Case Of Noma Research Articles

Nonparametric Testing of Body Mass Index as a Predictor of Severe Noma: Assessing Potential Association.

Noma, a devastating facial disease, primarily affects impoverished populations in low- and middle-income countries, often leading to severe disfigurement or fatality if untreated. Studies suggest malnutrition is a significant risk factor for noma, yet the association between body mass index (BMI) in kilograms per square meter and tissue damage severity remains underexplored. This study aimed to investigate the relationship between BMI and tissue damage severity among noma cases in Ethiopia. A retrospective analysis of medical records from Facing Africa's database covering noma cases treated between 2007 and 2019 was conducted. A standardized data collection template recorded demographic and clinical data, including patient demographics, BMI, and tissue damage severity levels. JASP statistical software was used for analysis. Analysis of 228 noma cases revealed a mean BMI of 17.8 kg/m2, ranging from 11.5 to 28.3 kg/m2. Females exhibited a higher mean BMI (18.3 kg/m2) than males (16.9 kg/m2). Differences in BMI distributions between major (67) and minor (30) tissue damage categories were observed, with "minor" cases having a slightly higher mean BMI. The study found a statistically significant association between BMI and tissue damage severity (P = 0.03), indicating that tissue damage due to noma worsened as BMI decreased. Nonparametric tests confirmed this association's significance. This study highlights low BMI as a predictor of severe noma. Public health interventions should focus on malnutrition to reduce noma severity and psychosocial and functional morbidity and improve outcomes. However, additional factors influencing the progression of noma and the severity of associated tissue damage require further investigation.

Resurgence of Noma (Cancrum Oris) in Nigeria.

Recent data from Médecins Sans Frontières and local health authorities highlight a concerning rise in noma cases across previously unaffected Nigerian states. Noma is a severe gangrenous disease affecting impoverished populations, causing severe facial disfigurement and high mortality rates, especially among children. Despite its eradication in developed regions, sub-Saharan Africa faces an escalating noma incidence. This communication highlights the urgent need for enhanced surveillance, awareness, regional treatment centers, and international support to mitigate its impact in Nigeria and avoid exacerbation of the condition across sub-Saharan Africa.

High burden of noma in the Gambella region of Ethiopia: a 12-year retrospective study on noma cases from the Facing Africa database.

Noma, an infectious disease, mainly affects impoverished children. This study retrospectively assessed noma's prevalence in Ethiopia using data from the Facing Africa database and the 2022 United Nations Development Programme poverty index report. A thorough review of medical records spanning 2007 to 2019 identified a total of 235 noma cases. A standardized data extraction template was employed to systematically gather pertinent clinical and demographic data for subsequent analysis. Prevalence rates were calculated nationally and regionally for both the general population and children aged ≤10 y. The analysis revealed estimated national prevalence rates of 0.65 per 100 000 individuals at risk and 1.9 per 100 000 children aged <10 y at risk. The Gambela region exhibited the highest prevalence rate (11.2 per 100 000), whereas the Benshangul Gumuz region had the lowest (0.25 per 100 000). Similar patterns were observed among children aged ≤10 y, with the Gambela and Benshangul Gumuz regions reporting rates of 32.9 and 0.74 per 100 000, respectively. The study highlights noma's significant impact on children aged <10 y in Ethiopia, especially in the Gambella region. It offers crucial baseline data to assist public health professionals, policymakers and healthcare providers in formulating evidence-based strategies to combat noma and improve affected individuals' well-being.

Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia.

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. The research employed a cross-sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database. 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. 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. 5.

