What is Noma?

March 24, 2025

Noma, also known as cancrum oris, is a severe, gangrenous disease primarily affecting children aged 2 to 6 years. It is classified as a neglected tropical disease by the World Health Organization (WHO) as of December 2023. Noma is most prevalent in sub-Saharan Africa but has also been reported in parts of Asia and the Americas. The disease is characterised by rapid progression, often leading to severe disfigurement and social stigma.

Pathogenesis

Noma’s development is linked to non-specific polymicrobial organisms.
The primary risk factors include malnutrition, poor oral hygiene, underlying infections, and extreme poverty.
Children with weakened immune systems, including those suffering from diseases like HIV, are particularly vulnerable.
The condition often arises during periods of nutritional vulnerability, such as weaning.

Stages of Noma

The WHO classifies noma into five clinical stages:

Stage 0 – Simple gingivitis
Stage 1 – Acute necrotising gingivitis
Stage 2 – Oedema
Stage 3 – Gangrene
Stage 4 – Scarring
Stage 5 – Sequelae

The disease typically begins with an intraoral ulcer or gingivitis, which can escalate rapidly if left untreated.

Treatment Approaches

Early detection is crucial for effective treatment. At the acute necrotising gingivitis stage, interventions include improved oral hygiene, antibiotics, and nutrition supplements. Proper treatment can prevent long-term complications. However, survival rates are low; approximately 15% of children survive acute noma. Survivors often face severe disfigurements, requiring reconstructive surgery and ongoing rehabilitation.

Global Response and Challenges

Accurate estimations of noma’s prevalence are difficult due to high case fatality rates, weak health systems, and social stigma. The WHO’s historical data from 1998 suggested a global incidence of 140,000 cases per year, but the true burden remains largely unknown. The WHO has initiated programmes to enhance awareness, improve health surveillance, and integrate noma control into broader health initiatives. In 2012, the UN Human Rights Council recognised the neglect surrounding noma as a potential violation of children’s rights. Efforts to combat this disease include ensuring food security, vaccinations, and treatment of concurrent illnesses.

Future Directions

The WHO aims to strengthen health systems to better manage and prevent noma. This includes training healthcare workers and increasing community awareness. The integration of noma into existing health frameworks is essential for effective monitoring and intervention. Thus, noma remains public health challenge, particularly in impoverished regions. Continued advocacy and resource mobilisation are critical for combating this neglected disease.

« Previous Post Next Post »