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Irani J, Rujumba J, Mwaka AD, Arach J, Lanyuru D, Idro R, Colebunders R, Gerrets R, Peeters Grietens K, O’Neill S. 'There Were Moments We Wished She Could Just Die': The Highly Gendered Burden of Nodding Syndrome in Northern Uganda. QUALITATIVE HEALTH RESEARCH 2022; 32:1544-1556. [PMID: 35549600 PMCID: PMC9411690 DOI: 10.1177/10497323221085941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nodding Syndrome (NS) occurs within a wide spectrum of epilepsies seen in onchocerciasis endemic areas of sub-Saharan Africa. It has debilitating consequences on affected individuals and increases the socio-economic, physical and psychological burden on care-givers and their households, diminishing their standing within the community. Social science research on the disproportionate burden of the disease on females is limited. Based on ethnographic research over 3 years in northern Uganda, we explored the burden of being ill and care-giving for persons with NS from a gendered perspective. We found that NS-affected females were at greater risk of physical and psychological abuse, sexual violence, unwanted pregnancies, sexually transmitted infections and stigma, in a context of deteriorating socio-economic conditions. Primary care-givers of the NS-affected, mostly women, struggled to make ends meet and were subjected to stigma and abandonment. Targeted interventions, including legal protection for affected females, stigma reduction, and psycho-social and financial support are needed.
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Affiliation(s)
- Julia Irani
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- The Ugandan Ministry of Health, Kampala, Uganda
| | - Jesca Arach
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Denis Lanyuru
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Idro
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- The Ugandan Ministry of Health, Kampala, Uganda
| | | | - René Gerrets
- The Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
- The Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
| | - Koen Peeters Grietens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- The Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Sarah O’Neill
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- CR5–School of Public Health and LAMC, Faculté de Philosophie et Sciences Sociales, Université Libre de Bruxelles, Brussels, Belgium
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Ongaya K, Aturinde A, Farnaghi M, Mansourian A, Maiga G, Oyo B, Bagarukayo E. Spatiotemporal Analysis of Nodding Syndrome in Northern Uganda 1990-2014. Health (London) 2020. [DOI: 10.4236/health.2020.122015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Irani J, Rujumba J, Mwaka AD, Arach J, Lanyuru D, Idro R, Gerrets R, Grietens KP, O’Neill S. "Those who died are the ones that are cured". Walking the political tightrope of Nodding Syndrome in northern Uganda: Emerging challenges for research and policy. PLoS Negl Trop Dis 2019; 13:e0007344. [PMID: 31220081 PMCID: PMC6605670 DOI: 10.1371/journal.pntd.0007344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/02/2019] [Accepted: 03/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background Nodding Syndrome was first reported from Tanzania in the 1960s but appeared as an epidemic in Northern Uganda in the 1990s during the LRA civil war. It is characterized by repetitive head nodding, often followed by other types of seizures, developmental retardation and growth faltering with onset occurring in children aged 5–15 years. More than 50 years after the first reports, the aetiology remains unknown and there is still no cure. The recent hypothesis that Nodding Syndrome is caused by onchocerciasis also increases the relevance of onchocerciasis control. Northern Uganda, with its unique socio-political history, adds challenges to the prevention and treatment for Nodding Syndrome. This article aims to show how and why Nodding Syndrome has been politicised in Uganda; how this politicisation has affected health interventions including research and dissemination; and, the possible implications this can have for disease prevention and treatment. Methodology Ethnographic research methods were used triangulating in-depth interviews, focus group discussions, informal conversations and participant observation, for an understanding of the various stakeholders’ perceptions of Nodding Syndrome and how these perceptions impact future interventions for prevention, treatment and disease control. Principal findings Distrust towards the government was a sentiment that had developed in Northern Uganda over several decades of war and was particularly linked to the political control and ethnic divisions between the north and south. This coincided with the sudden appearance of Nodding Syndrome, an unknown epidemic disease of which the cause could not be clearly identified and optimal treatment had not clearly been established. Additionally, the dissemination of the inconclusive results of research conducted in the area lacked sufficient community involvement which further fueled this political distrust. Disease perceptions revolved around rumours that the entire Acholi ethnic group of the north would be annihilated, or that international researchers were making money by stealing study samples. This discouraged some community members from participating in research or from accepting the mass drug administration of ivermectin for prevention and treatment of onchocerciasis. Such rumour and distrust led to suspicions concerning the integrity of the disseminated results, which may negatively impact future disease management and control interventions. Conclusions and recommendations Trust must be built up gradually through transparency and by de-politicising interventions. This can be done by engaging the community at regular intervals during research and data collection and the dissemination of results in addition to involvement during service delivery for prevention and treatment. Maintaining a regular feedback loop with the community will help control rumours, build trust, and improve the preparations for adequate dissemination. Nodding Syndrome, a form of epilepsy that occurs in onchocerciasis-endemic areas has affected about 3000 children in Northern Uganda where the epidemic emerged at the time of the civil war. Although an association with onchocerciasis has been established, the disease etiology has not yet been identified. In conjunction with the area’s history of war, political conflict and ethnic divides, many affected people were suspicious of government health interventions and scientific studies. Furthermore, ambiguities around the disease etiology leaves room for several interpretations, which in addition to distrust leads to rumours, that may hinder future interventions. In view of improving adherence to health interventions, this article explains the socio-political nature of Nodding Syndrome in Northern Uganda. We show how and why this disease has been politicised in Uganda; how this politicisation has affected research and dissemination; and, the implications this has for disease control. The insights presented will be critical for reducing resistance to research, to treatment and to the dissemination of knowledge which is necessary for the prevention and control of Nodding Syndrome and onchocerciasis in Northern Uganda.