Noma is a facial disfiguring childhood disease: Insights from cases of Noma in Ethiopia

ObjectivesNoma is a neglected infectious disease that causes severe destruction of facial tissues and poses a significant public health threat. The disease reportedly affects individuals with a debilitating health condition. This study aimed to identify the most vulnerable age group affected by Noma disease and assess the severity of tissue damage among Noma cases in Ethiopia. MethodsA cross-sectional study was conducted to determine the age group most susceptible to noma and assess the disease-associated severity of tissue damage. The research objectives were met by scrutinizing electronic medical records of noma cases treated in Addis Ababa, Ethiopia, from 2007 to 2019, obtained from the Facing Africa database. Data collection was carried out using a standardized survey form, while the severity of facial tissue damage was assessed using the NOIPTUS score. ResultsAmong 164 Noma cases with documented data on disease onset, 92.7 % occurred during childhood, with 92.1 % of those cases being children aged ten years and younger. Approximately 11.6 % of all noma cases had mild tissue damage, classified as NOITULP grade 1, while 26.2 % had an intermediate level of tissue damage, classified as NOITULP grade 2. Severe tissue damage (NOITULP grade 3) was present in 37.2 % of cases, while 25 % had very severe tissue damage (NOITULP grade 4). ConclusionsThe findings underscore the vulnerability of children, particularly those aged ten years and younger, to Noma disease, supporting the argument that Noma is a facial-disfiguring childhood disease. Targeted interventions and preventive measures during childhood can be vital in controlling Noma incidence.

Surgical Procedures, Complications, and Durations in Patients with Noma Disease: A Cross-sectional Study.

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. 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. 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. 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.

Noma in an 18months Toddler: A Rare Case Report with Review of Literature.

Noma is a polymicrobial necrotizing infection of the mouth and face which destroys the soft and hard tissues of the oral and paraoral structures. Malnutrition, poverty, lack of basic hygiene, and chronic disease state etc., possess a risk of developing noma. Noma neonatorum is a progressive gangrenous disease affecting the premature infants. We present a rare case of noma in an 18months toddler with a chronic debilitating condition predisposing to the disease progression. The necrotizing infection of the face developed after six months of multiple episodes of chronic blood-tinged diarrhea. The facial defect was managed with release of fibrosis and reconstruction with a superiorly based nasolabial flap. Noma reflects extreme malnutrition and poverty with a vast range of etiopathological agents. This case emphasizes the need to understand the host risk factors and etiopathologic agent predisposing to this rare opportunistic and dormant but devastating disease, the morbidities associated with it and measures to prevent it.

The severity of psychosocial and functional morbidity among facially disfigured untreated noma cases in Ethiopia

ObjectivesNoma is a facially disfiguring disease that affects the oral cavity and midface structures. If left untreated, the disease is fatal. Noma causes severe cosmetic and functional defects in survivors, leading to psychiatric and social problems. However, there are limited data on psychosocial and functional sequelae associated with this disease. This cross-sectional study aimed to investigate psychosocial and functional morbidity among facially disfigured untreated Noma cases. Study participants were volunteer patients diagnosed with noma and awaiting surgery at two noma treatment centers in Ethiopia. A questionnaire derived from the APA’s DSM-5, the DAS59, and the Appearance Anxiety Inventory protocol was used to measure the psychosocial and functional morbidity of the cases between September 16 and October 10, 2022.ResultsA total of 32 noma cases (19 women and 13 men) awaiting the next surgical campaigns were involved in the study. Study participants reported severe social (Likert score = 2.8) and psychological (Likert score = 3.0) morbidity. Functional limitation was moderate (Likert score = 2.9). This study has shown that psychosocial and functional morbidity in untreated noma cases in Ethiopia is substantial. Therefore, policymakers, clinicians, and researchers need to pay sufficient attention to providing adequate health care and preventing the occurrence of the disease in the long term.

Frequently Performed Surgical Procedures for The Treatment of Noma Cases in Ethiopia

Frequently Performed Surgical Procedures for The Treatment of Noma Cases in Ethiopia

An Update on the Epidemiology of Noma (Facial Gangrene) in Ethiopia

Noma is an infectious disease that mainly affects debilitated children in developing countries. The geographic region of the noma belt, stretching from Senegal to Ethiopia, is arguably the most affected area in the world. This updated retrospective cross-sectional study assessed the epidemiology of Noma in Ethiopia. The assessment was based on a review of patients' medical records from three noma treatment centers. A modified case report form (CRF) was used to collect the clinical information required for data analysis. One hundred eighty-two patient records from the medical registries of the three centers were analyzed to determine the results of the updated study. Data analysis revealed that the disease occurred primarily in children younger than ten years of age. However, the condition also occurred in neonates, infants, children, and adults. Amhara and Oromia regions had a high number of noma cases, 29.2% (n=38) and 25.4% (n=33), respectively. The geographical distribution also suggests that noma is a tropical disease. Cheeks, lower lips, and upper lips were the most commonly affected orofacial anatomic regions. Indeed, more attention should be paid to these geographic regions and children younger than ten.

