Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Jun 12;24(1):685.
doi: 10.1186/s12903-024-04451-y.

Prevalence and associated risk factors for noma in Nigerian children: a systematic review and meta-analysis

George Uchenna Eleje  1   2   3 , Emeka Emmanuel Okoh  4 , Emeka Philip Igbodike  5   6 , Folahanmi Tomiwa Akinsolu  7   8   9 , Francisca Obiageri Nwaokorie  7   10 , Joanne Marie Lusher  7   11 , Maha El Tantawi  7   12 , Abideen Olurotimi Salako  7   8   9 , Oliver Chukwujekwu Ezechi  7   8   9 , Morẹ́nikẹ́ Oluwátóyìn Foláyan  7   13
Affiliations
Meta-Analysis

Prevalence and associated risk factors for noma in Nigerian children: a systematic review and meta-analysis

George Uchenna Eleje et al. BMC Oral Health. .

Abstract

Objectives: To determine the prevalence, case-fatality rate, and associated risk-factors of Noma in children in Nigeria.

Methods: Search was conducted in PubMed, Google Scholar, and Cochrane Library databases. Data were extraction using a double-blind approach. Discrepancies were resolved by a third reviewer. Heterogeneity was evaluated using I2 statistics. Random-effects model was used for the meta-analysis and subgroup analysis was conducted. The study quality was evaluated using standard Critical-Appraisal-Checklist.

Results: Of the 1652 articles identified, 12 studies that met the inclusion criteria included 871 cases of Noma. Two studies had high-risk of bias and were excluded in the meta-analysis. Pooled prevalence of Noma was 2.95% (95%CI:2.19-3.71; Z = 7.60; p < 0.00001, I2:100.0). Case fatality was reported in one study. Sex-distribution had a male-to-female ratio of 1.1:1. Malnutrition (88.42%, 95%CI:52.84-124.00; I2:100.0), measles (40.60%; 95% CI:31.56-49.65; I2:100.0) and malaria (30.75%; 95% CI:30.06-31.45; I2:100.0) were the most notable associated risk-factors. Prevalence of Noma was non-significantly lower in southern (1.96%,95%CI:1.49-2.44;6 studies) than in northern (4.43%; 95%CI:-0.98-9.83; 4 studies) Nigeria. One study reported the prevalence of Noma in children younger than 5 years.

Conclusions: About every 3 in 100 children in Nigeria had Noma and the prevalence was non-significantly higher in northern than southern Nigeria. Malnutrition, measles, and malaria were major associated risk-factors. Case-fatality rate and prevalence based on different age-groups were inconclusive.

Keywords: Cancrum oris; Case fatality rate; Malaria; Malnutrition; Measles; Nigeria; Stomatitis gangrenosa.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Meta-analysis showing the pooled prevalence of noma in nigerian children. Abbreviation IV = inverse variance; Red circle = High risk of bias; white or empty circle = Moderate risk of bias; Green circle = Low risk of bias
Fig. 3
Fig. 3
Meta-analysis of frequency of Noma associated risk factor in Nigeria. Abbreviation IV = inverse variance
Fig. 4
Fig. 4
Meta-analysis showing the pooled prevalence of Noma in Nigeria according to year of publication. Abbreviation IV = inverse variance
Fig. 5
Fig. 5
Meta-analysis of prevalence of Noma in Nigerian Children according to regions of Nigeria. Abbreviation IV = inverse variance
Fig. 6
Fig. 6
Sensitivity analysis showing the prevalence of Noma in Nigerian children according to the pooled estimate of studies with high and low risk of bias. Abbreviation IV = inverse variance
Fig. 7
Fig. 7
Leave-one-out sensitivity analysis showing the influence of individual studies on the overall pooled prevalence of Noma from all the studies
Fig. 8
Fig. 8
Funnel plot of the included studies
Fig. 9
Fig. 9
Egger test* regression graph of included studies. Abbreviation se = standard error; *Data: number of XY pairs: 10; equation: y = 0.0.1745X + 264.0; Best-fit values: Slope: 0.1745 ± 0.2456; Y-intercept: 264.0 ± 171.7; X-intercept: -1513; 1/slope: 5.732; Goodness of fit: R square: 0.05934; Sy.x: 323.7; F: 0.5046; DFn, DFd: 1.8; p-value: 0.4977 (not significant)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Resurgence of Noma (Cancrum Oris) in Nigeria.
    Otorkpa OJ, Otorkpa CO, Adebola OA, Anuniru C. Otorkpa OJ, et al. Am J Trop Med Hyg. 2024 Sep 24;111(6):1164-1165. doi: 10.4269/ajtmh.24-0406. Print 2024 Dec 4. Am J Trop Med Hyg. 2024. PMID: 39317183

References

    1. Olatunji G, Kokori E, Olatunji D, Moradeyo A, Scott GY, Onyegbule JC, et al. WHO’s recognition of NOMA as a neglected tropical disease and its global health implications. New Microbes New Infect. 2023;57:101215. doi: 10.1016/j.nmni.2023.101215. - DOI - PMC - PubMed
    1. Burki T. Noma a neglected tropical disease, says WHO. Lancet Infect Dis. 2024;24(2):e89–90. doi: 10.1016/S1473-3099(24)00025-2.. - DOI - PubMed
    1. Tovani-Palone MR. Noma as a neglected tropical disease: coordinated actions are needed. Eur Arch Paediatr Dent. 2024 Feb;26. 10.1007/s40368-024-00872-z. - PubMed
    1. Srour L, Marck K, Baratti-Mayer D, Noma Overview of a neglected disease and human rights violation. Am J Trop Med Hyg. 2017;96(2):268–74. doi: 10.4269/ajtmh.16-0718. - DOI - PMC - PubMed
    1. Baratti-mayer D, Pittet B, Montandon D, Bolivar I, Bornand J, Jaquinet A, Schrenzel J, Pittet D. Review Noma: an infectious disease of unknown aetiology. Lancet Infect. 2003;3(7):419–31. doi: 10.1016/S1473-3099(03)00670-4. - DOI - PubMed

LinkOut - more resources