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 20th 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.

Low‐cost periodontal therapy

“…Also, infection with periodontopathic herpesviruses occurs at a higher prevalence in less‐developed countries than in affluent countries (4), and the herpesvirus seroprevalence in high‐income countries exhibits racial, educational and socioeconomic disparities (382). Taken together, low‐income individuals in developing countries tend to demonstrate a high level of risk factors for periodontal disease (110, 217), and are at increased risk of developing severe periodontitis (7, 26, 27, 336) and even potentially fatal oral infections such as noma (cancrum oris) (41, 220).…”

Promoting Oral Health through Programs in Middle Childhood and Adolescence

“…Survivors suffer lifelong impairments to speaking or eating because of significant tissue destruction. Victims and their families are often stigmatized, with increased risk of poverty for affected households (Marck 2013;Ogbureke and Ogbureke 2010). Noma is most prevalent in Burkina Faso, Ethiopia, Mali, Niger, Nigeria, and Senegal; however, because of unreliable documentation, there are no accurate epidemiologic data.…”

Pediatric dermatology at Northwestern University’s South Side Dispensary and Montgomery Ward Clinic, Chicago, circa 1900–1940

“…Noma, also known as cancrum oris or gangrenous stomatitis, is a necrotic infection that usually occurs in malnourished children aged 2-5 years; it has been described more recently as the ''true face of poverty.'' 5 During periods of compromised immunity (chiefly after exposure to measles, typhoid, or diphtheria), noma usually appears opposite one of the pre-molars with a small discolored infiltration on the mucous membrane of the cheek and is often seen externally as a small brownish spot. The spot rapidly takes on the black color of necrotic tissue and can spread to the lips and face in a matter of days.…”