Noma, otherwise known as necrotising ulcerative stomatitis, gangrenous stomatitis or cancrum oris is a bacterial infectious but non-contagious infection; resulting from poor oral hygiene, lack of sanitation and malnutrition, affecting both soft and hard tissues of the mouth and face, rapidly progressive and more often than not fatal.
Most common sign and symptom is the development of ulcer in the mucous membrane of the mouth before spreading to other parts of the face. If detected early, condition can be arrested with antibiotics, proper nutrition and oral hygiene while late diagnosis even if treated does not restore disfigured or damaged tissues.
Affecting children between two and six years of age, the disease is prevalent in impoverished communities in Asia and Africa, though infection was also found decades ago in Europe and South America, this infection has since vanished with improved livelihood and healthcare.
Preventable but deadly, all over the world, Noma has been given a cold shoulder (neglected) over the years. The absence of current epidemiological data has made the data of World Health Organisation (WHO) from 1998 the most frequently cited estimation of the disease, with a global estimation of 140,000 new cases recorded annually, with majority in Sub-Saharan Africa and a mortality rate of 90% if not treated within two weeks.
The infection has not spared the children in Nigeria, falling under the countries in Sub-Saharan Africa, killing numbers and leaving survivors disfigured, coupled with reality of leaving the rest of their lives under stigmatisation.
This informed the decision of the Federal Ministry of Health to call on the WHO at the 75th World Health Assembly to include Noma on the list of Neglected Tropical Diseases (NTDs) where it belongs.
The call was aimed at rallying global support in order to eliminate, start preventive and curative measures against the preventable but deadly disease.
Established in 1999, the Noma Children’s Hospital, Sokoto up until May 2022 when Noma Aid Nigeria Initiative (NANI) began construction of a new 100-bed National Noma Treatment Centre within the National Hospital, Abuja, has been the only specialist hospital shouldering the burden of the debilitating disease in the country.
The chief medical director of the hospital in Sokoto said “what is lamentable is that the disease is curable and even preventable but lack of awareness has made a good number of patients die at home without visiting the hospital, exacerbating knowledge gap.”
To create awareness on predisposing factors like malnutrition, vitamin (A and B) deficiency, contaminated drinking water, immunodeficiency and living in proximity with to livestock, November 20th has been set aside as Annual Noma Day.
Before resting my case, let me advocate that the awareness campaign held annually on Noma Day, be taken to people in the rural areas who are most vulnerable and unaware, as against holding the symposia in town or city halls where the inhabitants are most likely informed, more specialist should be trained on the infection with effort to establish more specialist hospital in at least each geopolitical zones of the country to unburden that in Sokoto and upcoming one in the Federal Capital Territory.
Furthermore, people should be emboldened to embrace oral hygiene and proper nutrition like a religious ritual, in suspected cases, patients should be taken to hospital for proper treatment to prevent disfigurement, routine vaccination for children ought to be taken as priority of every parent, and individuals with any information on Noma are encouraged to carry out personal campaign in their locality amongst family and friends because the little things we do can make a difference.
Lastly, I urge all to avoid stigmatisation of survivors because they where, but victims of circumstance.
Lawal Dahiru Mamman,