What is noma?

Noma, a neglected disease predominantly impacting impoverished populations, is an infectious yet non-contagious bacterial condition that begins as gum inflammation, resembling a minor mouth ulcer. The infection rapidly devastates bone and tissue, affecting the jaw, lips, cheeks, nose, or eyes, depending on the initial site of infection.

Within days, noma leaves its survivors with significant facial disfigurements, hindering their ability to eat, speak, see, or breathe. Moreover, survivors face the social stigma stemming from the extensive facial damage caused by the disease.

Primarily afflicting children under seven years old living in poverty, noma is fueled by factors such as poor health, malnutrition, inadequate oral hygiene, and diseases like measles or malaria. Children with these risk factors are particularly vulnerable to developing noma.

For noma survivors seeking a better life, the only option is to undergo comprehensive reconstructive surgery, which can help restore their facial structure and improve their overall quality of life.

Is noma deadly?

Noma proves to be a deadly disease, with up to 90% of those affected succumbing within the first two weeks if timely antibiotic treatment is not administered. This underscores the crucial role early detection and awareness-raising campaigns play in combating a disease that impacts an estimated 140,000 children annually. By emphasising prevention and intervention, lives can be saved and the devastating effects of noma can be mitigated.*

*These numbers are an estimate that the World Health Organization (WHO) made in 1994. The fact this data has not been updated in more than 25 years, shows how neglected this disease, and its survivors, are.

Where does noma exist?

Noma predominantly affects low-income regions in Africa, South America and Asia, where it continues to persist due to impoverished living conditions and limited access to healthcare. Historically, noma was prevalent in Europe but has since diminished as living standards and healthcare availability improved.

First documented by Hippocrates in the 5th century BC, noma was medically described in 1595 as “water cancer.” Notably, cases were reported in European concentration camps during World War II, highlighting the disease’s link to poor living conditions and inadequate healthcare services. By raising awareness and improving global health initiatives, it is possible to combat noma and improve the lives of those affected.

What are the symptoms?

Noma begins with a seemingly innocent symptom: gingivitis, which causes inflamed and bleeding gums. Within a mere three to four days, a painful ulcer emerges, and the gums and cheek start to swell. Alarmingly, in less than a week, the disease ravages the cheek tissue, leaving a gaping hole in its wake.

As the infection rapidly spreads, gangrene, the death of body tissue due to lack of blood supply, often leading to decay and infection, engulfs the affected region. Depending on the origin of the infection, the relentless destruction extends to the jaw, lips, cheeks, nose, or eyes, resulting in horrifying disfigurement and potentially life-threatening complications. The rapid progression and devastating effects of noma make it a truly shocking and distressing disease.

Treatment and Prevention

Noma is easily preventable and treatable with the right knowledge and resources. Good nutrition, oral hygiene, healthcare accessibility, and vaccinations against childhood diseases all contribute to noma prevention.

Early detection and management during the initial days of the disease are crucial for successful treatment. Basic oral hygiene, antibiotics, and wound dressing can facilitate recovery within a few weeks, especially when addressing underlying risk factors like malnutrition and diseases such as measles.

The high mortality rate associated with noma stems from a lack of knowledge and awareness about the disease. Early detection is often missed, and many families in impoverished, isolated areas lack access to or cannot afford the necessary antibiotics. These regions typically have minimal access to healthcare and dental services.

The rapid progression of noma makes it difficult for parents to identify the disease in their children. They often seek help within their community or from traditional healers, inadvertently losing valuable time and the chance for proper treatment. By raising awareness and improving healthcare access, more lives can be saved from this preventable and treatable disease.

Challenges after noma

Noma poses significant risks to survivors who often grapple with life-threatening secondary complications. The physical and emotional consequences of this disfiguring disease lead to social isolation, resulting in mental health issues and developmental delays, particularly in children. 

Survivors of noma frequently face challenges with basic functions, such as speaking and eating, and are subjected to stigma and discrimination within their communities due to the disfigurement. The social isolation experienced by children can further exacerbate developmental delays, while exposure to childhood diseases like measles and malaria, which are associated with noma, can also contribute to these delays.