Nodding Disease: A Special Focus On Uganda And Tanzania

A child suffering from nodding syndrome

What is nodding syndrome?

“Nodding syndrome is a neurological condition with unknown etiology. It was first documented in the United Republic of Tanzania in the 1960s, then later in the Republic of South Sudan in the 1990s and in northern Uganda in 2007.” – That is the World Health Organization’s definition of the ‘Nodding disease.’

Apart from slavery, colonialism, and Apartheid, which were used as tools to oppress Africa, bio-weapon agents, such as mycotoxin, was also used in some African countries, including Uganda and Tanzania.

In many scientific publications, one can read that in the early sixties and seventies African countries were affected by a stream of conflicts. During these wars and conflicts, Western countries frequently experimented with toxic substances.

It involved a deliberate distribution of various types of aflatoxins, mycotoxins, and genetically engineered microorganisms. These secretions of fungi have a life-threatening and cancer-causing effect on all living creatures.

These agents are particularly interesting for military biowarfare purposes for East and West during the cold war and the existence of the Iron Curtain. Because these toxins have a very strong resistance-reducing effect, making the body susceptible to life-threatening viruses and bacteria, people become ill easily with both old and new diseases.

Such toxins were strewn with the aid of aircraft or mixed with food and/or drinking water in for instance Uganda and Tanzania. As people come in contact with such mycotoxins, after they have been vaccinated against any disease, which in those years in Africa widely happened, it could lead to an explosion of entirely new diseases.

"During the hand-over of power to Milton Obote, the USA, England, and French did widespread biowarfare experiments in this specific region of Africa. Outside this region nodding disease is much less common or absent."

Amongst them Aids, Ebola, and for instance Nodding Disease.

There is no reason not to believe that also apes are contaminated with mycotoxins because it is spread into the open air. Subsequently, the monkeys develop several diseases and amongst them SIV, monkey Aids, caused by the Simian Immunodeficiency Virus

I read an article about one in: 'The Animal Health Yearbook 1990: FAO Animal Production and Health Series No. 30,' which was commissioned by the WHO in 1990, and released by the “Food and Agriculture Organization of the Treaties United Nations."

Within this publication, there are 58 brand new diseases described in Uganda and Tanzania since 1976, excluding diseases in some animals. An article in the Washington Post of July 7^th, 1992, reports the mass deaths of fish in Lake Victoria caused by cancer.

Yet more devastating is the communication in the alternative journal Science in1994, which in 1978 reported a certain mysterious brain disease in about 20 percent of all lions in Tanzania. Apparently, unfolds a strange sickening in African countries process by which humans and animals are massively ruined.

There is no reason to believe that apes remain free from such diseases. After poisoning with these mycotoxins not only certain brain diseases occur but people in that area became extremely violent. Within communities, behavioral changes have the effect of those associated with a strong increase in aggression and crime.

One should not remember that the genocide which to this day in Central Africa takes place, could be partly caused by the dispersion of mycotoxins!

Nobel Prize winner Daniel Carleton Gajdusek

Daniel Carleton Gajdusek, son of a poor Polish immigrant family, was an American scientist, pediatrician, commissioned during the World War II, as an army captain. Respectively in 1948, 1952 and 1954, he visited for the treatment of childhood diseases, as repeatedly and commissioned by the US military leadership post-war Germany.

From 1952 to 1953, he was a staff member of the French Institute Pasteur in Iran. At the same time, as an employee of the Walter Reed Army Medical Center, he published "Acute infectious hemorrhagic fevers and mycotoxins in the Union of Soviet Socialist Republic."

The publication describes the relationship between myocardial mycotoxins and hemorrhagic bleeding associated fever. Mycotoxins are residues of fungi which have a strong resistance-lowering action and therefore be effective in a biological warfare.

From 1954 to 1955, Gajdusek also became the advisor to the Australian Government in Melbourne. Afterward, until 1957, as a representative of the National Institutes of Health, he led a study on the growth and development of children and did research on disease patterns in primitive cultures regarding sleeping viruses in Papua New Guinea in connection with brain diseases.

