Influencing Factors for Social Acceptance of Noma (Cancrum Oris) Patients in Niger: A Hospital Based Retrospective Study

Abstract

Background: Noma causes severe orofacial disfigurement with significant mortality and morbidity, especially seen in malnourishment young children in the poor regions of the world. With majority of noma patient surviving with aesthetical effects, they were exposed to stigmatization and social rejection. Studies focusing on the socio-psychological impact of noma survivors have rarely been done. The aim of our study is to identify the differences in social acceptance/rejection and their influencing factors associated with social acceptance in noma patients. Methods: A cross-sectional study was conducted in the reception centre of NGO-Sentinelles (Niger), on patients with noma from Zinder, Maradi and Tahoua regions, between 9th May 2017 and 2nd June 2017. The survey was conducted on some patients admitted in the center and those discharged from the centre after treatment by a face-to-face interview. The questionnaire used for the interview comprised of 45 questions (Cronbach’s alpha coefficient =0.812) which contained pathological information, socio-demographic characteristics and socio-psychological information. Findings: We recorded 50 patients (43 from Zinder and 7 from Maradi and Tahoua). The younger patients (1-5years old), noma patients who stayed in school during follow-up treatment, patients who were referred by a health structure, patients enrolled into the centre in a short time (<30days), patients in acute phase of noma had a significantly high social acceptance rate with respectively 60.0, 82.9, 60.0, 57.1 and 94.3%; whereas single adults and cheek lesion site had the highest social rejection rate when compared to their corresponding factors with 60.0 and 86.7%. There were significant differences in victims’ perception of noma [χ2 =45.536, (P <0.001)] and acceptance of their new faces [P=0.023], between the social acceptance and social rejection rate, therefore all patients who accepted their new faces felt social acceptance. The social acceptance were significantly highly correlated with pathological history (admission method, phase of noma, care and treatment received at center) with rs raged from 0.609 to 0.810, moderately correlated with patient’s socio-demographic characteristics (age, marital status, and region) with rs raged from 0.381 to 0.474, and lowly correlated with clinical evolution after treatment (rs=0.293). Logistic regression results showed that the likelihood of social acceptance increased when the patients age was small (≤15 years), marital status was minor, and they were enrolled at the school before noma appearance, they were referred to the centre after diagnosis, the admission time to the centre was short (≤30 days), acute phase of noma, and care received at centre was non-surgery. The location of lesion on the cheek was a risk factor for social-acceptance, indicating cheek lesion from noma increased the likelihood of social rejection in our study. Conclusion: The sociodemographic characteristics, pathological history and psychological aspects of noma patients were correlated with each other, and they were important factors influencing their social acceptance/rejection rate. Funding: No funding received. Declaration of Interest: We declare that we have no conflicts of interest Ethical Approval: The ethics approval letter was provided by the NGO-Sentinelles. A collaboration agreement with the officials of NGO-Sentinelles to perform this study was made after a meeting with coordinators in both Switzerland and Niger.