Health Ministry should investigate the cause of nodding disease outbreak

Allow me to appreciate the Daily Monitor efforts in promoting the health of Ugandans by always reporting about the sector. I am certain that our leaders will soon realise the need health of citizens should be taken seriously. We have read stories of this ‘strange disease’ in northern Uganda and by all means, everyone has to get worried. The cause of nodding disease has proved complicated to establish. But it is a form of partial complex seizure disorder (epilepsy), which has also been reported in other parts of sub-Saharan Africa.

Head nodding is defined as a repetitive short loss of neck muscle tone resulting in nodding. It is sometimes associated with a short loss of muscle tone of the upper extremities resulting into a child dropping whatever they were carrying. Investigators in Tanzania evaluated 62 patients with head nodding and descried their clinical presentation that indicate high seizure frequency, unsatisfactory seizure control, a high burden of cognitive impairment and disease-associated barriers to education. The disease has been associated with a filarial (parasitic) infection technically known as Oncocerca Volvulus and laboratory and radiological investigations have supported this.

In 1992, E. Ovuga and colleagues observed an unusually high number of patients with epilepsy in Kyarusozi Sub-county where infection with Oncocerca Volvulus is hyperendemic. In a preliminary survey carried out in April 1991, when all patients with epilepsy and growth retardation were invited for medical examination, they found out that of the 231patients who were screened, 91 per cent were below the age of 19 years and a prevalence of epilepsy of 2 per cent. For those who have ever heard of the Nakalanga syndrome, which has been observed in areas highly endemic for O. volvulus, and nodding disease.

This means that head nodding disease in not a new illness. It is also not a result of witchcraft - we are getting convincing albeit anecdotal evidence that it is related to infection with O. volvulus. Other suggested possible causes included early brain damage from low oxygen supply to an infant’s brain and malnutrition. However, this is not what the public needs to know. What the community needs to know is that this is a complex disease that can be controlled with anti-epilepsy medicines.

The Ministry of Health should realise that there is a disease outbreak and they need to investigate its cause and how it can be dealt with.

Dr H. Ddungu,
Uganda Programme on Cancer
and Infectious Diseases
hddungu@fhcrc.org