1. By Macben Chibuife

2. 1IntroductionHypothesis Specific Aim 2CausesSignificance 3DesignInnovation

4. HYPOTHESIS Nigeria is vulnerable to the fast spreading nodding disease, with high rate of malnutrition and poor health service.

6. Significance  Its spreading fast  99% living Africa  UNICEF estimates that “1.1million children are threatened with severe malnutrition.”

7. AIM To conduct an epidemiological study to establish the association between malnutrition, metabolic disorder and Onchocerciasis to Nodding disease (ND) in Northern Uganda

8. Design  101 children that are infected  Inclusion criteria  2 – 15 years  Permission from parents.  Exclusion criteria  Previous issue of abnormal behavior before infection  Parents disapproval  101 children that are NOT infected  Inclusion criteria  Healthy children that have lived in the camp since they were 2 years old  Exclusion criteria  Healthy children that have not lived in that environment since they were 2 years old

9. Design  Questionnaires will be used to collect data  And parents will be interview  Body mass and height will be collected for both ND and non- ND according to their ages  Using the World Health Organization (WHO) chart, I will be able to detect the malnourished.  (Those with a BMI of –2SD or less were considered to be malnourished)

10. SPSS Software OR and CI  Depended variables  Infected  Independent variables  sex, age, level of education,  schooling status, anthropometric measurements  Weight, Pre, post and natal experiences of the  (serum albumen levels) and skin snips for OV microfilariae).

13. TESTS  Two blood and skin snip samples  serum albumen test, to check protein, a serum level of less than 38g/dL for a child was considered malnourished  Fishers test, Independent risk factor where p=0.025  Chi-square test, a statistical method assessing the goodness of fit between observed values and those expected theoretically.  BMI, (2SD -3SD)  a serum level of less than 38g/dL for a child was considered malnourished (Χ =2.935, p=0.087; OR 1.635 95%Ci 0.930, 2.875)

14. Result  (Χ 2=2.935, p=0.087; OR 1.635 95%Ci 0.930, 2.875)  (Χ2 =7.846, p=0.005; OR 11.361 95%CI 1.401, 92.137) Secrum potassium.  (Χ2 =5.127, p<0.001; OR 0.049 95%CI 0.023, 0.102). This indicated that most NS were in a state of hyponatraemia  Children with NS were more likely to have a positive skin snip for Onchocerciasis than controls  it was observed that most children with NS had not been treated with Ivermectin prior

16. Result cont..  45% NON-infected had OV treatment, while 55% did not  29% infected had OV treatment, while 71% did not  77.7 infected has OV, while 9.9 doesn't’  I expect over 60% to be malnourished

17. Conclusion  Nodding syndrome is associated with metabolic disorder in young children who are malnourished and infected with Onchocerciasis.  Nigeria need to quickly start treating OV and reduced the rate of malnourished kids. Currently, over 1.1 million per year

18. Reference page  Lacey M. Nodding disease: mystery of southern Sudan. Lancet Neurology.  2003;2(12):714.  2. Richer M, Baba S, Kolaczinski J. Nodding disease/syndrome In: Neglected tropical  diseases in Southern Sudan. Ministry of Health, Government of Southern Sudan.  2008;45-46.  3. Sejvar J, Foltz J, Dowell S. Nodding disease in Uganda – new clues, persistent  enigma. Scientific Seminar report by CDC, Kampala, Uganda; 2010.  4. Winkler AS, Friedrich K, König R, Meindl M, Helbok R, Unterberger I, et al. The head  nodding syndrome-clinical classification and possible causes. Epilepsia. 2008;49(12).  5. Gibson C. Two Cases of Head Nodding in Infants. Br Med J. 1909;2(2536):314.  PMID20764611.