By Mary Hearty
Despite noma- a disease that disfigures the mouth and face, and has a mortality rate of up to 90%- first being reported as far back as 1836, the specific organism responsible for its cause is still not known.
According to Dr. Elise Farley, an epidemiologist who has worked on the groundbreaking Médecins Sans Frontières (MSF) Noma disease operational research studies since 2016, it is important to find out the cause in order to help design treatments for all the stages of the disease.
Speaking during a media briefing hosted by Africa Science Media Centre (AfriSMC), Dr. Farley mentioned that there is minimal research on the disease as a few different organisms have been reported in literature reviews but none is consistent among noma patients.
“Data from the World Health Organization (WHO) only explores estimates which are quite old as they were done almost 30 years ago. But according to them, 140,000 are affected every year, and 770,000 survivors are living with sequelae,” she said.
Since 2013, only 10 priority countries have been receiving technical support from WHO. They include Nigeria, Mali, the Democratic Republic of Congo, Togo, Benin, Burkina Faso, Cote d’Ivoire, Guinea Bissau, and Senegal.
The disease mostly affects young children between the ages of 2 and 5 years suffering from malnutrition, living in extreme poverty, and with weakened immune systems.
Other risk factors of the disease are lack of vaccination against comorbidities such as malaria and measles, with three months prior recognizable symptoms.
According to WHO, noma starts as a lesion (a sore) of the gums, inside the mouth. The initial gum lesion then develops into ulcerative, necrotizing gingivitis that progresses rapidly, destroying the soft tissues and bones of the mouth and further progressing to perforate the hard tissues and skin of the face.
Currently, the WHO recommends the use of broad-spectrum antibiotics such as Amoxicillin as they have been observed to be effective but only in the early acute reversible stages of the disease.
Working at Sokoto Noma Hospital in Nigeria, Dr. Farley argued that these antibiotics could be effective because several of the secondary infections in the noma patients arriving at the hospital are bacterial.
Owing to the rapid progression of the disease and the high mortality rate associated with its acute phase, numerous cases of noma remain undetected.
“It is difficult to find the patients in the early stages of the disease to be able to take the oral swabs before they get treatment because most of the patients seek medical attention at very late stages of the disease,” Dr. Farley explained.
Once noma reaches the fourth stage without rapid treatment, Dr. Farley explained, the patient’s condition becomes irreversible and life-threatening within a short time as little as two weeks.
The patient will hopefully survive if treated on time but will need very complex reconstructive surgery which is not frequently available in the settings where the disease is prevalent.
“It is extremely rapid that is why it is important for patients to seek healthcare quickly to be able to diagnose noma and to be able to have the correct treatment,” she said, adding that treatment in the early stages is broad-spectrum antibiotics, nutritional support, and wound cleaning.
In this regard, Dr. Farley suggested that more focus should be on preventing noma rather than treating it, noting that preventive measures are available.
They include proper nutrition, where she advised that there should be feeding programs for malnourished children and adherence to routine childhood vaccination when the vaccines become available.
Another measure is oral screening. “If we can include oral screenings in routine healthcare visits for children, we would be able to identify children with early symptoms, especially gingivitis and acute necrotizing gingivitis, and then make sure they get access to nutrition and routine vaccination,” Dr. Farley stated.