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

Abstract

Background Noma (cancrum oris) is an ancient but neglected and poorly understood preventable disease, afflicting the most disenfranchised populations in the world. It is a devastating and often fatal condition that requires urgent and intensive clinical and surgical care, often difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and identify research gaps that need to be addressed to evolve our understanding of how to address this disease. Methods We searched 11 databases and collected primary peer reviewed articles on noma in all languages, the final search was conducted on 24th August 2021. The oldest manuscript identified was from 28th March 1843 and the most recently published manuscript was from 3rd June 2021. Search terms included cancrum oris and noma. Data was extracted using a standardised data extraction tool and key areas of interest were identified. The Preferred Reporting Items for Systemic review and Meta-Analyses requirements were followed. Results The review included 147 articles, the majority of the studies (n = 94, 64%) were case reports. Most manuscripts (n = 81, 55%) were published in the 2000s, 49 (33%) were from the 1900s and 17 (12%) from the 1800s. The main areas of interest identified were the history and epidemiology of the disease, noma’s clinical progression and aetiology, treatment regimens, mortality rates and the risk factors for the development of noma. Conclusions Noma has been reported in the literature for hundreds of years; however important gaps in our understanding of the disease remain. Future research should focus on determining the burden and distribution of disease; the true mortality rate, pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment.

Noma – a neglected disease of malnutrition and poor oral hygiene: A mini-review

“… 31 According to a shared evidence, noma cases were frequently found in children who have vitamins A, B, and C deficiency. 33 Thus, vitamin supplementation has a vital role in both the prevention and treatment of noma cases.…”

“…Poor oral hygiene is an attribute of noma disease, which expedites the disease’s progress. 20 , 26 , 33 It refers to the presence of debris, calculus, or extrinsic stains covering one-third to two-thirds of the tooth surface. 35 Poor oral hygiene plays an important role in the pathophysiology of noma, and it is typically seen in children from low-income families whose parents may lack the knowledge or resources to protect their children’s oral health.…”

“… 35 Poor oral hygiene plays an important role in the pathophysiology of noma, and it is typically seen in children from low-income families whose parents may lack the knowledge or resources to protect their children’s oral health. 33 – 36 The extremely poor oral condition has been recognized in noma survivors. 32 According to a study conducted in Ibadan, Nigeria, the magnitude and severity of noma were higher in children with poor oral hygiene.…”

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

“…The estimation of the number of potential noma cases in these countries was based on (i) the scientific literature produced on the subject between 2003 and 2021 (in particular the work of Farley [ 32 , 33 , 34 ], Bello [ 35 ], Fieger [ 18 ], [ 24 , 36 ], Konsem [ 37 ], Bonkoungou [ 38 ]; and on (ii) expert opinions consulted to determine the incidence of the disease [ 3 , 8 , 18 , 24 , 32 , 34 , 35 ].…”

A mixed cross-sectional and case-control study approach to investigate the risk-factors of Noma/Cancrum oris in Ethiopia

“…Noma is commonly seen in a population with extreme poverty, severe malnutrition, unsafe drinking water, poor sanitation, poor oral health practices, limited access to high-quality health care, and intrauterine growth retardation (10). Recently, an increased incidence of Noma has been reported in patients with Human Immune deficiency Virus (HIV) infection, cyclic neutropenia, leukemia, Down’s syndrome, Burkett’s disease, and herpetic stomatitis (11).…”