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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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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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Pham KT, Hotez PJ, Hamilton KL. Reconstructive Surgery for the Neglected Tropical Diseases: Global Gaps and Future Directions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4987. [PMID: 37207244 PMCID: PMC10191474 DOI: 10.1097/gox.0000000000004987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 05/21/2023]
Abstract
Several neglected tropical diseases (NTDs) are highly disfiguring, particularly those in resource-poor countries that lack access to basic surgery. There has been a push to integrate surgery into treatment programs for NTDs. In this article, we provide an overview of the major disfiguring NTDs and discuss the processes and barriers that impede access to reconstructive surgical treatments or their integration into health systems. Methods A review of the literature was conducted using the online database PubMed, from 2008 to 2021 with the specific diseases listed as NTDs either on the World Health Organization or the PLoS Neglected Tropical Disease websites. Reference lists of identified articles and reviews were also searched, as were databases from the World Health Organization's Weekly Epidemiological Record. Result Success in the surgical treatment and postoperative care of disfiguring NTDs would benefit from standardization and harmonization of surgical approaches and procedures. In some settings, reconstructive surgery should be used cautiously, emphasizing appropriate use of antibiotics, partnerships with global and local surgical teams, and local capacity building. Preventative hygiene approaches remain paramount in resource-poor areas. Conclusions Surgery is a promising treatment for NTDs that result in disfigurement and disability. The expansion of local capacity building, with medical trips and surgical training of local health workers, together with the development of universal surgical protocols remain essential cornerstones for NTD reconstructive surgery. Antibiotics and drug management should comprise key first steps before turning to surgery.
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Affiliation(s)
- Kala T. Pham
- From the Departments of Biology and Biochemistry, University of Houston, Houston, Tex
- Houston Premedical Academy, University of Houston and Baylor College of Medicine, Houston, Tex
| | - Peter J. Hotez
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Tex
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Isaiah PM, Palmeirim MS, Steinmann P. Epidemiology of pediatric schistosomiasis in hard-to-reach areas and populations: A scoping review protocol. F1000Res 2023; 11:1203. [PMID: 36761831 PMCID: PMC9898687 DOI: 10.12688/f1000research.126884.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
Background: Schistosomiasis is a neglected tropical disease (NTD) that affects millions of people. Children are the most vulnerable group to developing overt disease. An estimated 779 million people are at risk of schistosomiasis and 50 million preschool-age children (PSAC) need treatment. PSAC are not currently targeted by national chemotherapy campaigns due to a lack of suitable pediatric formulations of praziquantel. The Pediatric Praziquantel Consortium has developed an orally dispersible praziquantel formulation (arpraziquantel) and is facilitating its adoption for schistosomiasis control by endemic countries through the ADOPT program - an implementation research program that paves the way for the large-scale delivery of the child-friendly formulation to treat schistosomiasis in preschool-aged children in endemic countries. A key challenge for comprehensive NTD control including schistosomiasis is reaching all at-risk populations, including those hard to reach. Main access barriers include geographic, social and economic conditions. Objective : This scoping literature review aims to document the epidemiology of schistosomiasis in children under 6 years of age living in hard-to-reach areas and populations. Methods : This review will adopt the five-stage scoping review process of identifying the research question, identifying relevant studies, study selection, charting data and collating, summarizing and reporting results. Electronic databases including Medline, Web of Science, Embase (Ovid), LILACS and African Journals OnLine (AJOL) will be searched for relevant articles. Two independent reviewers will screen identified articles using a two-stage approach of reviewing the title/abstract and then the full text of provisionally retained articles. Relevant literatures will be downloaded into EndNote X9 to maintain and manage citation and facilitate the overall review process. A meta-analysis will be conducted if indicated. Relevance : The results will provide insights into the burden of schistosomiasis among marginalized PSAC, aiming to produce evidence on the need for inclusion of this population when designing the expansion of preventive chemotherapy programs.
