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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; 26:488-496. [PMID: 38502845 DOI: 10.1089/fpsam.2023.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Eleje GU, Okoh EE, Igbodike EP, Akinsolu FT, Nwaokorie FO, Lusher JM, Tantawi ME, Salako AO, Ezechi OC, Foláyan MO. Prevalence and associated risk factors for noma in Nigerian children: a systematic review and meta-analysis. BMC Oral Health 2024; 24:685. [PMID: 38867180 PMCID: PMC11170919 DOI: 10.1186/s12903-024-04451-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES To determine the prevalence, case-fatality rate, and associated risk-factors of Noma in children in Nigeria. METHODS Search was conducted in PubMed, Google Scholar, and Cochrane Library databases. Data were extraction using a double-blind approach. Discrepancies were resolved by a third reviewer. Heterogeneity was evaluated using I2 statistics. Random-effects model was used for the meta-analysis and subgroup analysis was conducted. The study quality was evaluated using standard Critical-Appraisal-Checklist. RESULTS Of the 1652 articles identified, 12 studies that met the inclusion criteria included 871 cases of Noma. Two studies had high-risk of bias and were excluded in the meta-analysis. Pooled prevalence of Noma was 2.95% (95%CI:2.19-3.71; Z = 7.60; p < 0.00001, I2:100.0). Case fatality was reported in one study. Sex-distribution had a male-to-female ratio of 1.1:1. Malnutrition (88.42%, 95%CI:52.84-124.00; I2:100.0), measles (40.60%; 95% CI:31.56-49.65; I2:100.0) and malaria (30.75%; 95% CI:30.06-31.45; I2:100.0) were the most notable associated risk-factors. Prevalence of Noma was non-significantly lower in southern (1.96%,95%CI:1.49-2.44;6 studies) than in northern (4.43%; 95%CI:-0.98-9.83; 4 studies) Nigeria. One study reported the prevalence of Noma in children younger than 5 years. CONCLUSIONS About every 3 in 100 children in Nigeria had Noma and the prevalence was non-significantly higher in northern than southern Nigeria. Malnutrition, measles, and malaria were major associated risk-factors. Case-fatality rate and prevalence based on different age-groups were inconclusive.
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Affiliation(s)
- George Uchenna Eleje
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Nigeria.
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka (Nnewi Campus), P.M.B. 5001, Nnewi, Anambra State, Nigeria.
| | - Emeka Emmanuel Okoh
- Department of Community Medicine and Primary Healthcare, Nnamdi Azikiwe University Teaching Hospital Nnewi, Nnewi, Nigeria
| | - Emeka Philip Igbodike
- Department of Obstetrics and Gynaecology, Havana Specialist Hospital, Surulere Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Advanced Minimal Access Surgical Hospital, Kelina Hospital, Victoria Island, Lagos, Nigeria
| | - Folahanmi Tomiwa Akinsolu
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Public Health, Faculty of Medicine, Lead City University, Ibadan, Nigeria
| | - Francisca Obiageri Nwaokorie
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Joanne Marie Lusher
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Provost's Group, Regent's University London, London, UK
| | - Maha El Tantawi
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, 21527, Egypt
| | - Abideen Olurotimi Salako
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Public Health, Faculty of Medicine, Lead City University, Ibadan, Nigeria
| | - Oliver Chukwujekwu Ezechi
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Public Health, Faculty of Medicine, Lead City University, Ibadan, Nigeria
| | - Morẹ́nikẹ́ Oluwátóyìn Foláyan
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Ashinze P, Nelson M, Ademola AS, Akande E, Moody FO, Chukwu BO, Joseph OT, Wireko AA, Abdul‐Rahman T. Breaking silence, igniting action: Noma's wail for global health recourse and intervention. Health Sci Rep 2024; 7:e2083. [PMID: 38812712 PMCID: PMC11130543 DOI: 10.1002/hsr2.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/05/2024] [Accepted: 04/01/2024] [Indexed: 05/31/2024] Open
Affiliation(s)
- Patrick Ashinze
- 82 Division Medical Service HospitalEnuguNigeria
- Faculty of Clinical Sciences, University of IlorinIlorinNigeria
- Division of ResearchToufik's World Medical AssociationSumyUkraine
| | - Mafua Nelson
- Faculty of Clinical Sciences, Madonna UniversityOgeneAnambraNigeria
| | | | - Eniola Akande
- Faculty of Clinical Sciences, University of IlorinIlorinNigeria
| | | | | | | | | | - Toufik Abdul‐Rahman
- Division of ResearchToufik's World Medical AssociationSumyUkraine
- Medical Institute, Sumy State UniversitySumyUkraine
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Baratti-Mayer D, Jeannot E, Dupuis M. Implementation and Evaluation of a Training Program for Traditional Healers to Improve Knowledge of Noma (Cancrum Oris) in Burkina Faso. Am J Trop Med Hyg 2024; 110:303-310. [PMID: 38150738 PMCID: PMC10859805 DOI: 10.4269/ajtmh.23-0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/06/2023] [Indexed: 12/29/2023] Open
Abstract
Noma (cancrum oris) is an orofacial gangrene affecting young children living in extreme poverty. The acute morbidity is high, and survivors suffer from physical and social sequelae. When diagnosed early, noma can be cured. Noma is especially prevalent in sub-Saharan Africa, where traditional medicine is the norm. The aim of this work was to provide 1-day training to traditional healers in Burkina Faso and to evaluate change in knowledge of noma across time. A sample of 78 healers who attended the training were asked to complete the same questionnaire before, immediately after, and 8 months after the training. A total of 66 healers completed the entire study. Before training, more than 40% of the participants did not know any of its key messages. Most of the key messages were acquired and still present after 8 months by a large proportion of the participants. Systematic intraoral examination was practiced by 7 (9.0%) of the traditional healers before training, and 43 (65.2%) reported doing so 8 months after training. The key messages aiming to improve early diagnosis as well as rapid and adequate treatment (the recognition of facilitating factors and the need to perform a systematic oral examination and to advise hospital transfer) have been well integrated. The study suggests that organizing a self-managed training program is feasible when done within an association, as was the case here, and owing to the willingness to collaborate shown by the traditional healers who participated in our study.
