Nigeria’s tenacious advocacy wins WHO Recognition for Noma

NIGERIA—The World Health Organization (WHO) has formally designated noma (cancrum oris or gangrenous stomatitis) as a neglected tropical disease (NTD), a significant step toward tackling one of the world’s most underrecognized health concerns.

The 17th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD) approved this critical decision, emphasizing WHO’s commitment to expanding health care to the world’s most vulnerable populations.

Noma, a severe gangrenous disease affecting the lips and face, typically affects malnourished young children aged 2 to 6 in impoverished areas.

It begins as gum irritation and spreads quickly, causing serious damage to facial tissues and bones if not treated swiftly.

Because of the disease’s rapid progression and associated stigma, accurate assessment of the number of noma patients is difficult. This contributes to the underdiagnosis of many instances.

Although epidemiological statistics on noma are limited, the current global incidence is estimated to be 30,000–40,000 cases per year, with a death rate of around 85% and a disease burden of 1–10 million disability-adjusted life years.

Noma has a high mortality rate, and survivors have such severe facial malformations that they are frequently excluded from society and family life, with survivors enduring severe disfigurement.

Only around 15% of children survive acute noma, and the majority of survivors have facial malformations and trismus or ankylosis of the jaw, which causes eating issues, oral incontinence, speech difficulties, and social isolation.

Although most instances have been recorded in sub-Saharan Africa, cases have also been identified in the Americas and Asia.

Noma is thought to be caused by bacteria in the mouth, and a variety of risk factors, such as poor dental hygiene, malnutrition, impaired immune systems, infections, and extreme poverty, all contribute to its occurrence.

While noma is not communicable, it does seem to hit when the body’s defenses are weak.

Early detection is critical since medication is most effective when the disease shows acute necrotizing gingivitis with significant swollen gums.

Antibiotics, advice on increasing oral hygiene with disinfectant mouthwash (such as salt water or chlorhexidine), and nutritional supplements are used in treatment. Treatment can result in proper wound healing without long-term effects if detected early.

Surgery, on the other hand, may be required in extreme situations. Survivors of the gangrenous stage frequently suffer from facial deformities, difficulties eating and speaking, social humiliation, and isolation, necessitating reconstructive surgery.

The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, emphasizes that noma is more than an illness; it is a social sign of extreme poverty and malnutrition that affects the most vulnerable groups.

WHO’s designation of noma as a neglected tropical disease tries to draw attention to a sickness that has plagued impoverished populations for centuries.

The organization is dedicated to collaborating with affected countries and communities to address the root causes of noma and alleviate the suffering it causes.

The designation of noma as a non-communicable disease (NTD) intends to increase worldwide awareness, encourage research, obtain funding, and strengthen efforts to control the condition through multisectoral and multi-pronged approaches.

Interventions aimed at reducing the burden of this fatal disease will help achieve universal health care by focusing on disadvantaged communities.

In endemic locations, noma is frequently controlled by oral health programs, and operational collaboration with NTD programs might be increased.

This can be accomplished most effectively by including noma into actions targeted at diagnosing and managing skin-related neglected tropical illnesses (skin NTDs).

The Nigerian government was a vocal supporter of noma inclusion on the list of NTDs. An official request, endorsed by 32 Member States, was filed with the WHO in January 2023.

This request contained a detailed dossier outlining the prevalence and spread of noma, as well as proof to meet WHO’s requirements.

Several partner institutions helped by providing information and advocating.

In 2016, the STAG-NTD established a structured approach for adding new disorders to the NTD list, which resulted in the inclusion of diseases such as mycetoma (2016), chromoblastomycosis and other deep mycoses (2017), scabies (2017), and snakebite envenoming (2017).

The addition of noma brings the WHO’s list of NTDs to 21 diseases or groups of disorders.