Uganda: how goes the nodding syndrome war?

30 www.thelancet.com/neurology Vol 15 January 2016 Northern Uganda, epicentre of the nodding syndrome epidemic. It is diffi cult to know how many children are aff ected: fi gures of 1700 to more than 3500 are reported, depending on the consensus case defi nitions used. In 2011, having asked WHO and the Centers for Disease Control and Prevention (CDC) for assistance in determining what they were dealing with, the Ugandan authorities drew up a two-phase response plan. Covering everything from the training of healthcare workers to the establishment of specialised treatment centres and special needs schools, through to spraying against the black fl y vector of Onchocerca volvulus—the river blindness nematode, with which nodding syndrome has a puzzling but consistently reported association—the plan was audacious for a country with scarce resources. With both phases now complete, is Uganda closer to gaining control? And what happens next? The fi rst emergency phase of the plan, which ran throughout 2012, made notable headway. “In early 2012, I was tasked to assemble a team and develop a clinical intervention”, explains Richard Idro (Makarere University College of Health Sciences, Kampala, Uganda). “We used previous clinical descriptions and our own observations to come up with a strategy for symptomatic management, we developed a training manual for health-care workers, and then ran two associated training courses.” The trainees were deployed to three newly formed specialised treatment centres. “There are now 17 such centres across northern Uganda where 3500 patients can receive treatment”, adds Bernard Opar (National Coordinator of the Nodding Syndrome Response, Ministry of Health, Kampala, Uganda). Other advances were made too. “A scientifi c conference on nodding disease was arranged in Kampala for late July 2012”, explains Mwaka Amos Deogratius (also of Makarere University College of Health Sciences). “District task forces were formed to track progress and identify problems at the local level, and a national task force formed to oversee and coordinate all interventions.”