NOMA: A Preventable “Scourge” of African Children

Abstract

Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma.Although a formidable public health challenge, noma can be prevented with a potential for subsequent global eradication. To achieve both desirable goals, detection of early disease is crucial because these early lesions respond to conventional antibiotic treatments when instituted side by side with nutritional rehabilitation, and obviates the necessity for extensive surgical reconstruction often indicated in late stage disease. The eradication of noma in the developed world in the mid 20 th century bears out the notion of a similar outcome following effective preventive strategies in Africa. A fundamental and necessary step towards attaining this goal is for the international community to adopt a perception of noma as an urgent global public health challenge. Research effort toward deciphering the microbiology, molecular events, and pathogenesis of noma also should intensify.

The Real Face of “Face of Poverty”: An Insight on Noma

“…7 In 1994, the World Health Organization (WHO) stated noma as a health priority and an action program was initiated by WHO, the United States National institute of health and the University of Maryland, Baltimore. 9 The epidemiology of noma globally is unresolved. 10 In the late 1990s, the incidence of acute childhood noma was set at 25,600 in countries bordering the Sahara.…”

Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region

“…Typically at the initial stages of cancer, they do not seek medical help because of ignorance and poverty (Aulock 2005). Preventable dental diseases such as noma (cancrum oris) are still very common (Ogbureke and Ogbureke 2010).…”

Noma (cancrum oris) in the South African context

“…Noma most frequently affects young children with bacterial plaque laden teeth whose immune response may have been diminished by any one of a number of states of general debilitation, chief among these being malnutrition . It is accepted that noma starts in the mouth, probably as necrotising gingivitis (Fig.…”

“…The foetid odour of noma and the fact that it responds to antibiotic treatment together are circumstantial if not scientific evidence of the bacterial infective nature of noma . The anaerobic bacteria in noma release proteolytic enzymes that degrade extracellular matrix, produce toxic metabolites that are cytopathic to local immuno‐inflammatory cells and tissue‐specific cells and release mediators that have the capacity to modulate host immuno‐inflammatory responses, thus reducing local immune competence .…”