‘I treat it but I don’t know what this disease is’: a qualitative study on noma (cancrum oris) and traditional healing in northwest Nigeria

Abstract

Background Noma, a neglected disease mostly affecting children, with a 90% mortality rate if untreated, is an orofacial gangrene that disintegrates the tissues of the face in <1 wk. Noma can become inactive with early stage antibiotic treatment. Traditional healers, known as mai maganin gargajiya in Hausa, play an important role in the health system and provide care to noma patients. Methods We conducted 12 in-depth interviews with caretakers who were looking after noma patients admitted at the Noma Children's Hospital and 15 traditional healers in their home villages in Sokoto state, northwest Nigeria. We explored perceptions of noma, relationship dynamics, healthcare practices and intervention opportunities. Interviews were audiorecorded, transcribed and translated. Manual coding and thematic analysis were utilised. Results Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers. Conclusions Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. This collaboration could save lives and reduce the severity of noma complications.

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021)

“…In Mali and Nigeria, traditional healers’ knowledge of noma was limited [ 126 , 146 ], however, several traditional healers in Nigeria reported treating different stages of the disease. In Nigeria, traditional treatments for noma include ground herbs, plants, ointments and piercing of the swollen cheek (in the oedema phase of noma) [ 126 ].…”

Noma and Necrotizing Fasciitis of the Face and Neck

“…44 Traditional healer treatment often involves a remedy using tree branches, herbs, and bark that is soaked for ingestion or grinded as a rub or a hot blade placed on areas of swelling to "burst the swelling," among other methods. 42 Both ensuring traditional healers can recognize early stages of noma with referral to appropriate medical institutions and developing increased partnerships with traditional healers to ensure efficient access to treatment for noma patients are essential for optimal patient outcomes. 42…”

“…42 Both ensuring traditional healers can recognize early stages of noma with referral to appropriate medical institutions and developing increased partnerships with traditional healers to ensure efficient access to treatment for noma patients are essential for optimal patient outcomes. 42…”

“…The psychosocial impact of noma extends to caretakers who help patients seek care at community health centers, clinics, or hospitals, or with traditional healers. 42 Often, access to treatment of any type is unavailable or may take days given remote locations, and inaccessible, unaffordable, or unreliable transportation. Additionally, many healthcare workers and traditional healers in endemic areas are unfamiliar with the disease, meaning presentation to a hospital may lead to, at worst, undiagnosed cases without appropriate care or, at best, requests for transfer to alternate healthcare sites and further delay in treatment.…”

Why is noma a neglected-neglected tropical disease?

“…Noma (cancrum oris) is an orofacial gangrene, an opportunistic infection, affecting primarily chronically malnourished young children, living in extreme poverty and often without access to medical care [ 1 ]. Many medical professionals and front-line healthcare workers have no knowledge about noma and would not recognize the early stages when treatment reduces mortality or be able to refer a noma survivor [ 2 , 3 ]. Although noma is the quintessential neglected tropical disease (NTD), noma is not included in lists of NTDs and remains a neglected-neglected tropical disease.…”