In the same period, Gajdusek published for the first time pneumocystis carinii, pneumonia PCP, a deadly secondary disease connected with Aids. He made a startling discovery among the Fore tribes in Papua New Guinea where the people appear to suffer from a particular brain disorder which changes the brain tissue into a kind of sponge.

He named this degenerative nerve disorder KURU, a disease like BSE. Back in Washington, he notes that the disease is contagious and it provides a link to CJD, a disease in its turn, is associated with "mad cow disease".

In 1985 and 1986 respectively, he published along with Gibbs and Epstein on operation in humans and found retroviruses as HTLV-I and HTLV-III (HIV-1) in monkeys and horses. In 1976 Gajdusek was awarded the Nobel Prize for medicine. Sources: Gajdusek, 1981; Geisler 1994, Johan van Dongen 1997, 2002 and 2014 (all in books and on our blog Secrets of Aids and Ebola).

Uganda Becomes Independent

Yet a 'wind of change' was blowing through Africa in the early 1960s and Uganda became independent from Britain on 9 October 1962. The first constitution was federalist and the Edward Muteesa was appointed as the first president of Uganda, King of Buganda, and the first prime minister was Milton Obote.

Whatever the merits and demerits of again reviewing the literature on Aflatoxin or Mycotoxin Fungi AF, this review has a specific purpose which has not been thoroughly explored in the past. This is to look at the ravages that these toxins have caused in Africa, not only from an animal and human health point of view but also from the economic consequence of having agricultural commodities contaminated with these toxins.

Although most countries of the world can be affected by AF, it is sub-Saharan Africa (SSA) that has suffered the most. This review reports on the early literature on mycotoxins affecting human up to 1960, which is the time of the discovery of aflatoxin, and to our present knowledge where this problem still persists with Aids, Ebola, and for instance Nodding Disease.

First Stage of Nodding Disease

This is a rapid onset of irritation to the upper gastrointestinal tract, beginning a few hours after ingestion of the toxic cereal product, often bread. The contaminated food would have a peppery taste and produce a burning sensation from the mouth to the stomach.

Within a few days, the patient develops acute gastroenteritis, with nausea, vomiting, and diarrhea, This local effect persists for 3 to 9 days and then spontaneously ends, even when the victim continue to eat the poisoned grain.

Second Stage

A slow degeneration of the bone marrow occurs within 9 weeks. Visible skin hemorrhage appears and hematologic examination reveals a marked decrease in the total number of leukocytes. Before the hemorrhages, the app can be noticed with ear bleedings (Ebola and Aids), some patients display nervous system problems: irritation, weakness, fatigue, vertigo, headache, palpitation and slight asthma.

Third Stage

The most serious stage comes about suddenly and has four essential features:

1. Hemorrhagic syndromes begin with petechial hemorrhage on the skin, axillary, and inguinal areas, arms, thighs, face, and head.

2. Necrosis begins in the throat and spreads throughout the mouth and into the larynx, vocal cords, lungs stomach and bowels.

3. Impaired hematopoietic and reticuloendothelial systems permit widespread bacterial infection in the necrotic areas. Lympnhodes become enlarged.

4. Laryngeal edema and stenosis of the glottis caused by the esophageal lesion, resulting in death because of asphyxiation.

Fourth Stage

Recovery period if clinical help is provided in time

Funding for criminal experiments is raised from development partners: USAID, NORAD, Rockefeller, VECO, and FAO.

In the north of Uganda (mainly Lamwo, Pader and Kitgum districts) as well as South Sudan, thousands of children have fallen ill with what is thought to be a fatal incurable disease known as nodding disease.

Communities are starting to panic and some people are losing hope as the medical community struggles to either find a cause or a cure” (BBC news). Little is known about Nodding Disease except that is thought to be a neurological condition causing abnormal brain activity and seizures.

Currently, the Ugandan Ministry of Health, WHO, CDC, USAID and a number of affiliate research institutions are completing investigations.

What is nodding syndrome and who is Colebunders?

Nodding syndrome is an unexplained epidemic epilepsy. Major unanswered questions remain about the reason for the persistent association with onchocerciasis, possible contributions of nutritional deficiencies or unidentified toxin exposures.

A Belgian professor and lead researcher on nodding syndrome had said, the disease is caused by black flies, validating separate Uganda government findings to be launched in Pader District today.

