First description of Nodding Syndrome in the Central African Republic.

BACKGROUND: The term Nodding Syndrome (NS) refers to an atypical and severe form of childhood epilepsy characterized by a repetitive head nodding (HN). The disease has been for a long time limited to East Africa, and the cause is still unknown. The objective of this study was to confirm the existence of NS cases in Central African Republic (CAR). METHODOLOGY/PRINCIPAL FINDINGS: This was a cross-sectional descriptive study in the general population. The identification of NS cases was conducted through a door-to-door survey in a village near Bangui along the Ubangui River. Based on Winkler's 2008 and the World Health Organization (WHO)'s 2012 classifications, the confirmation of cases was done by a neurologist who also performed the electroencephalograms. No laboratory tests were done during this investigation. Treatment was offered to all patients. A total of 6,175 individuals was surveyed in 799 households. After reviewing the cases, we identified 5 NS cases in girls aged between 8 and 16. The age of onset of the seizures was between 5 and 12 years of age. Two cases were classified as "HN plus" according to Winkler's 2008 classification. Four NS cases were classified as probable and one as confirmed according to the WHO's 2012 classification. Three of them presented with developmental delay and cognitive decline, and one had an abnormally low height-for-age z-score. Electroencephalographic abnormalities were found in four patients. CONCLUSIONS/SIGNIFICANCE: Nodding Syndrome cases were described in CAR for the first time. Despite certain peculiarities, these cases are similar to those described elsewhere. Given that only a small part of the affected area was investigated, the study area along the Ubangui River needs to be expanded in order to investigate the association between Onchocerca volvulus and NS and also evaluate the real burden of NS in CAR.

Focus of Ongoing Onchocerciasis Transmission Close to Bangui, Central African Republic.

Recently, there were anecdotal reports of a high number of persons with epilepsy, including children with nodding seizures in the Landja Mboko area located about 9 km from the capital city Bangui, Central African Republic. We suspected the area to be endemic for onchocerciasis, and that the alleged increase in the number of epilepsy cases was due to ongoing Onchocerca volvulus transmission. However, ivermectin mass drug distribution (MDA) had never been implemented in the area. Therefore we performed an Ov16 antibody prevalence study among children, aged 6-9 years, using the biplex rapid diagnostic test (SD Bioline Oncho/LF biplex IgG4 RDT). The overall Ov16 seroprevalence was 8.9%, and that of lymphatic filariasis (LF) was 1.9%. Ov16 seropositivity was highest in Kodjo (20.0%), a village close to rapids on the river. Our study shows that there is ongoing O. volvulus transmission in the Landja Mboko area. We recommend that the extent of this onchocerciasis focus should be mapped, and the introduction of ivermectin MDA should be considered in these communities.

Sociocultural representations of epilepsy in the Central African Republic: A door-to-door survey.

PURPOSE: To describe sociocultural representations of epilepsy in a sub-Saharan Africa rural community using a population-based approach. METHOD: A cross-sectional door-to-door survey was underway on a rural community of the Central African Republic in 2015. A two-stage stratified sampling was performed. Trained care personnel performed individual face-to-face interviews. A standardized questionnaire was used to assess epilepsy. We collected sociodemographic data and cultural representations toward epilepsy in general population. RESULTS: Overall, 1023 participants were interviewed. Epilepsy prevalence was 11.7 (95%CI 6.7-20.4) per 1000 people. In the rural community, epilepsy was identified as a supernatural disease related to bad luck (40.4%), witchcraft (31.3%) or a curse (28.3%). Epilepsy was confused with a mental disorder in 75.9% of subjects. Three quarters of participants (75.3%) considered epilepsy as a contagious disease. Saliva was mainly mentioned as a means of transmission in 63.8%. More than half of participants preferred or recommended traditional treatments. Only 24.8% believed in the efficacy of medical treatment for epilepsy. CONCLUSIONS: Epilepsy misconceptions are highly prevalent in rural sub-Saharan Africa. Understanding misrepresentations is an essential phase to develop culturally appropriate interventional programs in order to improve medical treatment adherence, quality of life, and to decrease stigma. Campaigns to raise awareness are needed in urban and rural population to reduce misconception and combat stigmatization.