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Affiliation(s)
- Denise Baratti-Mayer
- Service de santé de l’enfance et de la jeunesse, Département de l’instruction publique, de la formation et de la jeunesse, Geneva, Switzerland
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Emilien Jeannot
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Service of Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marc Dupuis
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Gebretsadik HG. The severity of psychosocial and functional morbidity among facially disfigured untreated noma cases in Ethiopia. BMC Res Notes 2023; 16:162. [PMID: 37550768 PMCID: PMC10408114 DOI: 10.1186/s13104-023-06440-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Noma is a facially disfiguring disease that affects the oral cavity and midface structures. If left untreated, the disease is fatal. Noma causes severe cosmetic and functional defects in survivors, leading to psychiatric and social problems. However, there are limited data on psychosocial and functional sequelae associated with this disease. This cross-sectional study aimed to investigate psychosocial and functional morbidity among facially disfigured untreated Noma cases. Study participants were volunteer patients diagnosed with noma and awaiting surgery at two noma treatment centers in Ethiopia. A questionnaire derived from the APA's DSM-5, the DAS59, and the Appearance Anxiety Inventory protocol was used to measure the psychosocial and functional morbidity of the cases between September 16 and October 10, 2022. RESULTS A total of 32 noma cases (19 women and 13 men) awaiting the next surgical campaigns were involved in the study. Study participants reported severe social (Likert score = 2.8) and psychological (Likert score = 3.0) morbidity. Functional limitation was moderate (Likert score = 2.9). This study has shown that psychosocial and functional morbidity in untreated noma cases in Ethiopia is substantial. Therefore, policymakers, clinicians, and researchers need to pay sufficient attention to providing adequate health care and preventing the occurrence of the disease in the long term.
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Kagoné M, Mpinga EK, Dupuis M, Moussa-Pham MSA, Srour ML, Grema MSM, Zacharie NB, Baratti-Mayer D. Noma: Experiences of Survivors, Opinion Leaders and Healthcare Professionals in Burkina Faso. Trop Med Infect Dis 2022; 7:142. [PMID: 35878152 PMCID: PMC9316781 DOI: 10.3390/tropicalmed7070142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
The scientific literature on noma (Cancrum Oris) has clearly increased in recent decades, but there seems to have been limited analysis of issues around the psycho-social impacts of this disease. Even when these issues have been addressed, the focus has tended to be on patient experiences, whereas the community dimension of the disease and the role of healthcare professionals and community leaders in mitigating these impacts remain largely unexplored. A study in the form of semi-directed interviews with 20 noma survivors and 10 healthcare professionals and community leaders was conducted between January and March 2021 in Burkina Faso with the aim of describing the experiences of noma survivors, generating knowledge about living with the burden of the disease and understanding the attitudes of community leaders towards the disease. The results reveal that noma is a disease that affects economically vulnerable populations and leads to extreme household poverty. As far as treatment is concerned, patients tend to turn to practitioners of both traditional and modern medicine. Within communities, noma survivors face discrimination and stigma. The study highlighted a lack of information and knowledge about noma. However, surgical operations lead to patient satisfaction and these remain one of the coping strategies used to tackle the stigma and discrimination. The recommendations set out in this article are aimed firstly at stepping up research into the psycho-social impacts of noma, and secondly at considering these impacts in regional programmes and national plans to combat the disease.
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Affiliation(s)
- Moubassira Kagoné
- Nouna Health Research Centre, National Institute of Public Health, Ouagadougou, Burkina Faso;
| | - Emmanuel Kabengele Mpinga
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.-P.); (D.B.-M.)
| | - Marc Dupuis
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, 1010 Lausanne, Switzerland;
| | | | | | - Maïna Sani Malam Grema
- Faculté des Lettres et Sciences Humaines, University Abdou Moumouni of Niamey, Niamey 10896, Niger;
| | - Ngoyi-Bukonda Zacharie
- Department of Public Health Sciences, Wichita State University, Wichita, KS 67260, USA;
- Faculty of Health Sciences, National Pedagogical University, Kinshasa, Democratic Republic of the Congo
| | - Denise Baratti-Mayer
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.-P.); (D.B.-M.)
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, 1202 Geneva, Switzerland
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