Asked in an interview in Kampala if it was "conclusive" that bites of infected blackflies, which causes river blindness, was responsible for nodding syndrome, Prof. Robert Colebunders of Antwerp University, replied: "Yes, it is clear that it is the black flies that cause river blindness is that causing the nodding syndrome."

Citing studies he has conducted in Cameroon, the Congo, South Sudan and Uganda, Prof Colebunders said they are yet to unravel the mystery of whether and how the worms or bacteria in the worms from bites of infected blackflies reach the brain of nodding syndrome victims. Of course, he did not mention the application of mycotoxins during the interbellum of handing over power from England to Milton Obote.

The Uganda study found no link between the disease and genetic predisposition, ingested food or water toxins and warfare chemicals.

"We have talked with elders in the community and they told us nodding syndrome was not there in the past. So, it's unlikely inherited," The researchers note in a leaked version of the government report.

It adds: "We also tested samples of blood, hair, and urine of patients and found no toxins. We, however, found many children with the syndrome lacking vitamin B6."

But Professor Colebunders, within scientific publications and official reports, there are 58 brand new diseases described in Uganda and Tanzania since 1976, excluding that of animals. What about an article in the Washington Post of July 7^th, 1992, reported the mass deaths of fish in Lake Victoria?

Belgian Professor Colebunders are you there? What about the devastating publication in the tentative Science Journal in1994? In 1978, reported a certain mysterious brain disease in about 20 percent of all lions in Tanzania. The Lions developed mysterious brain disease because the spread of mycotoxins into the air ending in Lake Victoria.

Another Belgium Professor Guido van der Groen once stated Ebola was made in Fort Detrick USA and Belgian authorities gave permission to Hillary Koprowski to vaccinated millions of Africans with contaminated polio vaccines causing Aids. This statement was in an interview he made with Humo, one of Belgium's leading news magazines but years later changed his statement to avoid 'lynching.'

Contamination of food with fungal toxins

Contamination of food with fungal toxins is not only a plausible etiologic factor in Nodding Syndrome but the cause of it. This form of epilepsy affecting thousands of children in East Africa has never been seen before.

Children developed eating and cold-induced atonic seizures (with head nodding) and generalized seizures during periods of community displacement when food sources were unreliable and food quality was compromised.

The seed of Sorghum bicolor, an important food source during displacement, was collected in a region with Nodding Syndrome. Food loaded up with mycotoxins spread in the open air and eaten by innocent people! Toxins ended up in bacteria and parasites on food and also on the ground. Bacteria and mycotoxins in parasites are like Onchocerca volvulus and the black fly.

The seed extracts were subjected to a multi-mycotoxin LS-MS/MS assay for 87 analytes. Among other mycotoxins, beauvericin (BEA) was identified and confirmed by comparison with a standard using both multiple reaction monitoring (MRM) and enhanced production scans.

Principal component analysis of all positive-mode MRM transitions revealed the clustering of BEA-positive samples (328-744 µg/kg) in "old" sorghum seed samples. BEA is an apolar lipophilic cyclo hexadepsipeptide that forms ionophores in membranes, disturbs intracellular calcium ion homeostasis, disrupts cellular metabolism and induces apoptosis.

Onchocerca volvulus

Onchocerca volvulus is a nematode that causes onchocerciasis or "river blindness" mostly in Africa. Long-term corneal inflammation, or keratitis, leads to thickening of the corneal stroma which ultimately leads to blindness. Humans are the only definitive host for O. volvulus. The intermediate host or vector is the black fly (Simulium).

O. volvulus, along with most filarial nematodes, shares an endosymbiotic relationship with the bacterium Wolbachia. In the absence of Wolbachia, larval development of the O. volvulus is disrupted or ceased.

The life cycle of O. volvulus begins when a parasitized female black fly of the genus Simulium takes a blood meal. The microfilariae form of the parasite found in the dermis of the host is ingested by the black fly.

Here the microfilariae then penetrate the gut and migrate to thoracic flight muscles of the black fly, entering its first larval phase (J1). After maturing into J2, the second larval phase, it migrates to the proboscis where it can be found in the saliva.

