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NOMA

“Noma is a little known disease that . . . threatens thousands of Africa’s children each year. Noma, derived from the Greek “nomein” meaning “to devour,” is a devastating bacterial necrosis that develops in the mouth and ravages the faces of its victims. It destroys both the soft and bone tissues of the face and mostly affects young children between the ages of two and six. It is essentially unknown now in the West since 20th century improvements in hygiene and nutrition.” http://www.documentingreality.com/forum/f149/noma-disease-23257/

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From Secure our Children Foundation, (c) 2002.  Accessed 2-1-2012 at http://www.secureourchildren.org/where-does-noma-occur/index.html

Noma can strike any community where poverty, malnutrition and infections are prevalent, and should not therefore be regarded as solely a disease of the developing world, as is all too often the case. Both genders are affected, and although it can be seen in adults, is predominantly a disease of young children between 2 and 16 years of age, with a peak incidence around ages 3 and 6.

Noma virtually disappeared from developed countries during the 20th Century except for isolated cases reported in the concentration camps of Bergen-Belsen and Auschwitz, and more recently, in patients with HIV infection/AIDS, as well as in Native American children with underlying Severe Combined Immunodeficiency Syndrome (SCID). In developing countries, particularly in sub-Saharan Africa, noma is an escalating public health scourge of economically disadvantaged communities. The victims are generally malnourished children residing under deplorable environmental/sanitary conditions and often in close proximity to livestock.

Worldwide, the number of children under 6 years of age who contract Noma is estimated to be several hundred thousands per year. Estimates of Noma incidence per 1000 children aged birth to 6 years for Niger, Nigeria and Senegal are 1.34, 0.80 and 0.7-1.2 respectively.

Notes:  See http://en.wikipedia.org/wiki/Noma_(disease); http://www.genomic.ch/research_gesnoma.php.  For more on SCID see http://en.wikipedia.org/wiki/Severe_combined_immunodeficiency.

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From Denise Baratti-Mayer, Brigitte Pittet, Prof Denys Montandon, Ignacio Bolivar, Jacques-Etienne Bornand, Stéphane Hugonnet, Alexandre Jaquinet, Jacques Schrenzel, Didier Pittet, for the Geneva Study Group on Noma (GESNOMA).  Noma: an “infectious” disease of unknown aetiology. The Lancet Infectious Diseases, Volume 3, Issue 7, Pages 419 – 431, July 2003 .  Accessed at http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(03)00670-4/abstract.

Noma (cancrum oris) is a devastating gangrenous disease that leads to severe tissue destruction in the face and is associated with high morbidity and mortality. It is seen almost exclusively in young children living in remote areas of less developed countries, particularly in Africa. The exact prevalence of the disease is unknown, but a conservative estimate is that 770 000 people are currently affected by noma sequelae. The cause remains unknown, but a combination of several elements of a plausible aetiology has been identified: malnutrition, a compromised immune system, poor oral hygiene and a lesion of the gingival mucosal barrier, and an unidentified bacterial factor acting as a trigger for the disease. This review discusses the epidemiology, clinical features, current understanding of the pathophysiology, and treatment of the acute phase and sequelae requiring reconstructive surgery. Noma may be preventable if recognised at an early stage. Further research is needed to identify more exactly the causative agents.

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Berthold P.  Noma: a forgotten disease. Dent Clin North Am. 2003 Jul;47(3):559-74.  Accessed at http://www.ncbi.nlm.nih.gov/pubmed/12848465.

According to recent reports from the WHO, noma (or cancrum oris), a hideous, ancient disease primarily affecting children living in poverty in parts of sub-Saharan Africa, is increasing. Noma often starts as an ulcer on the oral mucosa or as ANG and commonly after a bout of measles or other disease. It quickly develops into a massive necrosis, moving from the inside outward, often involving major portions of the face. Early treatment with antibiotics, rehydration, correction of electrolytic imbalances, and administering nutritional supplements will halt the disease. The high mortality rate, however, indicates that many children are not given care or brought for care in time. Surviving victims often display severe facial deformities that demand extensive reconstructive surgery. Current research has elucidated parts of the pathogenesis of noma. The WHO started the international Action Network Against Noma in 1992, with its official launch on the World Health Day in 1994: a five-point action plan was presented and current work follows that plan.

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Noma in the US

Noma illustrates a feature of mapping that is common to exceptionally rare diseases.  Clusters are seen, and usually occur in sume urban or periurban setting.  Generally speaking, for exceptionally rare diseases, the reasons for clusters include 

  • onset of an epidemic
  • highly localized availability of special services for victims of the disease offered by very few organizations in very few locations
  • highly localized availability of a rare medical service for the condition by very few health care facilities
  • group behaviors and gathering behaviors for people with akin to the “specific disease camp” scenario or a sociologically-defined disease related “quarantine” or special treatment facility 
  • coincidence

With rare foreign born diseases linked to poverty have this tendency to develop clusters or groups due to the limited availability of special service groups designed to serve this special needs group.  The availability of continued funding for these services from social settings, specific investors and high dollar donors, and the main office of the npo sponsoring this program often define where these individuals may travel to and in the end reside in order to receive adequate health care services.  This means that the distribution of such condition has two delimiters–

1) the probability of development in any part of the country in general, due to whatever causes exist for the malady, and  

2) the predictable likelihood that it will cluster in given areas due to sociological (npo, contributors’) history and service-related requirements and resources for the special service agency and patient. 

On occasion, this clustering of cases can also relate to onset of local epidemic activities for specific infectious diseases.  Since noma is for the most part a condition brought on by very long-lasting chronically unhealthy physical states, its distribution is primarily a result of human and social behaviors, not the spread of an infectious agent. 

 

 

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Other links

Facing Africa.  http://www.facingafrica.org/FA08/content/site/en/pages/whatisnoma/default.asp

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