Observational study determines risk factors for noma

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Observational study determines risk factors for noma


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Naziru, a 3-year-old boy from Sokoto State, Nigeria, with his mother during the screening at the hospital. Affected by noma, he was first admitted in September 2016. (Photograph: Fabrice Caterini - Claire Jeantet / Inediz)
Dental Tribune International

By Dental Tribune International

Fri. 7. September 2018


SOKOTO, Nigeria: Noma, a rare disease found predominantly in underserved areas, causes rapid progressive destruction, or gangrene, of the tissue of the face and jaw. Now, members of international humanitarian medical organisation Médecins Sans Frontières have analysed 74 cases of noma in north-west Nigeria and pinpointed risk factors for developing the disease.

Noma mostly affects children under the age of 5 years old, and it is estimated that up to 90 per cent of noma-affected people die. Those who survive are left with severe facial disfigurements and multiple health problems, resulting in difficulty eating and breathing, as well as social isolation. Noma is most prevalent along the “noma belt”, stretching from Senegal to Ethiopia, but cases have also been reported elsewhere. The World Health Organization estimates that 140,000 children contract noma each year.

The research team studied 74 children with noma and 222 controls matched by village of residence, current age and sex. The patients were admitted to the Noma Children’s Hospital in Sokoto between May 2015 and June 2016 and were all under the age of 15 at the time of onset. Each participant’s parents or caregiver answered questions about household socio-demographics, living conditions, vaccination history, breastfeeding and other nutrition-related practices.

While many factors were similar between cases and controls—including low vaccination rates—some stood out as risk factors for noma. Children who were fed pap, a corn porridge, every day were at a higher risk of contracting noma. The researchers hypothesise that eating pap is a proxy for overall poor variation in diet. Children whose mother was their primary caregiver, whose caregiver was married, and who were fed colostrum, the earliest breastmilk after birth, were less likely to get noma.

“Noma is a neglected disease, and current risk factors suggest that intervention efforts could be more effective by focussing on access to health care, the benefits of breastfeeding and a varied diet,” said lead-author Elise Farley, epidemiologist at Médecins Sans Frontières, on behalf of her research team. “However, more research is needed to better understand the pathogenesis of this disease in order to improve prevention, early detection and treatment.”

The study, titled “Risk factors for diagnosed noma in northwest Nigeria: A case–control study, 2017”, was published online in the August 2018 issue of PLOS Neglected Tropical Diseases.

It was conducted in collaboration with the University of Cape Town in South Africa, Cardiff University in the UK, and the Usmanu Danfodiyo University Teaching Hospital in Sokoto.

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