Saliva containing stage three (J3S) O. volvulus larvae passes into the blood of the host. From here the larvae migrate to the subcutaneous tissue where they form nodules and then mature into adult worms over a period of six to twelve months.

After maturation, the smaller adult males migrate from nodules to subcutaneous tissue where they mate with the larger adult females, which then produce between 1,000 and 3,000 microfilariae per day. The normal adult worm lifespan is up to fifteen years.

The eggs mature internally to form stage one microfilariae, which are released from the female's body one at a time and remain in the subcutaneous tissue.

Characterising Nodding Syndrome

Nodding syndrome is a progressive condition characterized by head nodding (hence the name), mental retardation and stunted growth affecting mainly children and young adults. Some reports suggest that the episodes of nodding occur when the child begins to eat food or feels cold.

These episodes are said to be brief and disappear when the child stops eating or feels warm again. Little is known about the prognosis of the nodding syndrome but it is thought to be a very debilitating physically and mentally diseased. Attacks can cause children to collapse and injure themselves or die, for example, by falling into a fire.

In September 2010, a team led by the Ministry of Health, Government of Southern Sudan (MoH-GoSS) visited Witto Payam in Western Equatoria State in order to investigate reports from UNOCHA and some INGOs of nodding syndrome in Witto Internal Displaced People (IDP) camp. The objective of the team (composed of the authors of this report) was to provide the MoH-GoSS with workable recommendations on how to tackle the syndrome.

The people now living in the IDP camp had been displaced from Diko, Tore and some surrounding villages by the Lord’s Resistance Army. Most of the IDPs are originally from Witto Payam who moved and settled in Diko during the wartime displacements. The team met community leaders, administrators, and families at Witto IDP camp, Lui town, and Jambo town.

At Witto IDP camp the community leader explained the purpose of the visit (the first government-led delegation to investigate the mysterious nodding phenomenon) to a large crowd of affected children and their parents. There they had a one-hour brainstorming session with a focus group of 25 parents, elders of the community and church leaders.

They used unstructured questions and answers to find out:

• when the community noticed the first case of nodding syndrome

• events that happened, including eating habits, during the civil war and

• what the community thinks causes the disease.

A victim of nodding disease tied to a tree to prevent self-injury during a seizure

The investigation team asked individuals to give a history of the syndrome and to suggest possible causes and ways the condition may be transmitted. They also interviewed five parents with affected children and we tried to elicit the nodding symptom in four children by asking their parents to feed them local foods.

In Jambo town, they repeated a similar brainstorming session with a fifteen-member group and interviewed the Clinical Officer at Jambo Health Centre. At Lui Hospital the group met the administrator and interviewed two doctors, the head nurse, the statistician and five cases at the outpatient department (OPD) and Medical Ward. Some of the team members briefly visited a nearby co-education primary school and collected a list of pupils reported to have the nodding syndrome.

Based on the team’s observations at Witto Payam and a review of the literature it is tentatively speculated that nodding syndrome may be a particular type of epilepsy, found mainly in certain areas of Eastern Africa, which begins with focal symptoms and later progresses to generalized convulsions.

However, its causes remain obscure. The present study relied mainly on data from interviews with local people, and the team recommends that further studies be carried out to investigate this syndrome (including its causes, clinical presentation, and prevalence) in more detail.

These should include laboratory investigations, brain scans, and EEGs, use objective research methods (e.g. case controls) and involve experienced clinicians. Note: After returning from Witto Payam we found that more than 500 cases of nodding syndrome were being treated in Usratuna PHCC in Juba. The PHCC record review indicated that the cases were coming from the wider community of Southern Sudan.

The Ministry of Health should provide adequate medicine for the symptomatic treatment of affected persons urgently conduct research into the possible causes of the nodding syndrome to allow better management of the patients with the illness and to help undertake preventive measures.

Nodding syndrome (NS) is a neurological condition with unknown etiology they stated. It was first documented in the United Republic of Tanzania (URT) in the 1960s, then later in the Republic of South Sudan in the 1990s, and in northern Uganda in 2007.

Typically, NS affects children between the ages of 5 and 15 years old, causing progressive cognitive dysfunction, neurological deterioration, stunted growth and a characteristic nodding of the head. Despite numerous and extensive investigations in all three countries, very little is known about the cause of the disease.

