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Satapathy P, Rustagi S, Kumar P, Khatib MN, Gaidhane S, Zahiruddin QS, Gaidhane AM, Neyazi M, Neyazi A. Understanding noma: WHO's recognition and the path forward in global health. Trans R Soc Trop Med Hyg 2024:trae031. [PMID: 38708708 DOI: 10.1093/trstmh/trae031] [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: 01/26/2024] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
The World Health Organization's (WHO) designation of noma as a neglected tropical disease (NTD) on 15 December 2023 marks a crucial advancement in global health efforts. This move sheds light on a condition predominantly affecting undernourished children in isolated regions of sub-Saharan Africa. Recognized as the 21st NTD, noma, or cancrum oris, is a serious condition leading to orofacial gangrene. The disease largely impacts young children and those with compromised immune systems, including individuals with human immunodeficiency virus or leukaemia. Determining the exact prevalence of noma is complex, hindered by rapid disease progression, societal stigma and a lack of reporting, especially in impoverished areas. The WHO's acknowledgment is a significant step, emphasizing the need for more in-depth research and resources to address this overlooked disease. It highlights the critical role of multifaceted prevention strategies, including economic empowerment, improved nutrition and enhanced vaccination efforts. This recognition is pivotal in guiding international health initiatives towards better outcomes for some of the most at-risk populations globally.
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Affiliation(s)
- Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Pawan Kumar
- Global Center for Evidence Synthesis, Chandigarh 160036 India
- EvidenceSynthesis Lab, Kolkata 700156, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Global Health Academy, Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher education and Research, Wardha. India
| | - Abhay M Gaidhane
- South Asia Infant Feeding Research Network, Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Mehrab Neyazi
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
- Afghanistan Center for Epidemiological Studies, Herat, Afghanistan
| | - Ahmad Neyazi
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
- Scientific Affairs, Herat Regional Hospital, Herat, Afghanistan
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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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Gebretsadik HG. Surgical Procedures, Complications, and Durations in Patients with Noma Disease: A Cross-sectional Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5496. [PMID: 38115840 PMCID: PMC10730030 DOI: 10.1097/gox.0000000000005496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
Background Noma is a devastating disease that causes severe destruction of facial tissue, necessitating comprehensive surgical intervention for functional restoration and improved quality of life. This cross-sectional study aimed to identify common surgical procedures used for noma defect reconstruction in Ethiopia, analyze their durations, and assess associated complications. Methods The study retrospectively analyzed noma patient records from Facing Africa's database, covering electronic medical data from 2007 to 2019, and utilized SPSS version 2020 for analysis. Results Facing Africa treated 235 noma cases (2007-2019) with 438 procedures. The most commonly used surgical technique was reconstructive surgery, which encompassed two or more other surgical methods and was used in 177 cases. This was followed by the submental flap in 47 cases and ankylosis release in 35 cases. The study also found complications in 11 cases, including flap necrosis, abscesses, and ankylosis-related mouth restriction. Additionally, the analysis of 102 noma cases revealed significant variations in the duration of surgical procedures, ranging from 10 to 48 hours for specific cases, with the majority (63.7%) requiring 2 to 5 hours. The mean duration of noma surgery was calculated to be 4.08 hours. Conclusions Comprehending common surgical techniques, complications, and durations benefits surgical planning, resource allocation, and patient care. Thus, the results of this study are a useful contribution to the development of effective noma treatment. However, further research and continuous efforts are needed to refine surgical practices, address potential complications, and enhance patient care in the battle against this devastating disease.
