NOMA: A Preventable “Scourge” of African Children

Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma

Treatment of Noma: medical missions in Ethiopia

There is a long tradition in medicine and dentistry to support medical missions in developing countries where health care is limited. These journeys facilitate the spread of knowledge and can be voyages of self-discovery. In the past it has been customary to bring patients to developed countries for treatment. This policy has proved expensive as the medical costs incurred to treat a single patient in the UK can match the cost of sending a ten unit surgical team abroad for two weeks. 50 patients may be treated in this period of time so the pattern of practice is now for teams of healthcare workers to move to areas of need rather than the other way round.(1