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Abstract

NODDING SYNDROME IN NORTHERN UGANDA; TREATMENT AND REHABILITATION OUTCOMES: A LONGITUDINAL STUDY DESIGN

David Kitara Lagoro* and Suzanne Gazda

ABSTRACT

Background: Nodding Syndrome (NS) is an emerging neurological disorder in East Africa that affects children that are subject to civil disruption, internal displacement, food insecurity, malnutrition and nematode infection, Onchocerca Volvulus (OV). This epilepsy of unknown aetiology which presents with a typically dorso-ventral head nodding affects thousands of children in Northern Uganda, South Sudan and Southern Tanzania. The burden it places upon affected communities is multifaceted; ranging from physical and mental health decline of an individual child to increasing health disparities of the entire community. Nodding Syndrome should be considered a critical and pervasive threat to human security in the affected communities of Northern Uganda because it exacerbates vulnerability of the people in the process of recovering from violent conflict. The aim of this study was to describe the rehabilitation outcomes of NS children who were being treated at the Hope for HumaNs (HfH) NS rehabilitation centre in Gulu District over a 9 months’ longitudinal study. Methods: The study was conducted on 19 NS children who were undergoing treatment and rehabilitation at the HfH centre from June 2012 to March 2013 (using local food supplements, sodium valproate (200mg BD) with or without carbamazepine (200mg BD), multivitamins, and psychosocial support. Anthropometry, clinical examinations, haematological and biochemical tests of blood samples were studied at baseline and follow-up. Ethical approval was obtained from the Gulu IRC (GU/IRC/02/01/13) and STATA version 12 (STATA Corp LP, Texas, USA) was used for data analysis. A p-value less than 0.05 was considered statistically significant. Results: We found NS associated with younger age-groups 9.71(p=0.001); improved nutritional status shown by increased height, weight and MUAC. The mean change in MUAC did not however reach statistical significance between baseline and follow-up accounting for age and sex (χ2)=2.39; p=0.0611. Male NS children had lower MUAC compared to females, 1.36 (p<0.000). There was a statistically significant increase in the anion Gap 16.4 (p<0.001) from baseline but was lower for younger NS children than older ones 4.35(p=0.002). The high Anion Gap was still associated with nodding episodes although with reduced frequencies. Conclusion: Nodding syndrome is a childhood neurological disorder associated with malnutrition and high anion Gap metabolic acidosis but the outcome of treatment and rehabilitation showed remarkable improvement in the physical conditions of NS children with improved height, weight, MUAC and reduced seizure frequencies.

Keywords: Nodding Syndrome, longitudinal study, multidisciplinary treatment, Gulu University.


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