RESEARCH ARTICLE


NOMA: A Preventable “Scourge” of African Children



Kalu U.E Ogbureke 1, 2, *, Ezinne I Ogbureke 2
1 Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta Georgia, U.S.A
2 Department of Oral Health and Diagnostic Sciences, School of Dentistry, Medical College of Georgia, Augusta Georgia, U.S.A.


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Creative Commons License
© Ogbureke and Ogbureke; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Oral Biology, School of Dentistry, Medical College of Georgia, 1120 15th Street, Augusta, Georgia 30912, USA; Tel: 706 721-2526; Fax: 706 721-3392; E-mails: kogbureke@mail.mcg.edu; kogbureke@netscape.net


Abstract

Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma.

Although a formidable public health challenge, noma can be prevented with a potential for subsequent global eradication. To achieve both desirable goals, detection of early disease is crucial because these early lesions respond to conventional antibiotic treatments when instituted side by side with nutritional rehabilitation, and obviates the necessity for extensive surgical reconstruction often indicated in late stage disease. The eradication of noma in the developed world in the mid 20th century bears out the notion of a similar outcome following effective preventive strategies in Africa. A fundamental and necessary step towards attaining this goal is for the international community to adopt a perception of noma as an urgent global public health challenge. Research effort toward deciphering the microbiology, molecular events, and pathogenesis of noma also should intensify.

Keywords: Noma, Cancrum Oris, Sub-Sahara Africa, Acute Ulcerative Gingivitis, Preventable Disease, Surgical Management.