Table 2.
Anamnestic information and clinical findings in patients with reported head nodding (nateera omutwe), identified in Kabende parish, western Uganda, March 1994–February 1996
| Patient number age/gender | Height (cm) height-for-age*/BMI* (z-scores) | Anamnestic information | Clinical findings | Skin snip for Onchocerca volvulus |
|---|---|---|---|---|
| Patients identified during initial epilepsy prevalence survey March – June 1994 (see refs. 3 and 4) | ||||
| 1. ♂/14 years | 146.5 cm −2.17/−2.02 | Always healthy, until HN started 5 months ago, still attending school (primary two) | 1 O.n.† otherwise normal examination, good communication. TS staging‡: G3 | Positive |
| 2. ♂/11 years | 116 cm−4.16/−0.87 | Born healthy. Episode of malnutrition at age of 1 year, full recovery. Growth failure and mental retardation from the age of 7 years (onset HN). Never in school | Stunting, itching skin rash, mental impairment, speaks some single words, disturbed coordination. TS staging‡: G1 | Positive |
| 3. ♀/14 years | 149 cm−1.75/−1.97 | Normal development until the onset of HN (age 8 years). Left school at primary two and was a good pupil | Impaired cognition, slow movements, otherwise normal. TS staging‡: B3/P3 | Positive |
| 4. ♂/14 years | 152.5 cm −1.47/+0.79 | Healthy and normal cognitive development up to the start of HN at the age of 6 years. Never in school | Apathetic, Slow movements, general weakness, unable to cooperate in neurological examination. 1 O.n.† TS staging‡: G3 | Positive |
| 5. ♀/8 years | 121 cm−1.20/+0.29 | Normal birth and development until HN started 2 years ago. Left school because of HN | During examination abruptly changing between proper comprehension/confusion. Otherwise normal. TS staging‡: B1/P1 | Positive |
| 6. ♀/14 years | 141 cm−2.97/−2.92 | Normal development up to primary two (good pupil), dropped out when HN started | Wasting, impaired communication (single words), and coordination. 1 O.n.† TS staging‡: B3/P2 | Positive |
| 7. ♀/12 years/ | 116 cm−4.64/−2.16 | Normal development up to age of 3 years (Start HN). Growth failure and mental decline thereafter | Apathetic, stunting, scars from burns, and thickened dark skin. 1 O.n.† TS staging‡: B1/P1 | Positive |
| 8. ♂/15 years§ | 110 cm−6.10/−9.4 | Normal speech and cognition until the age of 7 years. With the onset of HN progressing deterioration | Apathetic, stunting, wasting, unable to stand, infantile genitalia, and 1 O.n. TS staging‡: G1 | Positive |
| 9. ♀/12 years | 135 cm−1.97/−1.6 | Normal development before HN onset at the age of 8 years. Had to leave school 7 months ago | No details of examination available (left place before being examined) | n.d. |
| 10. ♂/15 years | 156 cm−1.72/−0.77 | Normal development until now, onset of HN 3 months ago, and was taken out of school for working (cattle keeping) | Normal examination. 1 O.n. TS staging‡ n.d. | Negative |
| Patients identified during follow-up July 1994–February 1996 (see refs. 18 and 19) | ||||
| 11. ♀/15 years | n.d. | Normal mental and physical development until now. Never in school, no reason given | Normal examination. TS staging§ B3/n.d. | n.d. |
| 12. ♀/12 years | 144 cm−1.01/−0.99 | Normal mental and physical development until now. Still attending school, primary four | Normal examination. TS staging§ B3/n.d. | n.d. |
| 13. ♂/12 years | 148 cm−0.18/−0.43 | Normal mental and physical development until now. Left school in primary three because of seizures 3 month ago | Papular, thickened, dark, and itching skin changes. 1 O.n.‡ Otherwise normal examination. TS staging§ n.d. | n.d. |
| 14. ♂/13 years | 143 cm−1.78/−1.87 | Normal development until 1 year ago when impairment started, had to leave school at primary one | Papular, thickened, dark, and itching skin changes. Mental impairment, drooling. TS staging§ n.d. | n.d. |
| 15. ♀/13 years | 136 cm−3.04/+0.34 | Healthy at birth, normal mental development until now. Attending school in primary three. Start of growth failure unclear | TS staging§ B1/P1. Otherwise normal | n.d. |
BMI = body mass index; n.d. = not done.
*
z-scores for height-for-age and BMI based on 2000 CDC child growth standard (ref. 20).
†
O.n. = palpable onchocerciasis nodule.
‡
TS = tanner maturity stages for breast (B1/infantile–B5) and pubic hair (P1–P5) for girls, and male genital maturity stages (G1-5) (refs. 21 and 22).
§
Details of patient published as case report (ref. 5).