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Verma A, Zaheer A, Ahsan A, Anand A, Abu Serhan H, Nazli Khatib M, Syed Zahiruddin Q, Gaidhane AM, Kukreti N, Rustagi S, Satapathy P, Sharma D, Arora M, Kumar Sharma R. Noma in the WHO's list of neglected tropical diseases: A review of its impact on undeveloped and developing tropical regions. Prev Med Rep 2024; 43:102764. [PMID: 38826589 PMCID: PMC11141281 DOI: 10.1016/j.pmedr.2024.102764] [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: 02/29/2024] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Background Noma is a neglected tropical disease and a global health concern. Objectives To elucidate the epidemiology, management, prevention, and public health implications of Noma. Methods PubMed, Scopus, and Web of Science, supplemented by Google Scholar and World Health Organization databases, were searched using keywords to gather both published and grey literature from 1970 to 2023 in English. Results Approximately 30,000-40,000 cases occur annually, with varying incidences across various African countries, such as Nigeria, Niger, and Chad. Incidence in Nigerian and Ethiopian states range from 0.6 to 3300 and 1.64 to 13.4 per 100,000 population, respectively. Mortality is approximately 8.5% in Niger. Risk factors include malnutrition, immunocompromised status, poor dental hygiene, inadequate sanitation, gingival lesions, low socioeconomic status, chronic and infectious diseases, low birth weight, high parity, diarrhoea, and fever. Diagnosis is primarily made based on clinical signs/symptoms and accordingly staging of disease is done. Stage I, II and II presents with acute necrotizing gingivitis, facial edema with halitosis, and necrotizing stomatitis, respectively. If the patient survives acute stages, the progress to Stage IV and Stage V manifests as trismus, difficulty in deglutition and phonation, and facial disfigurement, with increased severity in last stage. Treatment encompasses antibiotic therapy (amoxicillin, metronidazole, chlorhexidine, ampicillin, gentamicin), surgical interventions, wound management (honey dressing, ketamine), and nutritional support. Prevention strategies include oral hygiene, vaccination, health education, and community-based interventions. Conclusion Noma's recent inclusion in WHO list of neglected tropical diseases is a milestone in recognizing the importance of prevention and early intervention to globally enhance health outcomes.
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Affiliation(s)
- Amogh Verma
- Rama Medical College Hospital and Research Centre, Hapur, India
| | - Amna Zaheer
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Areeba Ahsan
- Foundation University Medical College, Islamabad, Pakistan
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health. Datta Meghe Institute of Higher Education, Wardha, India
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602117, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq
| | - Divya Sharma
- Centre of Research Impact and Outcome, Chitkara University, Rajpura, India
| | - Mithhil Arora
- Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, India
| | - Rakesh Kumar Sharma
- Graphic Era Hill University, Dehradun, India
- Graphic Era (Deemed to be University), Dehradun, India
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Ainsworth S. Noma finally recognised as a neglected tropical disease. PLoS Negl Trop Dis 2024; 18:e0012177. [PMID: 38814853 PMCID: PMC11139265 DOI: 10.1371/journal.pntd.0012177] [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: 06/01/2024] Open
Abstract
In December 2023, after decades of tireless advocacy from stakeholders and partners, the World Health Organization (WHO) gave noma the long overdue recognition as a neglected tropical disease. The significance of this official recognition cannot be overstated, and it is hoped this will serve as a turning point in our battle against this devastating disease.
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Affiliation(s)
- Stuart Ainsworth
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- International Noma Network (www.internationalnomanetwork.org)
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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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Health-related quality of life in patients with noma (cancrum oris): Case series. Int J Surg Case Rep 2023; 103:107878. [PMID: 36638584 PMCID: PMC9840349 DOI: 10.1016/j.ijscr.2023.107878] [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: 11/04/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cancrum oris (noma) is a destructive disease of orofacial tissues and adjacent structures that progress rapidly, causing functional and cosmetic problems to the patient and ultimately affecting their health-related quality of life. This case series focuses on the impact of the cancrum oris on the health-related quality of life of patients which has been underreported in literature. CASE PRESENTATION Herein, we present 3 cases (1 pediatric and 2 adult patients) of cancrum oris. One adult male succumbed to the disease while the remaining two are undergoing treatment. We used the modified versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the University of Washington-Quality of Life (UWQoL) questionnaire for pediatric and adult patients respectively. CLINICAL DISCUSSION The sequela of cancrum oris affects negatively the quality of life of the patients even after definitive management. Despite this, there is no validated questionnaire to assess the quality of life. The modified versions of the ECOHIS and the UWQoL questionnaires that were used in this case report can be used effectively to assess the HRQoL of the patients. CONCLUSION Cancrum oris is a neglected disease that affects negatively the health-related quality of life of patients who suffer from it, despite medical intervention.
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