Attachments
1. INTRODUCTION
Noma (cancrum oris) is a severe gangrenous disease of the mouth and face. It is a rapidly progressive and often gangrenous infection. The initial gum lesion develops into an acute necrotizing gingivitis that progresses rapidly, destroying the soft tissues and then the hard tissues and the skin of the face. It mostly affects children between the ages of 2 and 6 years living in extreme poverty. Noma is the result of complex interactions in immuno-compromised children with measles, malaria or human immunodeficiency virus (HIV). In addition to the known factors such as malnutrition, lack of vaccination in children and poor oral hygiene, several social and environmental factors such as maternal malnutrition and close spacing of pregnancies that result in offspring with increasingly weakened immune systems are potentially related to the onset of the disease.
The latest available data from the World Health Organization (WHO), albeit dated, estimated the global incidence of noma to be over 140 000 cases per year in 1998. 4,5 Noma is mostly found in sub-Saharan Africa, although cases have also been reported in Latin America and Asia. Cases remain undetected owing to 1) the rapid progression of the disease and the high mortality rate associated with its acute phase, 2) the inability of both the general population and health workers to recognize noma, 3) the lack of routine surveillance systems that include noma, and 4) the hiding of affected children by their families owing to the social stigma associated with the disease.
The United Nations Human Rights Council Advisory Committee’s study on “Severe malnutrition and childhood diseases with children affected by noma as an example” (2012, UN Doc. A/HRC/AC/8/7)emphasized that early detection of noma can facilitate rapid halting of the disease progression with simple interventions including basic hygiene and nutrition improvements and cost-effective antibiotics. However, the vast majority of the affected communities are situated in peri-urban and rural areas, where traditional beliefs and stigma are prevalent and where early detection and diagnosis of the disease and access to care are difficult.
The mortality rate for untreated noma is estimated to be 85%, but with treatment it decreases to 15–20%. Additionally, survivors of the acute phase often suffer from severe facial disfigurement, have difficulty eating or speaking, and face social stigma and isolation. The global burden of the disease is estimated to be between 1 million and 10 million disabilityadjusted life years (DALYs), mostly due to premature mortality and disability among noma survivors.