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Gebretsadik HG, Abera Y. High burden of noma in the Gambella region of Ethiopia: a 12-year retrospective study on noma cases from the Facing Africa database. Trans R Soc Trop Med Hyg 2024:trae015. [PMID: 38591224 DOI: 10.1093/trstmh/trae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/13/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Noma, an infectious disease, mainly affects impoverished children. This study retrospectively assessed noma's prevalence in Ethiopia using data from the Facing Africa database and the 2022 United Nations Development Programme poverty index report. METHODS A thorough review of medical records spanning 2007 to 2019 identified a total of 235 noma cases. A standardized data extraction template was employed to systematically gather pertinent clinical and demographic data for subsequent analysis. Prevalence rates were calculated nationally and regionally for both the general population and children aged ≤10 y. RESULTS The analysis revealed estimated national prevalence rates of 0.65 per 100 000 individuals at risk and 1.9 per 100 000 children aged <10 y at risk. The Gambela region exhibited the highest prevalence rate (11.2 per 100 000), whereas the Benshangul Gumuz region had the lowest (0.25 per 100 000). Similar patterns were observed among children aged ≤10 y, with the Gambela and Benshangul Gumuz regions reporting rates of 32.9 and 0.74 per 100 000, respectively. CONCLUSIONS The study highlights noma's significant impact on children aged <10 y in Ethiopia, especially in the Gambella region. It offers crucial baseline data to assist public health professionals, policymakers and healthcare providers in formulating evidence-based strategies to combat noma and improve affected individuals' well-being.
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Affiliation(s)
| | - Yenigat Abera
- Department of Global Health, School of Global Health & Bioethics, Euclid University, Banjul, Gambia
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Gebretsadik HG. Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. Laryngoscope Investig Otolaryngol 2024; 9:e1250. [PMID: 38651077 PMCID: PMC11034487 DOI: 10.1002/lio2.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/18/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Noma, an overlooked infectious disease, inflicts severe facial tissue damage, posing substantial challenges in patient care. This study delves into surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. Materials and Methods The research employed a cross-sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database. Results The review encompasses 235 noma cases. Twenty-four cases (19 females and 5 males) experienced various complications, predominately major complications leading to subsequent revision surgeries. The identified complications included flap necrosis, abscess formation, tenderness, graft site infection, flap bulking, dental misalignment, corner of the mouth dehiscence, infected bone and plate, flap malpositioning, restricted mouth opening with ankylosis, neuropathic pain, recurrent flap infection, and offensive odor. Revision surgeries included wound cleansing, abscess drainage, skin graft removal, exploratory surgery, wound care, debulking, scar removal, debridement, trismus release, commisuroplasty, and flap repositioning. Conclusion These findings illuminate the intricacies of noma surgery in Ethiopia, emphasizing the importance of understanding the nature and frequency of complications for optimizing treatment outcomes. Insights from this study can guide healthcare providers, especially novice surgeons, and policymakers, in refining surgical interventions and enhancing outcomes for noma patients. Improved knowledge in this realm is crucial for advancing patient care and developing targeted interventions. Level of Evidence 5.
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Amirtharajah M, Olaleye M, Oluyide B, Lenglet A, Ariti C, Farley E, Winters R, Taiwo AO, Shaye DA. Prospective Outcomes of Noma Facial Reconstructive Surgery in Sokoto, Nigeria. Facial Plast Surg Aesthet Med 2024. [PMID: 38502845 DOI: 10.1089/fpsam.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background: Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations. Objective: To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria. Methods: Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic. Results: Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, p = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001). Conclusions: Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria. Clinical Trial Registration: OCA017-63.
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Affiliation(s)
| | - Michael Olaleye
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | | | - Annick Lenglet
- International Centre for Antimicrobial Resistance Solutions, Copenhagen, Denmark
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elise Farley
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
| | - Ryan Winters
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital and New South Wales, New Lambton Heights, New South Wales, Australia
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Abdurrazaq Olanrewaju Taiwo
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - David A Shaye
- Médecins Sans Frontières, Noma Children's Hospital, Sokoto, Nigeria
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
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Gebretsadik HG. Noma is a facial disfiguring childhood disease: Insights from cases of Noma in Ethiopia. Int J Pediatr Otorhinolaryngol 2024; 177:111845. [PMID: 38176115 DOI: 10.1016/j.ijporl.2023.111845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Noma is a neglected infectious disease that causes severe destruction of facial tissues and poses a significant public health threat. The disease reportedly affects individuals with a debilitating health condition. This study aimed to identify the most vulnerable age group affected by Noma disease and assess the severity of tissue damage among Noma cases in Ethiopia. METHODS A cross-sectional study was conducted to determine the age group most susceptible to noma and assess the disease-associated severity of tissue damage. The research objectives were met by scrutinizing electronic medical records of noma cases treated in Addis Ababa, Ethiopia, from 2007 to 2019, obtained from the Facing Africa database. Data collection was carried out using a standardized survey form, while the severity of facial tissue damage was assessed using the NOIPTUS score. RESULTS Among 164 Noma cases with documented data on disease onset, 92.7 % occurred during childhood, with 92.1 % of those cases being children aged ten years and younger. Approximately 11.6 % of all noma cases had mild tissue damage, classified as NOITULP grade 1, while 26.2 % had an intermediate level of tissue damage, classified as NOITULP grade 2. Severe tissue damage (NOITULP grade 3) was present in 37.2 % of cases, while 25 % had very severe tissue damage (NOITULP grade 4). CONCLUSIONS The findings underscore the vulnerability of children, particularly those aged ten years and younger, to Noma disease, supporting the argument that Noma is a facial-disfiguring childhood disease. Targeted interventions and preventive measures during childhood can be vital in controlling Noma incidence.
