Proper nutrition gives promising results for nodding disease patients

By Gladys Kalibbala
Cases of nodding disease were rampant near rivers where river blindness was common making the experts suspect the two diseases were related

IT looked like a godsend when Deng village local leaders in Pader district came to the rescue of Isaac Okema. Okema, 15, had been abandoned by his parents with his 16-year-old sister Janet Amite. He could not sit, eat or talk. He was suffering from the nodding disease, while Amite was epileptic and occasionally got attacks, but she still had to cook and take care of her brother.

The local leaders learnt that their father had fled with another woman, abandoning the family. In desperation, the mother also fl ed with another man leaving the sickly children to fend for themselves. Lillian Ochieng, a nursing offi cer at Atanga Health Centre III in Pader says that on arrival at the centre, Okema was emaciated and could neither sit nor eat. “He had persistent convulsions and could not even see the plate of food placed in front of him,” she says.

The disease

Health experts have not found the cause of the nodding disease that has claimed the lives of about 200 children. At the peak of the rather strange disease last year, President Yoweri Museveni launched interventions against the disease onMay 26, 2012, in Pader. The launch brought together health experts from the health ministry and entomologists from the agriculture ministry, who worked together to unravel the mystery. Nodding disease had presented symptoms of another disease known as onchocerciasis commonly referred to as river blindness. Cases of nodding disease were rampant near rivers where river blindness was common making the experts suspect the two diseases were connected.

Experts explained that nodding disease is a form of epilepsy characterised by repeated head nodding and growth retardation in children, who were previously growing well. The ages ranged between 3-18 years with the victims suffering mental and cognitive function retardation where physical abnormalities, especially of both lips and dental, were common.

“The victims who were malnourished nodded towards their chests every 5-20 minutes,” explained Sister Ochieng. According to Dr. Benard Opar, a principal medical offi cer at the health ministry (national coordinator for nodding disease), elders in Kitgum fi rst reported the existence of this disease in August 2009. However, elders in Lamwo district explained that by 2007-08 there were already cases in their area.

Interventions
When the disease intensified, the health ministry set up screening centres in Lamwo, Kitgum, Pader and Gulu districts where UNICEF got involved in therapeutic feeding of the victims. Dr. Opar explains that by the time most of the children became sick, many of them were malnourished as a result of neglect by their parents. “Their parents had stayed in internally displaced people’s camps for long where they were used to free food.

On coming out of the camps, the dependence syndrome had got the better of them and instead of growing food, they still waited for donors to distribute food, which affected many children’s health,” he says. Sister Ochieng explains that Okema was one of the examples of the victims who gained strength after undergoing proper feeding with the food provided by the Government. “After a few weeks of proper feeding and treatment on Ivermectin drugs, Okema was up and praising God for the miracle,” she says.

The ward turned into a store was stocked with beans, posho and rice; fortifi ed foods including milk and soya. The kids were also provided eggs. Dr. Opar said explained that the nutrition status of the children were worsened by the fear by parents giving food to the sick children triggered the nodding disease episode. “Every sick person requires proper feeding and medication to get better,” he emphasised.

Current state Dr. Opar says there are no new cases of nodding disease since December 2012 although those who already had the disease and never got treatment still surface and are given treatment. Pader registered 1,200 cases, Kitgum 1,000, Lamwo 400, Amuru 60, Gulu 300; Lira 18, while the eight cases in Oyam district were suspects. Dr. Opar says health personnel are still monitoring the victims whom they continue giving food.

The treatment the victims are receiving is usually taken for 15-20 years and since they have only taken it for three years, they are expected to continue on treatment for some more years