Retrospective Characterization of Noma Cases Found Incidentally across Nigeria during Outreach Programs for Cleft Lip from 2011-2020.

Reports of cases of noma in Nigeria remain scarce despite its known and devastating effects on victims. This report presents a retrospective cross-sectional study based on data regarding on patients with noma encountered incidentally during Oral Health Advocacy Initiative outreach on orofacial diseases across 34 states and the Federal Capital Territory in Nigeria over 10 years (2011-2020), which was aimed at contributing to an understanding of the epidemiology of noma in Nigeria. The data were collated and analyzed, and are presented in frequency distribution tables and charts. A total of 7,195 patients with noma were encountered. The northeastern region had the greatest number of patients (n = 1,785, 24.8%) whereas the southwestern region had the least (n = 196, 2.7%). When aggregated by state, Ondo State had the least number of patients (n = 31, 0.4%) whereas Kano State had the greatest (n = 623, 8.7%). Patient age ranged from 3 to 70 years, with a slight male preponderance (56.9%). This report highlights the fact that noma is prevalent in Nigeria but remains neglected, with extensive but preventable physical, emotional, and social debilitation and devastation of the victims across all age groups. There is a need for a more robust survey to determine the true burden of the disease. There is also an urgent need for collaboration between governments and nongovernmental organizations to institute appropriate interventions by way of public education and enlightenment, as well as case detection and early treatment to mitigate the devastating consequences of delayed or poorly managed cases.

A review of noma cases in a tertiary hospital located in a conflict endemic region in Nigeria

ABSTRACT Noma, a neglected tropical disease (NTD), is a preventable oro-facial gangrenous infection causing destruction of oro-facial tissues if untreated. This descriptive study was conducted in North-Eastern Nigeria which has witnessed armed insurgency increasing risk of noma. Data was obtained from patients’ records at a tertiary hospital after a dental educational outreach using radio and visits to the hospital's ante/postnatal clinics. Data analysis was conducted at 95% confidence interval with p≤ 0.05 considered significant. Records of 49 patients were retrieved but 31 (63.3%) were utilised due to poor documentation. Age ranged from 2–63 years. Children (0–16 years) and Adults (17–59 years) were 67.7% and 25.8% respectively. Males were 13 (41.9%) and females, 18 (58.1%). Poor oral hygiene and malnutrition were common findings. Stage (WHO Staging System) 2 (51.6%) and 4 (22.6%) were the most common presentation. Successfully managed and referred cases were 51.6% and 48.4% respectively. Successful management was associated with early stages of noma (p = <0.001). Children were most vulnerable. Outreaches using radio and education to pregnant women and nursing mothers can boost early presentation and better outcomes. Attention to case documentation and inclusion of noma into the WHO list of NTDs are recommended.

Noma, a neglected disease: prevention is better than cure.

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. 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. 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.

Economic and Social Costs of Noma: Design and Application of an Estimation Model to Niger and Burkina Faso.