To date, Nodding Syndrome is known to occur in the southern region of the United Republic of Tanzania (URT) (Mahenge mountains, Ulanga District), South Sudan (Western Equatoria State, Eastern Equatoria State, Central Equatoria State, and Lakes State) and northern Uganda (Pader, Kitgum and Lamwo districts, with new cases starting to present in Gulu, Amuru, Oyam and Lira districts).

Jilek et al (1962) first described several children with attacks of “head nodding” in Mahenge, a region in URT. The current burden of NS in URT is unknown but observations during case-control studies in 2005 and 2009, in the Mahenge region do not suggest a notable increase in the number of cases relative to those detected in the late 1950s and early 1960s.

Samaritan Purse, a local NGO, described observations of head nodding among several children in southern Sudan in the Lui and Amadi villages of East Mundri County in the mid-1990s. A physician from Samaritan Purse reported the outbreak to the World Health Organization in 1997.

The 2001-2002 investigations by WHO and partners estimated the prevalence of NS at 4.6% among a small population in Western Equatoria State, which appeared to have the highest burden of the illness. By 2003, an estimated 300 cases had been reported from this region.

The Ministry of Health of South Sudan estimates the current burden of NS at between six and seven thousand cases, but no systematic large-scale prevalence study has been conducted. The Mundri region in the northeast of Western Equatoria is the presumed epicenter for the disease.

In 2008 and 2009, an illness consistent with NS was reported from Kitgum and Pader Districts in northern Uganda. As of February 2012, Uganda has reported over 3 000 cases of NS from the three districts of Kitgum, Lamwo, and Pader.

A community survey is underway in Uganda to determine the real burden of NS in the affected districts. Kaiser et al (2009) referred to a phenomenon of head nodding observed in the Kabarole District in Western Uganda as possibly constituting a feature of an epileptic syndrome caused by Onchocerca volvulus (O. volvulus).

The prevalence of both onchocerciasis and epilepsy in the areas affected by NS is high. The affected populations are impoverished and experience regular and prolonged periods of severe food shortages. In South Sudan and in northern Uganda, affected populations have a history of internal displacement and living in internally displaced persons (IDPs) camps.

Familial clustering has been observed in some families with NS patients, with more than one sibling with NS and/or siblings or relatives with other forms of epilepsy.

The age of onset of the vast majority of cases ranges between 5 and 15 years old, but cases have been reported in children as young as 2 years old and in adults up to 32 years old. There is no observed significant difference in the proportion of males to females among the affected, nor is there an observed seasonal variation

Testimonial of father John Oboda and others

"He started nodding his head at the age of two whenever we gave him food," father John Oboda stated. “Our family is unable to farm because I always have to care for the children, the family is slipping deeper and deeper into poverty.”

Francis Anywar, the child involved, sits in front of the grass thatched home. The 15-year-old is naked and appears to be in another world - never speaking.

A quote from the child’s mother: "When I go off to farm, I tie them to the tree so they don't get injured. If they walk off they don't know where they are going they just keep walking and get lost. We are getting stressed dealing with this traumatic situation.”

You see new cases every day - children having fits, others falling down. As a human being you feel the pain," says Adong Josephine, a psychiatric nurse in Kitgum hospital.

Mycotoxins and new diseases like mycosis fungoid

When scientists publish extensively in 1950 about biowarfare products like mycotoxins, the incidence of Kaposi sarcoma, a skin cancer caused by the cytomegalovirus CMV, causing mini-Aids, with a special reference of the incidence in South African black men, it was linked to experiments of the Nazis and the postwar consistently in Africa, that scientists dealt with specific occurrences and Kaposi’s sarcoma in Ugandan Africans blacks, mainly a disease affecting black children over there.

During the hand-over of power to Milton Obote, the USA, England, and French did widespread biowarfare experiments in this specific region of Africa. Outside this region nodding disease is much less common or absent.

They unanimously agreed that the death of children hypothesis was caused by a sudden increase of virulence in the local strain. “But why this virulent strain became so aggressive?” They didn’t say the reason, of course, because of the bio-warfare agents like mycotoxin and aflatoxin in public.