Nodding disease community dialogue meeting held in Pader district



Pader district has held a dialogue meeting as a move to begin containing the nodding disease that has greatly affected the district.


The meeting that was held at the District health board room attracted District officials, Health officials, development partners, media houses, stake holders and the public.


Oyet William the district vector control officer and the tropical disease focal person for Pader district welcomed the initiative and said it was timely and set out the position of the district on the epidemic.




The nodding disease which is said to be caused by “a black fly” which causes river blindnessaffects mostly children and has symptoms of cerebral malaria, seizures, wounds visible on the body, stunted growth and the children appear to be falling asleep - their eyes close and head droops (nodding), even though they may not be tired; this nodding particularly happens whenthey are given food or when it’s cold.


It is a mentally and physically disabling disease that only affects young children typically between the ages of 5 and 15 and can be fatal.


The disease which has affected more than 1000 people has been in existence since 1997 when people were still living in internally displaced persons camps during the insurgence in Northern Uganda.


In Pader, the most affected places include Lamac south, Ojuru, Ongany, Bolo Angagura and Awere.


Nodding disease remains a mystery in the region and it is so far no clear measures have been put in place to fight the disease although neurological scans have been done on some victims.


Delays in containing the disease


The government says that there were key issues that made it impossible for the government to to respond to the problem of the nodding disease in Pader district.


Insurgency and insecurity in Northern Uganda made mapping and implementation of the ONCH program impossible.


Land mines and unexploded ordinances (UXOs) left by the Lord’s resistance Army (LRA) rebels and the Uganda Peoples Defence Forces (UPDF) also made it difficult for experts and technocrats to access the affected areas.



2008 survey


In November 2008 the Neglected tropical disease department conducted a survey on Rapid Epidermiolgical Mapping of Onchocerciasis (REMO) in Pader district and the following were the findings.


The most affected villages were Lajeng, Latek west, Lamac south and Angagura with a nodule prevalence range from 26% to 78%.


There were many cases of skin lesions with severe itching, with a prevalence range from 26% to 60%.


Many cases of impaired vision with some blindness were also observed.


Epileptic cases or nodding cases were abnormally high in villages of Angagura, Ojuru, Ongany, Lamach south and Bolo.


A minimum of two cases per households was registered and in Angagura over 1000 cases were registered at the Health facility.


Infection with microfilariae was high in Lamach south, Ojuru, Ongany and Angagura with prevalence from 40% to 90%.


Infection amongst epileptic children or nodding children was equally very high ranging from 70% to 100%.




The survey revealed that the prevalence of nodding disease was higher in male with 54.8% than in female with 46.5%.


Male victims have a higher risk of attracting the disease because it is presumed that they frequently go hunting in the bushes; they go fishing and swimming in river banks where the black fly breeds from.




Since the Rapid Epidemiological Mapping of Onchocerciasis (REMO) survey on the affected victims was conducted, no clear solution has been reached to get to the root of the problem and possible cures to the disease, the district Neglected tropical disease department thought it wise to administer Albeendazole and Ivermectin tablets which cures river blindness with assumptions that these prescriptions can cure nodding disease since it is also assumed to be caused by the black fly.


However for a victim to get cured, he/she should take these tablets for fifteen years by which time, all but a few will have died.


In June/July 2009 the Neglected tropical disease department of Pader district did the first Mass Drug Administration (MDA) for 306,592 people out of a population of 357,750 people with coverage of Albeendazole and Ivermectin constituting to 85% while Praziqantel was administered to 186,670 people constituting to 51.3%.


The second round of the Mass Drug Administration (MDA) was done for December 2009 to May 2010 in a population of 357,750 people, where 248,491 people got Albeendazole tablets (88.9%), 306,592 got Ivermectin tablets (69.5%), 138,912 people got Praziqantel (33.8%) and 317,753 got Zithromax (86.6%).


However, there was a drop in the second round because of the side effects of the Ivermectin drugs that was given to people.


The last round treatment conducted in June 2010 had the lowest coverage of only 43.9% Ivermectin and Albeendazole 39.8% for treatment of river blindness.


Districts efforts towards the Neglected tropical disease program


There are continued lobbying for support from development partners like The Cater Centre (TCC), AND Africa Program for Onchocerciasis Control (APOC), which are institutions that helped northern Uganda wipe out the guinea worm epidemic.


The available health system structures are being used for implementation in the district, HSD in the

Sub county and village health teams (VHTs) in villages.


Politicians should use their mobilization rounds in educating the community on Neglected tropical diseases.


District leaders should be committed to sensitize the community on the effects of the disease.


District leaders should also be committed in informing the Ministry of Health and other ministries about the disease and the affected community.


Pader district is trying to advocate for the vector control mechanism of dosing all rivers in the district.


A taskforce should be formed involving District, Sub County and village health teams and education officers.


Training Health workers and village health teams on Neglected tropical diseases.




People must continue taking drugs ivermectin provided under the Neglected tropical diseases program.


There is need for more investigations on the cause of the nodding disease.


The affected children should get treatment for epilepsy from the near health facility.


The ministry of health should start a vector control program in Pader district.


The district should initiate an awareness campaign to sensitize the community on the issues of nodding disease


Parents and relatives of the victims should have a critical look on victims since when the condition gets worse, causes children to fall and injure themselves because they lose consciousness and have appalling accidents, like drowning when the victims go swimming or even fall into a cooking fire.


Pader district will on the 10th November 2011 host a stakeholders meeting that will attract 15 districts of Acholi sub region and the greater north so as to discuss and constitute a position paper that will be presented to parliament so that the government and other stake holders intervene in fighting the nodding disease.

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