Abstract
IntroductionNodding syndrome was first reported in Uganda in 2003 among internally displaced populations. Risk factors for the syndrome remain unknown. We therefore explored vitamin B6 deficiency and resulting high 3-hydroxykynurenine (3-HK) levels as risk factor for nodding syndrome in Northern Uganda.MethodsCase-control study conducted in Gulu and Amuru districts. Cases were children/young adults with nodding syndrome. Healthy children/young adults were recruited as controls from same community as cases. Data on socio-demographic and other risk factors was collected using questionnaires. Whole blood was collected in EDTA tubes for assay of 3-HK and vitamin B6 using sandwich ELISA. Conditional logistic regression model was used to assess associations.Results66 cases and 73 controls were studied. Factors associated with nodding syndrome were being positive for 3-HK (AOR=4.50, p=0.013), vitamin B6 concentration below mean (AOR=7.22, P=0.001), child being taken care of by mother only (AOR=5.43, p=0.011), child being taken care of by guardian (AOR=5.90, p=0.019) and child consuming relief food at weaning (AOR=4.05, p=0.021).ConclusionHaving low vitamin B6 concentration which leads to a build up of 3-hydroxykynurenine concentration in cases as a main risk factor. Therefore, cases should be treated with vitamin B6 and community members should be sensitise to ensure adequate dietary intake of vitamin B6 so that the risk of nodding syndrome among children is averted. We encourage future prospective intervention study to be conducted to assess the effect of low vitamin B6 on the development of nodding syndrome via raised 3-HK concentration.
Highlights
Nodding syndrome was first reported in Uganda in 2003 among internally displaced populations
Vitamin B6 concentration was negatively correlated with 3-HK concentration in the plasma of study participants and Source of food consumed at weaning
Factors associated with nodding syndrome were:- being taken care of by mother only (AOR=5.43, 95% confidence intervals (CI) 1.48 - 19.87, p=0.011), being taken care of by guardian (AOR=5.90, 95% CI 1.34 - 25.93, p=0.019), consumption of relief food at weaning
Summary
Nodding syndrome was first reported in Uganda in 2003 among internally displaced populations. We explored vitamin B6 deficiency and resulting high 3-hydroxykynurenine (3-HK) levels as risk factor for nodding syndrome in Northern Uganda. Nodding syndrome was first described in Tanzania in the 1960s and similar conditions were reported in the 1980s in the southern part of Sudan (presently the Republic of South Sudan) [1,2] It is currently unknown what causes nodding syndrome [3], which can be fatal or cause mental and physical disability in young children between the ages of 5 and 15 [4,5]. This study was set in the context of this prevailing knowledge gap to explore vitamin B6 deficiency and resulting high 3-HK levels as a risk factor for nodding syndrome in the Acholi subregion of Northern Uganda
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