Noma is a facial gangrene infection that affects children in particular. Its name comes from the Greek word “nomē”, meaning "to devour".
The disease starts in the mouth and eats away the facial tissue, leaving survivors with severe disfigurements. These can cause life-threatening impairments and crippling social stigma.
Noma mostly affects children under 10, from poor, remote communities in Africa.
The World Health Organization (WHO) estimates that around 140,000 new noma cases emerge every year, but this data has not been updated since 1998.
Where noma is detected at an early stage, its progression can be rapidly halted, through basic hygiene, antibiotics and nutritional rehabilitation. But without treatment, noma is fatal in 90 percent of cases.
Médecins Sans Frontières / Doctors Without Borders (MSF) supports the world's only dedicated noma hospital in northwest Nigeria. Our programme in Sokoto Children's Hospital, run in collaboration with the Ministry of Health, focuses on outreach, education and surgery. In 2018, our teams performed 150 surgeries on 117 noma patients.
An important step towards eradicating the disease is the inclusion of noma on the WHO's list of neglected tropical diseases which MSF, along with other organisations, is campaigning for.
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Noma: Key facts
PEOPLE WITH NOMA WHO DIE WITHIN TWO WEEKS WITHOUT TREATMENT
ESTIMATED NUMBER OF CHILDREN AFFECTED EACH YEAR
AMOUNT OF TIME RECOVERY TAKES WITH TREATMENT
This devastating disease is poorly understood.
There is no one determined cause for the disease. Multiple factors are thought to play their part, and we are investigating this as part of our noma project in Sokoto.
What is clear is that it's a disease associated with extreme poverty and malnutrition, affecting families living with poor access to sanitation and oral hygiene.
Noma was once reported globally, including in Europe and the United States. Cases appeared in prisoners of Nazi concentration camps during World War Two.
Noma begins as a severe gum infection (gingivitis), leading to painful lesions (ulcers) in and around the mouth.
It progresses into a necrotising infection that kills soft tissue. As it spreads, noma ravages the face, lips, and chin, leaving survivors with extensive scarring.
Depending on the stage or severity of infection, disfigurements can vary. Many patients will lose significant areas of their face, leaving the bone underneath exposed.
Some patients experience trismus (also known as “lockjaw”) and are unable to speak or chew, leading to malnutrition.
Other symptoms include fever, drainage and loss of teeth.
Though noma itself is relatively easy to treat, patients are still left with extensive disfigurements which can affect their physical and mental health.
In our noma project in Sokoto, we send highly specialised surgeons to the hospital to operate on patients. This happens four times per year, consisting of one plastic surgeon and one maxillofacial surgeon.
Plastic surgeons are responsible for the reconstruction of soft tissue, whilst maxillofacial surgeons deal with jaw work. Both are specialised in refiguring facial defects.
Multiple operations are needed to treat noma disfigurements, making recovery a long, gradual process. Some patients will need up to three surgeries spanning the course of several years.
Noma patients experience high levels of stigma within their communities. They are often considered cursed, and face exclusion or abandonment as a result. Parents of children infected with noma sometimes stop feeding them altogether.
In our noma project in Sokoto, we provide psychosocial care for our patients, and help to rebuild connections between parents and children.
We also provide skills-based activities for adult noma patients, who have grown up knowing only the stigma surrounding their condition.
We run education and community outreach programmes, seeking to reach patients unaware of our services and to improve public understanding.
Noma is a sad and horrific disease. But after completing their course of surgeries and counselling, we see our patients, both children and adults, find a restored dignity. People are once again able to re-integrate into society.
We see some children able to return to school, some adults finding jobs, and communities and families welcoming back their loved ones.