Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease

Speiser, Sophie; Langridge, Benjamin; Birkl, Moira Melina; Kubiena, Harald; Rodgers, Jeff

doi:10.1136/bmjopen-2020-046303

Cited by 19 publications

(27 citation statements)

References 37 publications

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“…However, there have been evaluations of noma survivors after surgery which have shown that surgical treatment for noma survivors greatly improves their quality of life, even if functional improvements (specifically mouth opening) are not pronounced [ 14 , 102 , 136 , 141 , 156 ].The extent of long-term sequelae and their impact on quality of life of noma patients depends on the severity of the disease at initial presentation, efficacy of antibiotic treatment, wound debridement and the facial structures affected [ 91 , 92 , 96 , 97 ]. It was noted that a validated, standardized noma patient-reported outcome measurement tool would be helpful in standardizing outcome reporting after surgical treatment [ 136 , 141 , 175 ].…”

Section: Resultsmentioning

confidence: 99%

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

Farley

Mehta

Srour³

et al. 2021

PLoS Negl Trop Dis

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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.

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Section: Resultsmentioning

confidence: 99%

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

Farley

Mehta

Srour³

et al. 2021

PLoS Negl Trop Dis

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“…The burden of the disease can be explained through its high mortality rate and psychosocial morbidity [14,27]. Noma survivals are often left with devastating orofacial defects [23]. All cases reviewed in this study have reported minor to severe orofacial tissue damages.…”

Section: Discussionmentioning

confidence: 94%

“…Often, those patients that survive are not only severely disfigured, but also rejected from family and society [22]. However, these longer-term effects, including psychosocial aspects, are incompletely understood and an area for further study [23].…”

Section: Introductionmentioning

confidence: 99%

A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia

Gebretsadik

Kiev

2022

PLoS Negl Trop Dis

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Introduction Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal. Materials and methods A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,—the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score. Results A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25–50%), Grade-3 (50–75%), Grade-1 (0–25%), and Grade-4 (75–100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma. Discussion The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one’s family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.

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“…Weighted population mean outcomes will then be calculated for prevalence among PSAC. 25 To calculate pooled prevalence estimates (PPE), the inverse variance heterogeneity (IVhet) model 26 in MetaXL will be used for the selected studies, to ensure that statistical error is not underestimated. 24 The level of heterogeneity on selected studies will be evaluated using Cochran's Q and I 2 statistics.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of pediatric schistosomiasis in hard-to-reach areas and populations: A scoping review protocol

Isaiah

Palmeirim²,

Steinmann³

2022

F1000Res

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Background: Schistosomiasis is a neglected tropical disease (NTD) that affects millions of people. Children are the most vulnerable group to developing overt disease. An estimated 779 million people are at risk of schistosomiasis and 50 million preschool-age children (PSAC) need treatment. PSAC are not currently targeted by national chemotherapy campaigns due to a lack of suitable pediatric formulations of praziquantel. The Pediatric Praziquantel Consortium has developed an orally dispersible praziquantel formulation (arpraziquantel) and is facilitating its adoption for schistosomiasis control by endemic countries through the ADOPT program – an implementation research program that paves the way for the large-scale delivery of the child-friendly formulation to treat schistosomiasis in preschool-aged children in endemic countries. A key challenge for comprehensive NTD control including schistosomiasis is reaching all at-risk populations, including those hard to reach. Main access barriers include geographic, social and economic conditions. Objective: This scoping literature review aims to document the epidemiology of schistosomiasis in children under 6 years of age living in hard-to-reach areas and populations. Methods: This review will adopt the five-stage scoping review process of identifying the research question, identifying relevant studies, study selection, charting data and collating, summarizing and reporting results. Electronic databases including Medline, Web of Science, Embase (Ovid), LILACS and African Journals OnLine (AJOL) will be searched for relevant articles. Two independent reviewers will screen identified articles using a two-stage approach of reviewing the title/abstract and then the full text of provisionally retained articles. Relevant literatures will be downloaded into EndNote X9 to maintain and manage citation and facilitate the overall review process. A meta-analysis will be conducted if indicated. Relevance: The results will provide insights into the burden of schistosomiasis among marginalized PSAC, aiming to produce evidence on the need for inclusion of this population when designing the expansion of preventive chemotherapy programs.

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Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease

Cited by 19 publications

References 37 publications

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

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

A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia

Epidemiology of pediatric schistosomiasis in hard-to-reach areas and populations: A scoping review protocol

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