Background: While noma affects hundreds of thousands of children every year, taking their lives, disfiguring them and leaving them permanently disabled, the economic and social costs of the disease have not been previously estimated. An understanding of the nature and levels of these costs is much needed to formulate and implement strategies for the prevention and control of this disease, or to mitigate its burden. The objectives of our study were to develop a model for estimating the economic and social costs of noma and to provide estimates by applying this model to the specific contexts of two countries in the “noma belt”, namely Burkina Faso and Niger. Methods: Three main approaches were used. The estimation of prevalence levels of potential noma cases and of cases that should receive and actually do receive medical care was carried out using a literature review. The documentary approach made it possible to estimate the direct costs of noma by analyzing the database of a non-governmental organization operating in this field and present in both countries. Indirect costs were estimated using the human capital method and the cost component analysis technique. Results: The direct costs of care and management of noma survivors amount to approximately USD 30 million per year in Burkina Faso, compared to approximately USD 31 million in Niger. They mainly include costs for medical treatment, surgery, hospital stays, physiological care, psychological care, social assistance, schooling, vocational training and care abroad. Indirect costs are estimated at around 20 million in lost production costs in Burkina and around 16 million in Niger. Costs related to premature deaths are estimated at more than USD 3.5 billion in Burkina Faso and USD 3 billion in Niger. Finally, the costs to survivors who are unable to marry are around USD 13.4 million in Burkina and around USD 15 million in Niger. Intangible costs were not calculated. Conclusions: The neglect of noma and inaction in terms of prevention and control of the disease have enormous economic and social costs for households, communities and states. Future studies of this kind are necessary and useful to raise awareness and eradicate this disease, which impacts the health and well-being of children and results in lifelong suffering and severe economic and social costs to survivors and their families.

Is noma a neglected/overlooked tropical disease?

Noma is a debilitating orofacial necrotizing bacterial disease that disproportionately affects impoverished malnourished persons, particularly young children, the vast majority of whom live in tropical and subtropical areas in sub-Saharan Africa. It has a very high mortality rate; causes significant physical and psychological morbidity, stigmatization and social discrimination; could be prevented, controlled and indeed eliminated by common public health interventions; and is overlooked with regard to public health awareness, in-depth scientific research activities and allocation of funding for prevention, treatment and research.According to the WHO, noma comprises five sequential ‘stages’: (1) necrotizing gingivitis, (2) edema, (3) gangrene, (4) scarring and (5) sequelae. This WHO staging of noma is contentious, leading to diagnostic confusion with misestimation of the number of noma cases reported in epidemiological studies. We therefore suggest a simpler, more practical and scientifically valid two-stage classification comprising only (1) acute noma and (2) arrested noma.Noma meets all the WHO criteria for classification as a neglected tropical disease (NTD). Most survivors of noma live with gross physical disfigurement and disability, and with impaired psychosocial functioning, so they are very often stigmatized and unjustifiably discriminated against. Owing to the paucity of evidence-based epidemiological data on noma, the relatively low number of people affected worldwide, and its apparently limited geographic distribution, noma does not yet feature on the WHO's list of NTDs, or on any global health agenda, and thus has not become a health priority for global action. We strongly support the inclusion of noma within the WHO list of NTDs. Without doubt this will increase the awareness of noma among healthcare providers and promote the systematic international accumulation and recording of data about noma.

Noma disease (cancrum oris, orofacial gangrene) in an acute myeloid leukemia patient: a case\xa0report

BackgroundNoma is a rare disease that occurs mainly in malnourished patients in developing countries. Noma starts as facial swelling and gingival necrosis that eventually necrotizes underlying tissues including the jaw bone, leaving severe disfigurement. It is reported extremely rarely in patients with severe immunosuppression or blood dyscrasia.Case presentationThe gingivitis that occurred in a 12-year-old Asian female patient with acute myeloid leukemia was getting increasingly worse. Although the proper treatment was done, the patient’s condition did not improve, and eventually, a large full-thickness defect was left in the maxillofacial part.ConclusionsEarly diagnosis and management is the only way to prevent the progression, which leads to facial disfigurement. We present a case of noma in a pediatric acute myeloid leukemia patient, in which oral function was restored through surgical intervention.

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021).

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. 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. 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. 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.

