Noma, a deadly but neglected infection
By Lawal Dahiru Mamman
Noma, otherwise known as necrotising ulcerative stomatitis, gangrenous stomatitis, or cancrum oris, is a bacterial infectious but non-contagious infection; resulting from poor oral hygiene, lack of sanitation and malnutrition, affecting both soft and hard tissues of the mouth and face, rapidly progressive and more often than not fatal.
The most common sign and symptom is the development of an ulcer in the mucous membrane of the mouth before spreading to other parts of the face. If detected early, the condition can be arrested with antibiotics, proper nutrition and oral hygiene, while late diagnosis does not restore disfigured or damaged tissues even if treated.
Affecting children between 2 to 6 years of age, the disease is prevalent in impoverished communities in Asia and Africa. However, infection was also found decades ago in Europe and South America. This infection has since vanished with improved livelihood and healthcare.
Preventable but deadly, all over the world, Noma has been given the cold shoulder (neglected) over the years. The absence of current epidemiological data has made the data of the World Health Organisation (WHO) from 1998 the most frequently cited estimation of the disease, with a global estimate of 140,000 new cases recorded annually, with a majority in Sub-Saharan Africa and a mortality rate of 90% if not treated within two weeks.
The infection has not spared the children in Nigeria, falling under the countries in Sub-Saharan Africa, killing numbers and leaving survivors disfigured, coupled with the reality of leaving the rest of their lives under stigmatisation.
This informed the decision of the Federal Ministry of Health to call on the WHO at the 75th World Health Assembly to include Noma on the list of Neglected Tropical Diseases (NTDs) where it belongs.
The call was aimed at rallying global support to eliminate and start preventive and curative measures against the preventable but deadly disease.
Established in the year 1999, the Noma Children’s Hospital, Sokoto, up until May 2022, when Noma Aid Nigeria Initiative (NANI) began construction of a new 100-bed National Noma Treatment Centre within the National Hospital, Abuja, has been the only specialist hospital shouldering the burden of the debilitating disease in the country.
The Chief Medical Director of the hospital in Sokoto said, “what is lamentable is that the disease is curable and even preventable, but lack of awareness has made a good number of patients die at home without visiting the hospital, exacerbating knowledge gap.”
To create awareness on predisposing factors like malnutrition, vitamin (A and B) deficiency, contaminated drinking water, immunodeficiency and living in proximity to livestock, November 20th have been set aside as Annual Noma Day.
Before resting my case, let me advocate that the awareness campaign held annually on NOMA DAY be taken to people in rural areas. These people are most vulnerable and unaware. Therefore, it will be better than having the symposia in town or city halls where the inhabitants are most likely informed. Moreover, more specialists should be trained on the infection to establish more specialist hospitals in at least each geopolitical zones of the country to unburden that in Sokoto and the upcoming one in the Federal Capital Territory.
Furthermore, people should be encouraged to embrace oral hygiene and proper nutrition like a religious ritual. In suspected cases, patients should be taken to the hospital for appropriate treatment to prevent disfigurement. Routine vaccination for children ought to be taken as a priority of every parent, and individuals with any information on Noma are encouraged to carry out a personal campaign in their locality amongst family and friends because the little things we do can make a difference.
Lastly, I urge all to avoid stigmatisation of survivors because they were but victims of circumstance.
Lawal Dahiru Mamman, a corp member, writes from Abuja and can be reached via dahirulawal90@gmail.com.
