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Volume 19, Number 9—September 2013

Synopsis

Nodding Syndrome

Scott F. DowellComments to Author , James J. Sejvar, Lul Riek, Katelijn A.H. Vandemaele, Margaret Lamunu, Annette C. Kuesel, Erich Schmutzhard, William Matuja, Sudhir Bunga, Jennifer Foltz, Thomas B. Nutman, Andrea S. Winkler, and Anthony K. Mbonye
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.F. Dowell, J.J. Sejvar, S. Bunga, J. Foltz); Ministry of Health, Juba, South Sudan (L. Riek); World Health Organization, Geneva, Switzerland (K.A.H. Vandemaele, M. Lamunu, A.C. Kuesel); University of Innsbruck, Innsbruck, Austria (E. Schmutzhard); Muhimbili University, Dar es Salaam, Tanzania (W. Matuja); National Institutes of Health, Bethesda, Maryland, USA (T.B. Nutman); Technical University of Munich, Munich, Germany (A.S. Winkler); Ministry of Health, Kampala, Uganda (A.K. Mbonye); Makerere University, Kampala (A.K. Mbonye)

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Table 4

Selected risk factors for nodding syndrome from 4 case–control studies*

Risk factor Study (reference)
Sudan, 2002; 13 case-patients, 19 controls (2) Uganda, 2009; 49 case-patients, 49 controls (6) Uganda, 2010; 73 case-patients, 73 controls† South Sudan, 2011; 38 case-patients, 38 controls (7,8)
Infectious
History of measles Less common (15% cases vs. 58% controls; p = 0.03) No difference (24% case-patients vs. 6% controls; p = 0.02‡) NA NA
History of malaria NA ND NA NA
History of meningitis No difference (0% vs. 6%; p = 1.0) NA NA NA
Prior treatment for onchocerciasis (ivermectin) No difference 62% cases vs. 37% controls) No difference (33% case-patients vs. 25% controls) NA NA
Consumption of animal brain (risk for prion disease)
Baboon brain consumption (46% vs. 22%; p = 0.25)
No association with brain consumption
NA
NA
Toxic/environmental
Exposure to munitions NA More common in case-patients (71% vs. 51%; p = 0.06) Exposure to gun raids more common in case-patients (54% vs. 27%) ND
Exposure to pesticides (on seeds) No difference ND NA NA
Consumption of crushed roots NA More common in case-patients (39% vs. 16%; p = 0.02) No differences in 17 root types before onset of nodding syndrome; root consumption more common after onset of nodding syndrome (22% vs. 0%) ND
Consumption of cassava (thiocyanate toxicity)
Widely consumed, no acute toxicity reported
ND (100% consumption)
Specifically asked about bitter cassava: no difference
NA
Nutritional
Early malnutrition NA NA NA Hunger more common for case-patients 2 y of age (24% vs. 8%; p = 0.03)
Current wasting Weight-for-age Z scores lower in case-patients (−1.6 vs. −1.0, p = 0.09) Low BMI for age (42% vs. 13%; p<0.01) Low BMI for age (42% vs. 26%; p = 0.03) Low BMI for age (16% vs. 3%; p = 0.06)
Current stunting Height-for-age Z scores lower in case-patients (−1.5 vs. −0.8, p = 0.29) Low height for age (60% vs. 29%; p<0.01) Low height for age (35% vs. 20%; p = 0.05) Low height for age (24% vs. 3%; p = 0.03)
Consumption of red sorghum 54% case-patients vs. 16% controls; p = 0.05 ND ND ND
Consumption of spoiled relief foods NA ND NA NA
Consumption of river fish NA ND NA ND
Consumption of rodent brain NA ND NA NA
Consumption of river water NA ND NA NA

*Selected risk factors, all positive associations and selected negative findings (see original reference for full listings). NA, not assessed; ND, no difference; BMI body mass index.
†Unpub. data.
‡Not significant after age adjustment.

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