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Affiliation(s)
- Heron G. Gebretsadik
- From the Department of Global Health, School of Global Health & Bioethics, Euclid University, Banjul, Gambia
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Farley E, Amirtharajah M, Shaye DA. Noma, a neglected disease: prevention is better than cure. Curr Opin Otolaryngol Head Neck Surg 2022; 30:219-225. [PMID: 35906973 DOI: 10.1097/moo.0000000000000819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There is a need for concerted effort to increase Global awareness about noma (cancrum oris). This paper aims to summarize the recent literature on noma and provide suggestions that could be implemented to raise awareness about this neglected disease. RECENT FINDINGS Noma has been recognized, diagnosed and reported for centuries. Despite significant progress in scientific methods over time, the published literature on noma has predominantly been of low level clinical and scientific evidence. Recent studies have reported on noma's global distribution and its predisposing risk factors, its treatment, its knowledge and beliefs and has included a number of literature reviews. Noma cases are being reported from an increasingly diverse set of geographical locations. SUMMARY Noma has largely been neglected in the research sphere. Noma is a preventable disease and its progression can be halted if patients are recognized and treated in the early stages of disease. Treatment for late stage noma survivors remains complex and time consuming, requiring substantial human and financial resources most commonly not achieving functional and cosmetic anatomy. The ultimate aim is therefore prevention, initiatives should be integrated into existing health programs.
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Affiliation(s)
- Elise Farley
- Nudibrink Research Consultancy, Cape Town, South Africa
- Centre for Applied Human Rights, University of York, York, United Kingdom
| | | | - David A Shaye
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Gezimu W, Demeke A, Duguma A. Noma – a neglected disease of malnutrition and poor oral hygiene: A mini-review. SAGE Open Med 2022; 10:20503121221098110. [PMID: 35707345 PMCID: PMC9190046 DOI: 10.1177/20503121221098110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this review was to describe malnutrition and poor oral hygiene, the most common risk factors for noma. Methods: A vigorous literature searches were conducted on databases such as Scopus, Elsevier, Web of Science, PubMed, Virtual Health Library, and Google Scholar by inserting keywords such as ‘noma’ OR ‘cancrum oris’ OR ‘cancrum oris cases’. A total of 65 articles gathered. Of these, 38 articles found to be eligible for this study. Results: A total of 38 full-length articles were included in the review. According to the evidence gathered and summarized in this review, malnutrition, especially protein-energy malnutrition and vitamin deficiencies, makes the oral mucosa susceptible to opportunistic pathogens of noma, and then, in so doing, pathogens invade the oral cavities. Malnutrition has a bidirectional relationship with noma. Since noma is a disease of the oral cavity, poor oral hygiene has the potential of predispose and worsen the disease’s progress. Conclusion: Malnutrition and poor oral hygiene found to be ingrained in the pathogenesis of noma. For effective management and prevention of noma, it is necessary to underpin adequate nutritional supplementation (including vitamins). As a primary prevention strategy, healthcare workers’ training should be strengthened to improve the diagnosis and treatment of oral infections, including noma.
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Affiliation(s)
- Wubishet Gezimu
- Department of Nursing, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Ababo Demeke
- Department of Nursing, College of Health Science, Dilla University, Dilla, Ethiopia
| | - Abdissa Duguma
- Department of Nursing, College of Health Science, Mettu University, Mettu, Ethiopia
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Abstract
Trench mouth, as it occurred especially in World War I in soldiers, is a necrotizing ulcerative gingivitis (NUG) in people who have poor oral hygiene, malnutrition, vitamin deficiency, a smoking history, and psychic stress. When not treated properly, this condition can lead to noma. NUG and noma are mainly seen today in severely malnourished, poorly cared for, and immunocompromised children in extremely poor living conditions, mainly in sub-Saharan Africa. In 20th century history, the occurrence of noma in Turkey was described by Albert Eckstein (1891-1959), but noma is particularly linked to the atrocious living conditions in the Nazi exterminations camps, such as Auschwitz, where large numbers of patients with noma were treated in Berthold Epstein's (1890-1962) Noma Department in the Zigeunerlager (Gypsy Camp) under the supervision of SS physician Josef Mengele (1911-1979). Although these patients were treated successfully, all of them, mostly children, were ultimately killed. The protocols of the noma research are lost, and descriptions from Auschwitz are scarce. Fortuitously, there are some testimonies, especially from postwar trials, that give insight on this ambiguous and repressed topic.
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Miller LE, Shaye DA. Noma and Necrotizing Fasciitis of the Face and Neck. Facial Plast Surg 2021; 37:439-445. [PMID: 33517575 DOI: 10.1055/s-0041-1722894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.
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Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - David A Shaye
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.,Doctors without Borders, Noma Project, Sokoto, Nigeria
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