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Affiliation(s)
- Julia Irani
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | - Joseph Rujumba
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- The Ugandan Ministry of Health, Kampala, Uganda
| | - Jesca Arach
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Denis Lanyuru
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Idro
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
- The Ugandan Ministry of Health, Kampala, Uganda
| | - Rene Gerrets
- The Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | | | - Sarah O’Neill
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- CRISS, Ecole de Santé Publique and LAMC, Faculté de Philosophie et Sciences Sociales, Université Libre de Bruxelles, Brussels, Belgium
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O’Neill S, Irani J, Siewe Fodjo JN, Nono D, Abbo C, Sato Y, Mugarura A, Dolo H, Ronse M, Njamnshi AK, Colebunders R. Stigma and epilepsy in onchocerciasis-endemic regions in Africa: a review and recommendations from the onchocerciasis-associated epilepsy working group. Infect Dis Poverty 2019; 8:34. [PMID: 31109376 PMCID: PMC6526597 DOI: 10.1186/s40249-019-0544-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/21/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In onchocerciasis-endemic areas, particularly in those with a sub-optimal onchocerciasis control programme, a high prevalence of epilepsy is observed. Both onchocerciasis and epilepsy are stigmatizing conditions. The first international workshop on onchocerciasis-associated epilepsy (OAE) was held in Antwerp, Belgium (12-14 October 2017) and during this meeting, an OAE alliance was established. In this paper, we review what is known about epilepsy-associated stigma in onchocerciasis-endemic regions, and present the recommendations of the OAE alliance working group on stigma. MAIN BODY For this scoping review, literature searches were performed on the electronic databases PubMed, Scopus and Science Direct using the search terms "epilepsy AND onchocerciasis AND stigma". Hand searches were also undertaken using Google Scholar, and in total seven papers were identified that addressed epilepsy-related stigma in an onchocercisasis-endemic area. Due to the limited number of published research papers on epilepsy-associated stigma in onchocerciasis-endemic areas, other relevant literature that describes important aspects related to stigma is discussed. The thematic presentation of this scoping review follows key insights on the barriers to alleviating the social consequences of stigma in highly affected onchocerciasis-endemic areas, which were established by experts during the working group on stigma and discrimination at the first international workshop on OAE. These themes are: knowledge gaps, perceived disease aetiology, access to education, marriage restrictions, psycho-social well-being, burden on the care-giver and treatment seeking behaviour. Based on the literature and expert discussions during the OAE working group on stigma, this paper describes important issues regarding epilepsy-related stigma in onchocerciasis-endemic regions and recommends interventions that are needed to reduce stigma and discrimination for the improvement of the psycho-social well-being of persons with epilepsy. CONCLUSIONS Educating healthcare workers and communities about OAE, strengthening onchocerciasis elimination programs, decreasing the anti-epileptic treatment gap, improving the care of epilepsy-related injuries, and prioritising epilepsy research is the way forward to decreasing the stigma associated with epilepsy in onchocerciasis-endemic regions.
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Affiliation(s)
- Sarah O’Neill
- CRISS – School of Public Health, Université Libre de Bruxelles and LAMC Faculté de Philosophie et de Sciences Sociales Université Libre de Bruxelles, Brussels, Belgium
| | - Julia Irani
- Department of Public health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Denis Nono
- Department of Mental Health, Austrian Partnership Programme in Higher Education and Research for Development (APPEAR) Project & AVSI Foundation, Gulu University, Gulu, Uganda
| | - Catherine Abbo
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Yasuaki Sato
- Department of Environmental Science and Technology, Osaka Sangyo University, Osaka, Japan
| | | | - Housseini Dolo
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Maya Ronse
- Department of Public health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alfred K. Njamnshi
- Department of Neurology, Yaoundé Central Hospital/FMBS, The University of Yaoundé I, Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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van Bemmel K, van der Weegen K. Universal classifications, national approaches and specific situations: a comparative study on the conceptualization of nodding syndrome in Uganda and Tanzania. Anthropol Med 2017; 26:177-196. [PMID: 29081237 DOI: 10.1080/13648470.2017.1361652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper presents a comparative study on conceptualizations of the poorly understood nodding syndrome (NS) in Uganda and Tanzania. NS has been constructed as a biomedical category to serve global health discourse as well as national contexts of managing the condition. The paper looks into the shifting meanings and conceptualizations of NS in the affected areas of Kitgum (UG) and Mahenge (TZ) district. The perceived universality of biomedical classifications is problematized as conflicting with the specific contexts of lucluc and kifafa cha kusinzia. Reconciliation proves to be challenging, poignantly evoking the cultural construction as such of any medical condition.
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Affiliation(s)
- Karin van Bemmel
- Department of African Languages and Cultures, Ghent University , Ghent , Belgium
| | - Kim van der Weegen
- Department of Cultural Anthropology, Utrecht University , Utrecht , Netherlands
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