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NOMA disease in Nigeria

Mr. Jean Ziegler, Vice-President of the Human Rights Council Advisory Committee writes on the”The tragedy of Noma

Malnutrition and hunger are not only direct killers of children and adults all over the developing world. A lesser-known but horrible result of the negligence and callousness of the rich Western world is a cruelly disfiguring disease called noma (from Ancient Greek nom “spreading of sores”), a scourge which is destroying lives in large parts of the developing nations.
Faces of Noma from saharamarathon.co.uk

Until very recently, little has been done in the world in order to deal with this awful disease, partly because it was mostly hidden away, due to the cruelly disfiguring facial sores that it causes.[2] Impoverished parents, having children who were infected by noma, tended to hide their children away with their animals out of shame that they might bring dishonor on their families. It should be noted that noma is not even mentioned in a fact sheet on the top killer diseases in the developing world.

Nevertheless, for quite a few years now, private individuals as well as organizations have begun to deal with the victims of this horror. Treatment is possible at an early stage and surgery to restore destroyed faces is quite possible even at later stages. But the steps that have been taken so far are so few and far between that attention has to be drawn to the need for the World Health organization (WHO) to deal with it on a far larger scale.

The characteristics of noma

But let us first take a look at how and why this disease is spreading in poor parts of the world and then what can be done to make serious efforts to eradicate it, as has been done with other scourges such as leprosy, malaria, tuberculosis, measles and a multitude of other diseases that are now increasingly under control.

Noma (cancrum oris), which borrows its name from the Greek term “to devour”, is a devastating infectious disease that destroys the soft and hard tissue of the face. The lesion begins as a localized ulceration in the gingiva or the mucosa of the cheek or lip and spreads rapidly through the orofacial tissues. Untreated, the skin of the cheek or lip is typically perforated within a week of the start of the swelling.

The gangrene of the facial tissue quickly spreads to other parts of the face such as the nose or an eye, leaving a terrible hole in the face. Noma leads to gangrene, sepsis and in 70-90% of cases, death. Most deaths are attributed to complications such as pneumonia, diarrhoea and septicaemia associated with severe malnutrition.

Survivors suffer threefold: disfigurement, functional impairment and social stigma.

This terrible, disfiguring and lethal disease mainly affects children aged 1 to 6, but late stages have also been observed in adolescents and adults.

From studies in Nigeria it can clearly be seen that it affects children suffering from malnutrition and that affluent sectors of the population are spared. It is clear that it has to be seen as “a socioeconomic disease afflicting preferentially the deprived malnourished children in poor and mostly rural communities” (Reshma S Phillips et al. 2005)

Incidence of noma

The disease has virtually been eradicated from Europe and other countries with a high standard of living. It reappeared however in Nazi concentration camps (Bergen-Belsen and Auschwitz) during World War II, where food shortages were particularly prevalent. The disease has also been documented in HIV/AIDS infected patients from developed nations. A retired 68-year-old man from Great Britain was reported in a study from 2006 as suffering from noma.

However, the majority of people suffering from noma live in sub-Saharan countries. Cases are also reported from other countries in Africa, Asia and also in Latin America.

It is estimated (according to WHO in 1998) that 140,000 individuals yearly are infected by noma and that 100,000 of these are children between 1 and 7 living in sub-Saharan Africa.