Nodding Syndrome – An Investment Case for Global Health?

Abstract

Nodding syndrome represents a complex encephalopathy in previously healthy children and adolescents that occurs in hot spots of South Sudan, northern Uganda and southern Tanzania. The core feature of this neurological disorder is a repetitive forward bobbing of the head towards the chin of a variable length of time associated with other features such generalized epileptic seizures, psychiatric symptoms/signs, stunted growth, wasting and reduced sexual development, among others. The etiology of this neuropediatric disorder so far has remained obscure, but there seems to be some evidence in support of a post-measles disorder as well as an involvement of the parasite Onchocerca volvulus which can cause skin and eye disease (river blindness). While discussing potential etiology and pathogenesis of nodding syndrome, we also explore reasons while funding for research on nodding syndrome has been so scarce and compare it to other similarly neglected diseases. Furthermore, we discuss the inclusion of nodding syndrome in the WHO list of neglected tropical diseases with the aim of creating a disease specific lobby, thereby supporting financing and collaboration on research and development for nodding syndrome. In the last paragraph we examine a global health approach to nodding syndrome via the sustainable development goals and conclude that by investing in some of the goals concerning health, poverty alleviation and quality education, among others, individuals suffering from nodding syndrome and their families may derive clear benefits which eventually can lead to an overall reduction in morbidity and mortality. However, other diseases will also benefit from employment of the sustainable development goals and therefore awareness of nodding syndrome needs to be raised, so that it will not be forgotten.