Management of noma: practice competence and knowledge among healthcare workers in a rural district of Zambia

Ahlgren, Mathilda; Funk, Tjede; Marimo, Clemence; Ndiaye, Charlotte Faty; Alfvén, Tobias

doi:10.1080/16549716.2017.1340253

Cited by 23 publications

(23 citation statements)

References 20 publications

(35 reference statements)

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“…More importantly, the lack of knowledge related to the diagnosis and therapy of Hp was concerning. This study replicates findings of multiple previous studies in Africa about general knowledge of bacterial diseases being low among healthcare workers [17,18]. When we consider the inconsistent practices for the management of chronic dyspepsia, coupled with a limited knowledge of possible etiologies and appropriate Hp eradication regimens, it stands to reason that this population could be at risk of antibiotic resistant infection.…”

Section: Discussionsupporting

confidence: 85%

Survey on the prevalence of dyspepsia and practices of dyspepsia management in rural Eastern Uganda

Lee¹,

Adusumilli²,

Kyakulaga

et al. 2019

Heliyon

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Aim To investigate the current prevalence and management of dyspepsia in rural Eastern Uganda. Methods Residents older than 18 years of age across 95 study sites in Namutumba District, Eastern Uganda were surveyed. Each respondent was administered a questionnaire about dyspepsia and pertinent health-seeking behaviors. Health workers at 12 different clinics were also assessed on their competence in managing dyspepsia. Proportion-based analysis was used to determine self-reported outcome variables reported in this study, including: prevalence of dyspepsia; breakdown of symptoms; initial diagnosis location; management strategies; and appropriate medication usage. Results 397 residents (average age of 41.2 years) participated in this study (54.4% males, 45.6% females). 57.9% self-reported currently having dyspepsia, of average duration 4.5 years. Of this subset, 87% reported experiencing epigastric pain, and 42.2% believed that ulcers were “wounds in the stomach.” Only 3% of respondents had heard of Helicobacter pylori (Hp) . Respondents varied in their management of dyspepsia, with frequent eating (39.1%), doing nothing (23.9%), and taking Western medicine (20%) being the most common strategies. The diagnosis of “peptic ulcer disease” was made by a health worker in 64.3% of cases, and 27% of cases were self-diagnosed. Notably, 70.3% of diagnoses at formal health centers were based on clinical symptoms alone and only 22.7% of respondents received treatment according to Ugandan Ministry of Health guidelines. Among the 12 health care workers surveyed, 10 cited epigastric pain as a common symptom of “ulcer,” although only two reported having heard of Hp. Only two out of 12 clinics had the capability to prescribe the triple therapy as treatment for presumed Hp. Conclusion There is a high incidence of dyspepsia in Eastern Uganda, and current management strategies are poor and inconsistent, and may contribute to antibiotic resistance. Further studies are needed to investigate the causes of dyspepsia to guide appropriate management.

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Section: Discussionsupporting

confidence: 85%

Survey on the prevalence of dyspepsia and practices of dyspepsia management in rural Eastern Uganda

Lee¹,

Adusumilli²,

Kyakulaga

et al. 2019

Heliyon

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“…27 Many cases will never seek care, and, even if they do, noma is unknown to many healthcare workers in endemic areas. 28 The condition may thus go undiagnosed, and rapid detection with opportunities for early treatment through improved oral hygiene, nutritional support and antibiotics, may be missed.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of noma in northwest Nigeria

Farley¹,

Oyemakinde

Schuurmans

et al. 2020

BMJ Glob Health

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BackgroundNoma, a rapidly progressing infection of the oral cavity, mainly affects children. The true burden is unknown. This study reports estimated noma prevalence in children in northwest Nigeria.MethodsOral screening was performed on all ≤15 year olds, with caretaker consent, in selected households during this cross-sectional survey. Noma stages were classified using WHO criteria and caretakers answered survey questions. The prevalence of noma was estimated stratified by age group (0–5 and 6–15 years). Factors associated with noma were estimated using logistic regression.ResultsA total of 177 clusters, 3499 households and 7122 children were included. In this sample, 4239 (59.8%) were 0–5 years and 3692 (52.1%) were female. Simple gingivitis was identified in 3.1% (n=181; 95% CI 2.6 to 3.8), acute necrotising gingivitis in 0.1% (n=10; CI 0.1 to 0.3) and oedema in 0.05% (n=3; CI 0.02 to 0.2). No cases of late-stage noma were detected. Multivariable analysis in the group aged 0–5 years showed having a well as the drinking water source (adjusted odds ratio (aOR) 2.1; CI 1.2 to 3.6) and being aged 3–5 years (aOR 3.9; CI 2.1 to 7.8) was associated with being a noma case. In 6–15 year olds, being male (aOR 1.5; CI 1.0 to 2.2) was associated with being a noma case and preparing pap once or more per week (aOR 0.4; CI 0.2 to 0.8) was associated with not having noma. We estimated that 129120 (CI 105294 to 1 52 947) individuals <15 years of age would have any stage of noma at the time of the survey within the two states. Most of these cases (93%; n=120 082) would be children with simple gingivitis.ConclusionsOur study identified a high prevalence of children at risk of developing advanced noma. This disease is important but neglected and therefore merits inclusion in the WHO neglected tropical diseases list.

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“…Noma is a difficult disease to study due to its rapid progression, reported high mortality rate, and the remote location of affected patients [ 1 ]. Noma is infrequently taught in medical, nursing, or tropical medicine courses, and this leads to a lack of knowledge about noma among healthcare workers [ 6 , 7 ]. Affected patients often lack access to quality healthcare, and, even when healthcare is sought, noma is regularly misdiagnosed due to a lack of knowledge about noma among healthcare workers, leading to underreporting of the disease [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Noma is infrequently taught in medical, nursing, or tropical medicine courses, and this leads to a lack of knowledge about noma among healthcare workers [ 6 , 7 ]. Affected patients often lack access to quality healthcare, and, even when healthcare is sought, noma is regularly misdiagnosed due to a lack of knowledge about noma among healthcare workers, leading to underreporting of the disease [ 6 , 7 ]. Patients with noma thus remain invisible within their communities, the health systems that are supposed to serve them, and the global community, feeding into the poor understanding of this disease and its subsequent neglect.…”

Section: Introductionmentioning

confidence: 99%