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Abdullahi MAS, Balarabe MR, Tyndall JA, Alele FO, Habib AG, Adegboye OA. Noma disease among internally displaced persons in Northeast Nigeria: a retrospective descriptive study. Ther Adv Infect Dis 2024; 11:20499361241261269. [PMID: 38883922 PMCID: PMC11177724 DOI: 10.1177/20499361241261269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Background Recently recognized by the World Health Organization as a neglected tropical disease, Noma, an acute and destructive gangrenous disease affecting the gums and facial structures within the oral cavity, has a high mortality rate if untreated. Objectives To investigate the prevalence and impact of Noma among internally displaced populations in Northeastern Nigeria. Design A retrospective study. Methods This retrospective study investigates the prevalence and impact of Noma among internally displaced populations in Northeastern Nigeria. Noma is endemic in Northern Nigeria, Africa, and its occurrence has been linked to extreme poverty, malnutrition, poor hygiene, and inadequate healthcare - conditions exacerbated by the ongoing Boko Haram conflict. Results The retrospective descriptive cross-sectional analysis of 17 cases reveals a median age of 8 years, with most of the patients being children who suffer significant social stigmas, such as difficulties in speaking, eating, and social integration, including reduced school attendance and marital prospects. Conclusion The study highlights the urgent need for comprehensive research into the etiology of Noma and its socio-economic impact. It emphasizes the necessity for early and effective intervention strategies, particularly in conflict-stricken areas with limited healthcare access.
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Affiliation(s)
- Mohammed A S Abdullahi
- Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Muhammad R Balarabe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jennifer A Tyndall
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
| | - Faith O Alele
- School of Health, University of Sunshine Coast, Sippy Downs, Australia
| | - Abdulrazaq G Habib
- Infectious and Tropical Diseases Unit, Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Oyelola A Adegboye
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810, Australia
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Kanmodi KK. Noma: a PubMed-based informetric analysis of a neglected tropical orofacial disease in Nigeria. Sudan J Paediatr 2023; 23:42-59. [PMID: 37663101 PMCID: PMC10468626 DOI: 10.24911/106-1633358254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/31/2022] [Indexed: 09/05/2023]
Abstract
Noma is an orofacial gangrenous infection commonly affecting malnourished children in the tropical region of the World, particularly the sub-Saharan Africa. Nigeria is a sub-Saharan African country which is among the countries seriously affected by noma. In Nigeria, noma has been classified as a priority disease. However, only very little attention has been focused on noma research in Nigeria, unlike many other priority diseases. This study conducted an informetric analysis of research outputs on noma in Nigeria, using the PubMed database - a world-leading and authoritative database of medical literature. This study revealed that only 26 PubMed-indexed publications on noma (PONs), published between January 1990 and September 2021, were available. A trend analysis of these PONs showed that the average output (outputs from 1999 to 2020 = 23) rate per year (from 1990 to 2020 [31 years]) was 0.74 (23/31). Sokoto (n = 11), Oyo (n = 4) and Kebbi (n = 3) were the top three Nigerian states surveyed on noma in the included PONs. Only 12 publications had international co-authors, of which only few publications had co-authors affiliated with institutions in other African countries: South Africa - 5 publications; and Rwanda - 2 publications. Only two publications were funded. Also, the top five prolific Nigerian authors on noma in Nigeria were affiliated with Noma Children Hospital, Sokoto State, Nigeria. In conclusion, PONs by Nigerian authors is so meagre in quantity. This low output is an issue of medical concern. More research focused on noma in Nigeria is needed through funding and other research capacity-strengthening measures.
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Affiliation(s)
- Kehinde Kazeem Kanmodi
- Child Health and Well-being (CHAW) Program, Cephas Health Research Initiative Inc., Ibadan, Nigeria
- Medical Research Unit, Adonai Hospital, Karu, Nigeria
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
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Gebretsadik HG, de Kiev LC. A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010372. [PMID: 36099293 PMCID: PMC9506604 DOI: 10.1371/journal.pntd.0010372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/23/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
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. Noma is orofacial gangrene that rapidly disintegrates the hard and soft tissue of the face. The mortality rate of Noma varies between 85–90%. The remaining 10–15% of Noma survivors permanently suffer from severe facial deformities. Noma is a widely neglected disease affecting poor people globally. Most cases of Noma are reported from the so-called Noma belt, located south of the Sahara and runs across Africa from Senegal to Ethiopia. Though Ethiopia is one of the countries in the Noma-belt region where people, particularly children, are significantly affected by the disease, the attention given to this devastating condition is remained to be very low. Therefore, we believe that assessing the severity and sequela of Noma in Ethiopia is crucially essential to lay bare the burden of the disease and increase the overall understanding of the condition among different stakeholders. We are also convinced that the study’s findings can serve as baseline data for further in-depth scientific investigations and preventive policy development.
