Unusual Ascitic Syndromes in Two Health Districts in Niger: A Public Health Alert and Etiological Hypotheses

Abstract

Background: Ascites is rare in children and typically linked to hepatic, infectious, or nutritional causes. In early 2025, an unusual cluster of pediatric ascitic syndromes was reported in two health districts in central Niger, prompting an epidemiological investigation. Methods: A field investigation was conducted in the Dogondoutchi and Tibiri districts between March 12 and 16, 2025. Data were collected through record reviews, interviews with local health teams, and field visits. Community engagement activities were also implemented to assess local perceptions and identify additional cases. Results: A total of 128 cases, mostly children aged 5–14 years (66.4%), were identified, with a case fatality rate of 1.56%. Clinical features included progressive abdominal distension, ascites, hepatomegaly, and generalized edema. Ascitic fluid was citrine yellow and sterile. No clear infectious cause was found. Conclusion: This outbreak constitutes a public health alert. Further etiological investigations, including toxicological and virological analyses, are urgently needed. A One Health approach involving human and veterinary sectors is crucial to identify the source and prevent recurrence.