Noma: A Neglected Tropical Disease

On December 15, 2023, the World Health Organization officially added Noma to the list of neglected tropical diseases, which will make it easier to combat and research this poverty-related disease.

What are Neglected Tropical Diseases?

Over a billion people worldwide suffer from the devastating infectious diseases known as neglected tropical diseases (NTDs). These people reside in resource-poor countries with inadequate access to basic healthcare services, and they are primarily found in remote rural areas, urban slums, and shanty towns.

What is Noma?

Noma is a neglected illness that primarily affects the poor. This bacterial disease is communicable but not contagious; it begins as a little mouth ulcer-like gum inflammation. Depending on where the infection originated, the infection can quickly destroy bone and tissue in the jaw, lips, cheeks, nose, or eyes. Hippocrates reported the illness for the first time in the fifth century BC. Noma was originally described in medicine in 1595 under the name "water cancer." During World War II, examples from concentration camps in Europe were also documented. The disease is an opportunistic infection that aggressively spreads across both soft and hard tissues. Its name is taken from the Greek verb meaning "to devour." It has a death rate which may reach 90%. Affecting children younger than six years old most frequently, according to WHO estimates, there are 140,000 new cases globally each year. The frequency is highest in West Africa and is primarily documented in sub-Saharan countries in a belt extending from Mauritania to Ethiopia. Its pathogenesis is linked with non-specific polymicrobial organisms and a range of modifiable risk factors and underlying social determinants shared with other neglected tropical diseases (NTDs) with Fusobacterium necrophorum and Prevotella intermedia being purported as microbiological isolates. Accurate estimations of noma’s burden are challenging, as many cases go undiagnosed, untreated and unreported due to the fast progression of the disease, high case-fatality rate, weak health systems including surveillance, associated stigma and lack of awareness of noma by healthcare workers and caregivers. Survivors suffer from severe facial disfigurement, have difficulty speaking and eating, endure social stigma, and require complex surgery and rehabilitation.

When Noma is detected at an early stage, its progression can be rapidly halted through basic hygiene, antibiotics and improved nutrition. Early detection and prompt treatment are essential for improving outcomes in NOMA patients. Treatment typically involves a combination of antibiotics to control the infection, wound debridement to remove necrotic tissue, nutritional support to improve the patient's overall health, and reconstructive surgery to repair the facial deformities caused by the disease.

Prevention is crucial in combating NOMA. Measures such as promoting proper nutrition, improving access to clean water and sanitation, and educating communities about oral hygiene can help prevent the disease. Vaccination against diseases like measles and tetanus can also reduce the risk of developing NOMA.

REFERENCES

https://www.ajtmh.org/view/journals/tpmd/103/2/article-p613.xml

Noma: giving a face to a deadly disease

What is Noma

WHO Factsheet on Noma

Liviu Feller, Johan Lemmer, Razia Abdool Gafaar Khammissa, Is noma a neglected/overlooked tropical disease?, Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 116, Issue 10, October 2022, Pages 884–888, https://doi.org/10.1093/trstmh/trac043

Rickart AJ, Rodgers W, Mizen K, et al. Facing Africa: Describing Noma in Ethiopia. The American Journal of Tropical Medicine and Hygiene. 2020;103(2):613-618. doi:10.4269/ajtmh.20-0019