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Affiliation(s)
- Phyllis Munyiva Isaiah
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland,
| | - Marta Sólveig Palmeirim
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
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Gebretsadik HG, de Kiev LC. A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010372. [PMID: 36099293 PMCID: PMC9506604 DOI: 10.1371/journal.pntd.0010372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/23/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal. Materials and methods A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,—the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score. Results A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25–50%), Grade-3 (50–75%), Grade-1 (0–25%), and Grade-4 (75–100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma. Discussion The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one’s family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity. Noma is orofacial gangrene that rapidly disintegrates the hard and soft tissue of the face. The mortality rate of Noma varies between 85–90%. The remaining 10–15% of Noma survivors permanently suffer from severe facial deformities. Noma is a widely neglected disease affecting poor people globally. Most cases of Noma are reported from the so-called Noma belt, located south of the Sahara and runs across Africa from Senegal to Ethiopia. Though Ethiopia is one of the countries in the Noma-belt region where people, particularly children, are significantly affected by the disease, the attention given to this devastating condition is remained to be very low. Therefore, we believe that assessing the severity and sequela of Noma in Ethiopia is crucially essential to lay bare the burden of the disease and increase the overall understanding of the condition among different stakeholders. We are also convinced that the study’s findings can serve as baseline data for further in-depth scientific investigations and preventive policy development.
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Azañedo D, Visconti-Lopez FJ, Hernández-Vásquez A. A Web of Science-Based Bibliometric Analysis of Global Noma Publications. Trop Med Infect Dis 2022; 7:tropicalmed7080198. [PMID: 36006290 PMCID: PMC9412599 DOI: 10.3390/tropicalmed7080198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The World Health Organization recognizes noma as a global health problem and has suggested prioritizing research into this disease. A bibliographic search of original articles published in the Web of Science database up to 2022 was performed. A bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. We identified 251 articles published in 130 journals. The first publication was in 1975, the highest number of publications was in 2003, and the average number of citations per document was 12.59. The author with the highest number of publications was Enwonwu CO, and the Noma Children's Hospital had the highest number of articles on this topic. Plastic and Reconstructive Surgery was the journal with the most publications, and the study by Petersen PE was the most cited. The country of corresponding authors that had the most publications and the most significant number of total citations was the United States. "Children" and "Reconstruction" were the most used keywords. In conclusion, there are few publications on noma worldwide, confirming the neglected status of this disease. Urgent actions are needed to increase evidence in regard to the epidemiology of noma and public health interventions to mitigate the ravages of this disease.
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Affiliation(s)
- Diego Azañedo
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima 15067, Peru
| | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Correspondence:
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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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Farley E, Mehta U, Srour ML, Lenglet A. Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021). PLoS Negl Trop Dis 2021; 15:e0009844. [PMID: 34905547 PMCID: PMC8670680 DOI: 10.1371/journal.pntd.0009844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Noma (cancrum oris) is an ancient but neglected and poorly understood preventable disease, afflicting the most disenfranchised populations in the world. It is a devastating and often fatal condition that requires urgent and intensive clinical and surgical care, often difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and identify research gaps that need to be addressed to evolve our understanding of how to address this disease. Methods We searched 11 databases and collected primary peer reviewed articles on noma in all languages, the final search was conducted on 24th August 2021. The oldest manuscript identified was from 28th March 1843 and the most recently published manuscript was from 3rd June 2021. Search terms included cancrum oris and noma. Data was extracted using a standardised data extraction tool and key areas of interest were identified. The Preferred Reporting Items for Systemic review and Meta-Analyses requirements were followed. Results The review included 147 articles, the majority of the studies (n = 94, 64%) were case reports. Most manuscripts (n = 81, 55%) were published in the 2000s, 49 (33%) were from the 1900s and 17 (12%) from the 1800s. The main areas of interest identified were the history and epidemiology of the disease, noma’s clinical progression and aetiology, treatment regimens, mortality rates and the risk factors for the development of noma. Conclusions Noma has been reported in the literature for hundreds of years; however important gaps in our understanding of the disease remain. Future research should focus on determining the burden and distribution of disease; the true mortality rate, pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment. Noma is a devastating and often fatal condition that mainly affects children in severely disenfranchised communities. Noma is preventable and requires urgent basic medical care in the early stages of disease. Once the disease reaches the last stage, sequelae, survivors require expert surgical care, usually difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and to identify research priorities that will evolve our understanding of how to eradicate this disease. Our review showed that noma has been reported in the literature for hundreds of years; however several major gaps in knowledge still exist. There is appreciation among the small community of clinicians and researchers involved in noma care and research that these gaps in knowledge impact on the ability to develop and implement sound evidence-based policies and activities aimed at eradicating noma from communities that continue to be afflicted by this ancient disease. The main focus of future research should be to study the burden and distribution of disease; the true mortality rate, and the pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment.
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Affiliation(s)
- Elise Farley
- Noma Children’s Hospital, Médecins Sans Frontières, Sokoto, Nigeria
- Nudibrink Research Consultancy, Cape Town, South Africa
- * E-mail:
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
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