SSMJ February 2011
Editorials
In September 2010 the Government of Southern Sudan’s Ministry of Health sent a team to Kediba, Witto Payam, Mundri East County in Western Equatoria State after reports that there was an increase in the number of cases of a bizarre disease known as ‘nodding syndrome’ in the area. The team found 96 cases registered in the internally displaced camp1 (see the main article in this issue).
News, Reports and Policy
Each year GOAL in South Sudan conducts a Multiple Indicator Cluster Survey (MICS) at their field sites in Twic County (Warrap State), Agok (Abyei) and Sobat (Ulang and Baliet Counties, Upper Nile State). These give comprehensive and representative data on many indicators including: nutritional status; mortality; morbidity in the last two weeks; immunisation coverage; child feeding practices; household food security; water; sanitation & hygiene; maternal and general health; malaria prevention; HIV/AIDS, and education.
The redevelopment of the Martha PHCC Eye Clinic took place during 2010. Figure 1 shows what the building looked like at the start of the year. It had been constructed as two wards for the former eye clinic, and was to have been operated by an NGO. However, it was never completed and for several years the empty building was used by youths for drug taking and graffiti, and to generally cause a nuisance to those who lived nearby.
Clinical Guidance
This is the first in a series of articles on malaria. It is intended for everyone in South Sudan who diagnoses and treats malaria, and advises on how to prevent it. This article gives an overview of the epidemiology of malaria, the parasite’s lifecycle and the pathophysiology of the disease. There is more information in items listed at the end of the article. Also in this issue of the journal are two articles on the diagnosis of malaria. Treatment and prevention will be covered in future issues.
The previous article, ‘Introduction and patho-physiology’, reviewed the mechanism of transmission of malaria, the types of parasite and the life cycle of the malarial parasite. In South Sudan, 90% of malaria is caused by Plasmodium falciparum (P. falciparum). This article focuses on the clinical features and diagnosis of P. falciparum but for completeness will also discuss the other main species of malarial parasites.
The previous article described the clinical features and diagnosis of malaria. However, for a definite diagnosis, the malaria parasite must be seen in a blood film. In this article we cover laboratory tests used to diagnose malaria...
In Kenya we are trying to focus on confirming the diagnosis of malaria using microscopy or rapid test diagnostic kits (RDTs) rather than just treating a presumed clinical diagnosis. Many health staff in dispensaries and health centres still believe that every fever is malaria and that malaria tops the list of diseases even in non-endemic area. This belief is strong particularly among those who have had training in IMCI (Integrated Management of Childhood Illness). One result of this belief is that many patients are given artemether-lumefantrine treatment (AL) unnecessarily with the additional risk that other causes of fever go untreated. I wonder if it is the same in South Sudan?
Research
Observations and reports of the nodding episodes both from this study and from others in Tanzania and Uganda lead us to speculate that the nodding syndrome may be a particular form of epilepsy found mainly, perhaps only, in this area of Africa. The study in Tanzania, which did MRI scans and EEG recordings (4), concluded that head nodding is “possibly a new epilepsy disorder in sub-Saharan Africa”. A previous study in Lui indicated that EEG results were consistent with a specific encephalopathy, which progresses in well-defined stages, and nodding represents the onset of symptoms and the ictal events common to all stages of epilepsy (5). However until this condition can be further investigated by a clinical neurologist and by doing more EEGs it is difficult to come to definite conclusions.
Malnutrition is a chronic public health problem in Aweil East and North counties with an estimated prevalence of between 15% and 25%.
Underlying contributing factors include: political instability, poor infrastructures, droughts and floods resulting in low crop yields, poverty and limited awareness of good nutrition and health practices.
At the time of the survey there were six decentralised centres feeding severely and moderately malnourished children below 5 years. As well as feeding activities, nutrition and health education was given in order to improve health and nutrition awareness.
The objective of this survey was to assess knowledge, attitudes and practices of mothers (or caretakers) of children admitted in the feeding programme.
Case Reports
Here are two photographs of a baby boy, aged 11 months, who was born in Nyala, Darfur. The mother is married to her direct/first cousin. This is her 6th child – two of them were born with the same condition – a boy died at age 3 months and a girl at age 27 months. Her brother had two children with the same condition – both died.
Summaries
These resources are listed under:
Chronic diseases
HIV and other infections
Maternal and child health
Nutrition
Medicine and other conditions
Surgery
Continuing medical education