부산대학교 도서관

Background: Nodding syndrome (NS) is a progressive neurological disease that has been described in several sub-Saharan African counties, but South Sudan is considered the most affected. However, knowledge about the exact burden and the epidemiological risk factors of NS in South Sudan is lacking. Objective: To determine the prevalence, distribution and epidemiological risk factors of NS in the Greater Mundri area, the epicenter of NS in South Sudan. Methods: A NS prevalence house-to-house survey was conducted in multiple villages between February 2018 and November 2019. Geographical distribution and clustering of NS cases was identified using spatial and binomial regression analysis. Epidemiological risk factors of NS were identified using univariate and multivariate models. Results: Of the 22,411 persons surveyed in 92 villages, 607 (2.7%) persons with NS were identified, of which 114 (19%) were new-onset cases. The highest prevalence was found in Diko village with a prevalence of 13.7%. NS showed a significant spatial pattern with clustering of cases between adjacent households and along rivers. Risks factors for NS include all behaviors around rivers (drinking, cooking, handwashing and bathing) and exposure to poultry. On the other hand, ownership of mobile phone decreased the risk of NS. Many other factors, including prior ivermectin treatment and internal displacement were not associated with NS. Conclusion: Our study demonstrates a very high burden of the NS disease in the Greater Mundri area, strengthens the association with rivers, and identified possible new clues for an underlying cause. Author summary: Nodding syndrome (NS) is a neglected and progressive neurological disorder that is disabling and of unknown cause. The Greater Mundri area in South Sudan is currently considered to be the epicenter of new cases. In this study, we evaluated the prevalence, spatial pattern and epidemiological risks of NS. We found that the prevalence of NS is very high–more than one in five households affected–in the Greater Mundri area, which is comparable with the previously reported rates within smaller populations in the same area, but higher than the rates reported in all the other NS-endemic countries. We found that NS cases significantly cluster between adjacent households but we could not find clustering within the same household. In addition, we prove that living near the rivers, as well as using river water for drinking, cooking, handwashing and bathing strongly increased the risk of having a NS case in households. We further identified a new association of NS with ownership of poultry. [ABSTRACT FROM AUTHOR]