EPIDEMIOLOGICAL INVESTIGATION OF NOMA IN PAPUA PROVINCE IN 2017

Background: Indonesia Ministry of Health in October 2017 obtained information from the Public Health Emergency Operation Center that there allegations of noma case in a toddler from the Korowai tribe in Asmat district. Purpose: This study aims to describe the magnitude of the noma problem, identify risk factors, and find other noma cases for prevention and control. Methods: This was a descriptive study using a case study approach. Primary data was obtained from interviews with family or close relatives of patients to obtain information about patient identity, medical history, and risk factors. Measurement of nutritional status and oral health was done by measuring weight or height and checking their oral health. Secondary data was obtained from Asmat DHO and Yaniruma Health Center. The data analyzed were geographical, demographic, socio-cultural, transportation, and communication condition. Results: Noma sufferer was a 5-years-old child who lived in Afimabul village. There was not other cases of Noma found in Korowai tribal community. A long distance to reach health services and no availability of communication tools to Korowai tribe in Afimabul village made them inaccessible. The results of the identification of risk factors in 46 children found that the majority of them had low oral hygiene (73.91%) and consumed uncooked water (80.43%). Besides, some had an index of thin body weight (15.22%), and very lean (6.52%), and also found the suspected measles. Conclusion: There was only one case found in the Asmat district. Moreover, there were still found Korowai children with thin and very lean nutritional status and suspected measles who are risk factors for noma.

Language and beliefs in relation to noma: a qualitative study, northwest Nigeria.

Noma is an orofacial gangrene that rapidly disintegrates the tissues of the face. Little is known about noma, as most patients live in underserved and inaccessible regions. We aimed to assess the descriptive language used and beliefs around noma, at the Noma Children's Hospital in Sokoto, Nigeria. Findings will be used to inform prevention programs. Five focus group discussions (FGD) were held with caretakers of patients with noma who were admitted to the hospital at the time of interview, and 12 in-depth interviews (IDI) were held with staff at the hospital. Topic guides used for interviews were adapted to encourage the natural flow of conversation. Emergent codes, patterns and themes were deciphered from the data derived from IDI's and FGDs. Our study uncovered two main themes: names, descriptions and explanations for the disease, and risks and consequences of noma. Naming of the disease differed between caretakers and heath care workers. The general names used for noma illustrate the beliefs and social system used to explain the disease. Beliefs were varied; participant responses demonstrate a wide range of understanding of the disease and its causes. Difficulty in accessing care for patients with noma was evident and the findings suggest a variety of actions taking place before reaching a health center or health worker. Patient caretakers mentioned that barriers to care included a lack of knowledge regarding this medical condition, as well as a lack of trust in seeking medical care. Participants in our study spoke of the mental health strain the disease placed on them, particularly due to the stigma that is associated with noma. Caretaker and practitioner perspectives enhance our understanding of the disease in this context and can be used to improve treatment and prevention programs, and to better understand barriers to accessing health care. Differences in disease naming illustrate the difference in beliefs about the disease. This has an impact on health seeking behaviours, which for noma cases has important ramifications on outcomes, due to the rapid progression of the disease.

Estimated incidence and Prevalence of noma in north central Nigeria, 2010-2018: A retrospective study.

BackgroundNoma is a spreading and fulminant disease believed to be native to Sub-Saharan Africa over the last decade and associated with low socioeconomic status of citizens of the region. Within this noma belt, most epidemiological reports regarding the disease have emanated from the north western region of Nigeria. However, our indigenous surgical mission encountered a substantial number of cases of noma and post-noma defects noteworthy of epidemiological representation across north central Nigeria.MethodsAll noma cases encountered within the 8-year study period were included and divided based on clinical signs into acute and sequelae groups. Incidence estimation was based on acute/recently active cases and was calculated using the statistical method proposed by the WHO Oral Health Unit (1994). Period prevalence of noma was calculated considering the population at risk in the zone.FindingsA total of 78 subjects were included in the study with age ranging from 2–75 years. Twelve subjects (15.4%) presented with acute disease while 66 (84.6%) had various forms of post-noma defects. The estimated incidence of noma in the north central zone was 8.3 per 100000 with a range of 4.1–17.9 per 100000 across various states. Period prevalence of noma which incorporated all cases seen within the study period was 1.6 per 100000 population at risk.ConclusionAlthough noma may be more prevalent in the north western region of Nigeria, substantial number of cases occurs within the north central zone which calls for deliberate public awareness campaign on disease risk factors and prevention, and education of primary health-care providers.