? that leaves children in a vegetative state- their parents bewildered.

It is hard to ignore the bitter irony.

If the ? Northern Uganda? war had nothing to do with ?nodding disease? perhaps we can discuss the geography of this disease more intelligently than has transpired so far? It would be fair since the geography of this place has been essential to the response by Ugandan institutions and development partners as well as the public to its well publicised horrors.

Why has nodding disease emerged in the war?s most affected districts of Pader, Kitgum and Gulu? What is it about 5-15 year olds, just out of the camps that makes them susceptible to the disease?

There is a term for this conversation.Correlation is not causation.Geography however is also essential to the science of diseases...

http://scienceblogs.com/aetiology/2012/03/the_emergence_of_nodding_disea.php

The emergence of "nodding disease"

Category: General Epidemiology ? Infectious causes of chronic disease ? Infectious disease ? Outbreak ? Public health
Posted on: March 27, 2012 9:30 AM, by Tara C. Smith

The emergence of "new" diseases is a complicated issue. "New" diseases often just means "new to biomedical science." Viruses like Ebola and HIV were certainly circulating in Africa in animal reservoirs for decades, and probably millenia, before they came to the attention of physicians via human infections. Hantavirus in the American southwest has likely infected many people, causing pneumonia of unknown origin, before the Four Corners outbreak led to the eventual identification of the Sin Nombre virus. Encroachment of humans into new areas can bring them into contact with novel infectious agents acquired via their food or water, or by exposure to new disease vectors such as mosquitoes or ticks. Occasionally, emerging diseases may be truly "new"--such as recombinant influenza viruses that resulted from a mixture of viruses from different host species to form a unique variant, different from either parent virus....