Noma in the WHO's list of neglected tropical diseases: A review of its impact on undeveloped and developing tropical regions

Abstract

Background: Noma is a neglected tropical disease and a global health concern.

Objectives: To elucidate the epidemiology, management, prevention, and public health implications of Noma.

Methods: PubMed, Scopus, and Web of Science, supplemented by Google Scholar and World Health Organization databases, were searched using keywords to gather both published and grey literature from 1970 to 2023 in English.

Results: Approximately 30,000-40,000 cases occur annually, with varying incidences across various African countries, such as Nigeria, Niger, and Chad. Incidence in Nigerian and Ethiopian states range from 0.6 to 3300 and 1.64 to 13.4 per 100,000 population, respectively. Mortality is approximately 8.5% in Niger. Risk factors include malnutrition, immunocompromised status, poor dental hygiene, inadequate sanitation, gingival lesions, low socioeconomic status, chronic and infectious diseases, low birth weight, high parity, diarrhoea, and fever. Diagnosis is primarily made based on clinical signs/symptoms and accordingly staging of disease is done. Stage I, II and II presents with acute necrotizing gingivitis, facial edema with halitosis, and necrotizing stomatitis, respectively. If the patient survives acute stages, the progress to Stage IV and Stage V manifests as trismus, difficulty in deglutition and phonation, and facial disfigurement, with increased severity in last stage. Treatment encompasses antibiotic therapy (amoxicillin, metronidazole, chlorhexidine, ampicillin, gentamicin), surgical interventions, wound management (honey dressing, ketamine), and nutritional support. Prevention strategies include oral hygiene, vaccination, health education, and community-based interventions.

Conclusion: Noma's recent inclusion in WHO list of neglected tropical diseases is a milestone in recognizing the importance of prevention and early intervention to globally enhance health outcomes.

Keywords: Neglected tropical disease; Noma; Poverty; Prevention; Public health.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram for identification of studies included in the review.

Fig. 2

Five Stages of Noma Disease. [Created with Biorender.com].

Fig. 3

Stepwise Diagnostic Guide for Noma. CBC: Complete Blood Count, CRP: C-Reactive Protein, MRI: Magnetic Resonance Imaging, CT: Computed Tomography. [Created with Biorender.com].

Fig. 4

Clinical Features of Noma Disease. [Created with Biorender.com].