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Dominic C, Farley E, Elkheir N. More than 100 years of neglect: a bibliometric analysis of global research on noma (cancrum oris). Trans R Soc Trop Med Hyg 2022; 116:479-486. [PMID: 34664068 DOI: 10.1093/trstmh/trab161] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Research plays a significant role in quantifying and addressing the burden of disease, improving healthcare delivery and developing evidence-based policy for neglected tropical diseases (NTDs). Since noma is not a recognised NTD by the World Health Organization (WHO), research activity is hypothesised to be low. This study aims to understand patterns and trends of research conducted on noma, to understand the patterns of citations, highlight networks of collaboration and analyse stakeholders in noma research. METHODS The SCOPUS database was selected and searched. Data analysis was conducted using the bibliometrix package for R in RStudio. Areas of interest included the distribution of research output on noma by year and location, the academic impact of publication output, mapping the major academic community and conducting a thematic analysis of high-frequency keywords. RESULTS A total of 208 documents were identified. The annual growth rate of publications is 4.3%. The average number of citations per publication was 11.0 (rounded from 10.98) and the average citations per year per publication was 0.57. The USA was the country with the highest percentage 10.6% (n=22) of corresponding authors, followed by Nigeria (6.7% [n=14]), the UK (6.3% [n=13]) and India (5.8% [n=12]). For those papers with multiple authors, there was an average of 3.22 co-authors per document. The collaboration index was 3.3. Upon plotting collaboration networks between authors, only 11 clusters were identified (frequency and intensity of collaboration). Mapping of trending topics showed a focus on skin grafting and transplantation within the literature. CONCLUSIONS In order to progress towards eventual elimination of noma it is key that more research should be undertaken and more interest and funding should be dedicated to work on noma. Recognition of noma as an NTD by the WHO would be a first step in moving towards increased awareness.
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Affiliation(s)
- Catherine Dominic
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Natalie Elkheir
- London School of Hygiene and Tropical Medicine, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Farley E, Mehta U, Srour ML, Lenglet A. Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021). PLoS Negl Trop Dis 2021; 15:e0009844. [PMID: 34905547 PMCID: PMC8670680 DOI: 10.1371/journal.pntd.0009844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
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. Noma is a devastating and often fatal condition that mainly affects children in severely disenfranchised communities. Noma is preventable and requires urgent basic medical care in the early stages of disease. Once the disease reaches the last stage, sequelae, survivors require expert surgical care, usually 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 to identify research priorities that will evolve our understanding of how to eradicate this disease. Our review showed that noma has been reported in the literature for hundreds of years; however several major gaps in knowledge still exist. There is appreciation among the small community of clinicians and researchers involved in noma care and research that these gaps in knowledge impact on the ability to develop and implement sound evidence-based policies and activities aimed at eradicating noma from communities that continue to be afflicted by this ancient disease. The main focus of future research should be to study the burden and distribution of disease; the true mortality rate, and the pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment.
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Affiliation(s)
- Elise Farley
- Noma Children’s Hospital, Médecins Sans Frontières, Sokoto, Nigeria
- Nudibrink Research Consultancy, Cape Town, South Africa
- * E-mail:
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
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Isah S, Amirtharajah M, Farley E, Semiyu Adetunji A, Samuel J, Oluyide B, Bil K, Shoaib M, Abubakar N, de Jong A, Pereboom M, Lenglet A, Sherlock M. Model of care, Noma Children's Hospital, northwest Nigeria. Trop Med Int Health 2021; 26:1088-1097. [PMID: 34080264 PMCID: PMC9292046 DOI: 10.1111/tmi.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Nigerian Ministry of Health has been offering care for noma patients for many years at the Noma Children’s Hospital (NCH) in Sokoto, northwest Nigeria, and Médecins Sans Frontières has supported these initiatives since 2014. The comprehensive model of care consists of four main components: acute care, care for noma sequelae, integrated hospital‐based services and community‐based services. The model of care is based on the limited evidence available for prevention and treatment of noma and follows WHO’s protocols for acute patients and best practice guidelines for the surgical treatment of noma survivors. The model is updated continually as new evidence becomes available, including evidence generated through the operational research studies performed at NCH. By describing the model of care, we wish to share the lessons learned with other actors working in the noma and neglected tropical disease sphere in the hope of guiding programme development.
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Affiliation(s)
| | | | - Elise Farley
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | - Joseph Samuel
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | - Karla Bil
- Médecins Sans Frontières, Amsterdam, Netherlands
| | | | - Nura Abubakar
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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