‘Noma’: The latest addition to WHO’s list of neglected tropical diseases

Context

The severe gangrenous disease of mouth and face has 90% mortality rate and is associated with extreme poverty, malnutrition

WHO and Noma:

The World Health Organization (WHO) took a significant step on December 15, 2023, by officially adding noma, a severe gangrenous disease affecting the mouth and face, to its list of neglected tropical diseases (NTD).
Commonly known as cancrum oris, noma poses a significant health threat, especially to marginalized children living in extreme poverty.

Neglected Tropical Diseases (NTDs)

NTDs are a group of infections that are very common amongst marginalized communities in the developing regions of Africa, Asia and the Americas.
They are caused by a variety of pathogens such as viruses, bacteria, protozoa and parasitic worms.
NTDs are common in tropical areas where people do not have access to clean water and sanitation.
These NTD diseases receive less funding for research and treatment than malaises like tuberculosis, HIV-AIDS and malaria.
Examples of NTDs are: snakebite envenomation, scabies, yaws, trachoma, Leishmaniasis and Chagas disease etc.

The Severity of Noma

High Mortality Rate: Noma, with a mortality rate of approximately 90%, is associated with extreme poverty, malnutrition, poor sanitation, and limited access to oral hygiene.
Primary Target: It primarily targets children aged 2-6 years and is prevalent in impoverished communities.

Lack of Awareness and Reliable Data

Lack of Awareness: The lack of awareness surrounding noma is compounded by the absence of reliable data.
Disease Prevalence: While the WHO estimates 140,000 cases per year with a prevalence of 770,000 cases, the latest data dates back to 1998, emphasizing the hidden and neglected nature of this disease.

Origins and Risk Factors

Origin of Disease: The name "noma" is derived from the Greek word "nom?," meaning "to devour," reflecting the disease's ability to consume facial tissue and bones if not treated early.
Risk Factors: Noma is linked to poor oral hygiene, malnutrition, weakened immune systems, infections, and extreme poverty.
Although not contagious, it tends to strike when the body's defenses are weak.

Global Distribution and Impact

Developing Countries: Noma is frequently observed in developing countries, particularly in sub-Saharan Africa, where it disproportionately affects poor children aged 3-10 years.
Need for Early Detection: Early detection is crucial due to its high mortality rate, and interventions involving basic hygiene, antibiotics, and nutritional rehabilitation can significantly slow its spread.

Treatment Challenges and Consequences

Early treatment: Early treatment is imperative, as noma often starts as an ulcer on the mucous membrane, quickly developing into massive necrosis.
Consequences: Survivors face significant consequences, including facial disfigurement, jaw muscle spasms, oral incontinence, and speech problems.
Effective drugs and Treatment: Access to effective drugs and surgical treatments remains a challenge, particularly for those in extreme poverty.

Historical Context and Progress

Noma and Developed Countries: Noma was prevalent in the Western world in previous centuries but disappeared with economic progress and improved child feeding.
World War 2: It was also reported in concentration camps during World War 2.
Recognizing noma as an NTD: Recognizing noma as an NTD is seen as a critical step towards eradicating the disease, marking progress in global health efforts.

Call to Action and Global Awareness

Global Awareness: The inclusion of noma as an NTD aims to raise global awareness, catalyze research, stimulate funding, and enhance efforts to control the disease through multidimensional approaches.

Way Forward:

The acknowledgment of noma as a neglected tropical disease by the WHO signals a call to action.
It emphasizes the need for global collaboration, research, and resource allocation to address this devastating health challenge, with the ultimate goal of achieving universal health coverage and improving the lives of underserved populations.