The prevalence of noma in northwest Nigeria

Abstract

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.

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

“…This estimate was calculated using a WHO recommended formula ( S1 Equation ), based on a 5–20% presentation rate of patients with acute noma or sequelae, and an 80–90% mortality rate in the acute stages of the disease [ 157 ]. A Nigerian study (retrospective chart review from 2010 to 2018) estimated the incidence of noma in the north central zone was 8.3 per 100,000 population members at risk [ 135 ] and a further study from Nigeria (2018) estimated the community-based point prevalence in the northwest was 3,300 out of every 100,000 children aged 0–15 years [ 142 ]. The large variation in these results is due to the differing study designs and the different stages of noma (and case definitions for these stages) included in the estimates.…”

Model of care, Noma Children’s Hospital, northwest Nigeria

“…The noma research committee has employed both qualitative and quantitative methods to examine the biopsychosocial features of noma, its epidemiology in northwest Nigeria and treatment practices for the disease [ 7 , 27 , 57 , 58 , 59 ]. Published studies include a case–control study assessing the risk factors for diagnosed noma [ 7 ]; two qualitative studies examining the names and beliefs about noma [ 57 ] and traditional healers experiences of noma [ 58 ]; a case series of patients surgically treated at the NCH [ 59 ]; and a cross‐sectional prevalence survey [ 27 ]. Findings from these studies are incorporated into the messaging used by the outreach team and care provided at the hospital.…”

“…Noma cases are frequently reported in Nigeria [ 8 , 9 , 21 , 22 , 23 , 24 , 25 , 26 ]. In northwest Nigeria in 2018, 3300 out of every 100 000 children in the 0–15 year age group were estimated to have any stage of noma at the time of the survey [ 27 ]. For the past 21 years, the Nigerian Ministry of Health has run a specialised programme for the treatment of noma at The Noma Children’s Hospital (NCH) in Sokoto State in the northwest of the country.…”

Noma and Necrotizing Fasciitis of the Face and Neck

“…The World Health Organization (WHO) estimates an incidence of noma of 140,000 cases per year, 22 with 770,000 total ongoing global cases. 23 However, epidemiological studies on noma have proven difficult to conduct given the disease's high mortality rate, its prevalence in countries without infrastructure to track disease statistics, and the inability to follow up with afflicted patients due to both nomadic lifestyles and the disease's social stigmatization. 22 Noma's prevalence appears to rise from January to May within sub-Saharan Africa, as these months are often "the dry months, the hungry months, and when the incidence of Measles is at its highest."…”