Risk factors for diagnosed noma in northwest Nigeria: A case-control study, 2017

Abstract

BackgroundNoma (cancrum oris), a neglected tropical disease, rapidly disintegrates the hard and soft tissue of the face and leads to severe disfiguration and high mortality. The disease is poorly understood. We aimed to estimate risk factors for diagnosed noma to better guide existing prevention and treatment strategies using a case-control study design.MethodsCases were patients admitted between May 2015 and June 2016, who were under 15 years of age at reported onset of the disease. Controls were individuals matched to cases by village, age and sex. Caretakers answered the questionnaires. Risk factors for diagnosed noma were estimated by calculating unadjusted and adjusted odds ratios (ORs) and respective 95% confidence intervals (CI) using conditional logistic regression.FindingsWe included 74 cases and 222 controls (both median age 5 (IQR 3, 15)). Five cases (6.5%) and 36 (16.2%) controls had a vaccination card (p = 0.03). Vaccination coverage for polio and measles was below 7% in both groups. The two main reported water sources were a bore hole in the village (cases n = 27, 35.1%; controls n = 63, 28.4%; p = 0.08), and a well in the compound (cases n = 24, 31.2%; controls n = 102, 45.9%; p = 0.08). The adjusted analysis identified potential risk and protective factors for diagnosed noma which need further exploration. These include the potential risk factor of the child being fed pap every day (OR 9.8; CI 1.5, 62.7); and potential protective factors including the mother being the primary caretaker (OR 0.08; CI 0.01, 0.5); the caretaker being married (OR 0.006; CI 0.0006, 0.5) and colostrum being given to the baby (OR 0.4; CI 0.09, 2.09).InterpretationThis study suggests that social conditions and infant feeding practices are potentially associated with being a diagnosed noma case in northwest Nigeria; these findings warrant further investigation into these factors.

Language and beliefs in relation to noma: a qualitative study, northwest Nigeria

“…Access to health care in this part of Nigeria is difficult, especially in the rainy season, as poor infrastructure makes transportation to health facilities challenging. A lack of access to healthcare has been widely reported as a risk factor for noma development [4,[29][30][31][32][33][34][35], and our results add weight to these assertions in that caretakers mention the difficulties they experienced accessing care for this disease. The rapid progression of noma, lack of access to care, and the delays caused by caretakers having to progress through several facilities (clinics or traditional healers), means that resulting morbidity and mortality can be severe.…”

Estimated incidence and Prevalence of noma in north central Nigeria, 2010–2018: A retrospective study

“…These factors include socioeconomic factors such as low standards of living, extreme poverty, poor sanitary conditions and close proximity of residence to livestock. Oral conditions such as poor oral hygiene and presence of simple gingivitis; systemic conditions like severe malnutrition, measles, malaria, tuberculosis, HIV infection, leukaemia, Non-Hodgkin’s lymphoma and cyclic neutropenia; and miscellaneous factors including low birth weight, improper weaning, birth position within the family and absence of mother as primary care giver [4,6,8–9].…”

“…Epidemiological research targeted at determining noma incidence and prevalence has been highlighted as a main feature of public health action programs against the disease. As determination of actual epidemiological parameters of noma is difficult due to high mortality associated with untreated disease, regional health data record inadequacies, remoteness of affected areas in addition to sufferers’ lack of access to primary health centres; current epidemiological data estimates a global incidence of 30,000–40,000 cases annually with seventy-five percent of these occurring in sub-Saharan Africa (the noma belt) [9–10]. Furthermore, in Nigeria (particularly the north west and south west sub-regions), incidence rates between 0.8–6.4 per 1000 children have been reported in the last two decades mostly according to data provided by foreign non-governmental organizations or surgical missions [10–11].…”

Noma in a boy with septic shock: a case report

“…The cause of noma is unclear, and its main pathogenic factors might include malnutrition and low vaccination coverage [5], poor oral hygiene and home sanitation [6], pre-infection conditions like measles or diarrhea [7], and immunodeficiency [8], among other factors. The male patient in this report suffered from noma; however, the patient did not display any special contact or past history, and essentially presented with fever and diarrhea, which implied the patient might have suffered from a previous infection.…”

“…Furthermore, the treatment of noma in the acute phase of progression mainly serves to improve the general condition of the patient and the quality of life. Clinical management of this condition thus includes wound cleaning and debridement, maintaining the balance of water and electrolytes through rehydration support, improving and sustaining the nutritional condition of the patient, supplementing the patient with trace elements (especially of vitamin A) and appropriate use of antibiotics [3–5].…”