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


CONCLUSIONS
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.
Department of Neurology, School of Medicine; Senior Scientist, Center for Research on Occupational and Environmental Toxicology, and Director, Global Health Center, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, L356, Portland, Oregon 97239, USA.
P S
PS
Spencer
K
K
Vandemaele
M
M
Richer
V S
VS
Palmer
S
S
Chungong
M
M
Anker
Y
Y
Ayana
M L
ML
Opoka
B N
BN
Klaucke
A
A
Quarello
J K
JK
Tumwine
D000818:Animals; D003141:Communicable Diseases; D016001:Confidence Intervals; D004781:Environmental Exposure; D005506:Food Contamination; D006306:Health Surveys; D006801:Humans; D064128:Nodding Syndrome / Q000453:epidemiology / Q000209:etiology*; D016017:Odds Ratio; D036301:Qualitative Research; D013397:Sudan / Q000453:epidemiology; D015047:Zoonoses
Dinka; Epilepsy; Moru; filariasis; neurotoxins; sorghum