Economic and Social Costs of Noma: Design and Application of an Estimation Model to Niger and Burkina Faso

Abstract

Background. While noma affects hundreds of thousands of children every year, taking their lives, disfiguring them and leaving them permanently disabled, the economic and social costs of the disease have not been previously estimated. An understanding of the nature and levels of these costs is much needed to formulate and implement strategies for the prevention and control of this disease, or to mitigate its burden. The objectives of our study were to develop a model for estimating the economic and social costs of noma and to provide estimates by applying this model to the specific contexts of two countries in the “noma belt”, namely Burkina Faso and Niger. Methods. Three main approaches were used. The estimation of prevalence levels of potential noma cases and of cases that should receive and actually do receive medical care was carried out using a literature review. The documentary approach made it possible to estimate the direct costs of noma by analyzing the database of a non-governmental organization operating in this field and present in both countries. Indirect costs were estimated using the human capital method and the cost component analysis technique. Results. The direct costs of care and management of noma survivors amount to approximately USD 30 million per year in Burkina Faso, compared to approximately USD 31 million in Niger. They mainly include costs for medical treatment, surgery, hospital stays, physiological care, psychological care, social assistance, schooling, vocational training and care abroad. Indirect costs are estimated at around 20 million in lost production costs in Burkina and around 16 million in Niger. Costs related to premature deaths are estimated at more than USD 3.5 billion in Burkina Faso and USD 3 billion in Niger. Finally, the costs to survivors who are unable to marry are around USD 13.4 million in Burkina and around USD 15 million in Niger. Intangible costs were not calculated. Conclusions. The neglect of noma and inaction in terms of prevention and control of the disease have enormous economic and social costs for households, communities and states. Future studies of this kind are necessary and useful to raise awareness and eradicate this disease, which impacts the health and well-being of children and results in lifelong suffering and severe economic and social costs to survivors and their families.

Psychosocial aspects of Noma (Cancrum Oris) in sub-Saharan Africa: A scoping review

“…peer-reviewed original articles published in SSA on the topic) covering four of the 46 SSA nations, namely Burkina Faso, Niger, Nigeria, Ethiopia, and both Niger and Burkina Faso, three studies are qualitative, two cross-sectional and one retrospective. Key conclusions are: (1) one-third experience significant psychological distress 5 ; (2) social issues such as bullying, social exclusion and isolation are frequent 9,12 ; (3) the disease has significant social and economic costs, with lost productivity estimated between 16 and 20 m US$ 6 ; and (4) many patients and caregivers are involved.…”

“…1 In spite of these theories, there are serious psychosocial issues across the whole duration of illness continuum. 4,5 The few studies addressing psychosocial aspects in Noma [4][5][6] are unanimous in their findings of significant psychological and social issues either as complications of the disease [4][5][6] or contributing to help-seeking. 5 Psychiatric disorders are known to be common among the facially disfigured and have been estimated to range from 30-50% with anxiety-related and depressive disorders being predominant.…”

The severity of psychosocial (appearance anxiety and social phobia) and functional morbidity among patients presented with non-treated Noma-induced facial disfigurements in Ethiopia

“…Noma is associated with long-term functional, aesthetic, and psychosocial morbidities [14]. For example, Noma survivors in Laos reported a high level of hopelessness and related functional impairments [15].…”

Noma: Experiences of Survivors, Opinion Leaders and Healthcare Professionals in Burkina Faso

“…Other social consequences include fear of contagion and popular beliefs that attribute noma to a curse or spell cast on the child or their family [ 4 , 5 ]. Of note, because noma is present in high-poverty areas, the economic cost of its treatment (i.e., surgery, accommodation) largely overpasses household financial resources [ 6 ]. Calls for the recognition of noma as a neglected tropical disease by WHO have emerged in the recent literature [ 7 , 8 , 9 ].…”