Noma: Giving a Face to a Deadly Disease

Last Updated on February 11, 2024 by Joseph Gut – thasso

February 10, 2024 – Noma is a disease that many people prefer to ignore. The sight of the affected small children is unbearable. There are open wounds on the face. Entire cheek areas appear as if eaten away. Children who survive an illness are left disfigured for life and struggle with speech problems and problems eating. Noma eats away the faces of people like 27-year-old Aliyu from Nigeria, who likes to protect his face, which has been disfigured by Noma, with a cloth (see large picture above)

At the end of 2023, the World Health Organization officially added the infectious disease Noma to the list of neglected tropical diseases. This means that the disease of poverty can be better combated and researched. Noma primarily affects people who fall through the cracks of poor health care. Noma typically meets children between the ages of two and six. The disease begins seemingly harmlessly with sore gums and slight bad breath. At this stage, the disease would be easy to cure with a broad-spectrum antibiotic. If left untreated, the infection spreads to tissue necrosis within a few days. First, soft tissue dies, then cartilage structures and bones are attacked and literally eaten away by the infection.

The time period to detect and treat the disease is extremely short, says private lecturer Dr. Steinmann, epidemiologist at the Swiss Tropical and Public Health Institute (Swiss TPH) and the University of Basel. After just ten to twelve days, the damage to the face is irreversible. Currently, an estimated nine out of ten children die as a result of the disease because they are not diagnosed and treated in a timely manner. By the time affected children come to the health center from places with poor health care, it is often too late.

Only complicated plastic surgery can help affected children in the long term. Children who survive this stage of the disease often have lost large parts of their faces. Lips are disfigured, the nose area is missing, and a damaged jaw, for example, prevents chewing food. Without complicated operations, affected children remain scarred for life and are often stigmatized and excluded.

The face of poverty

Noma is also known as the face of poverty. Because the disease occurs mainly in areas with extreme poverty, today mainly in Africa, India, East Asia, Southeast Asia and Latin America. The first clinical descriptions can be found in the notes of a Flemish surgeon in the 16th century. Particularly during times of war and periods of extreme poverty, children in Europe also suffered from noma until the 20th century. Most recently, the disease was observed in inmates in German and Soviet concentration camps.

Thanks to increased health care and higher living standards, Noma has completely disappeared in Europe and has therefore been forgotten. The disease is still widespread in other regions of the world. According to estimates, more than 140,000 children develop noma every year. Noma mainly affects people who are extremely difficult to reach and live in isolation, says Dr. Steimann firmly. These are people who live far from public health facilities and often fall through the cracks of weak health care. Dr. Steinmann, together with doctoral students, examined the scientific evidence on the spread of the disease as part of a study. The study was published in the journal Lancet Infectious Diseases in 2022

Exact cause is unknown

It is still unclear what causes the disease. It probably occurs as a result of a bacterial infection coupled with a weakened immune system. Extreme malnutrition can lead to this, as can a recent bout of measles or malaria. A lack of vitamins or minerals could also make children more susceptible to noma disease, suspects Dr. Steinmann.

32 countries led by Nigeria have submitted a request to the WHO to add Noma to the list of neglected tropical diseases. The basis for this was the work of an international consortium of scientists, financed by the Swiss Network for International Studies, which examined the current state of knowledge about the disease. The Swiss TPH was responsible for processing the knowledge. The task of the Swiss TPH was to compile existing knowledge from investigations in affected countries and from published studies. This also included the representation of the global spread. Until now, people have often spoken of the Noma Belt, which stretches from West to East Africa. However, the data collected now shows that Noma also occurs in Asia and South America. The study thus provided one of the prerequisites for WHO recognition as a neglected disease of global importance.

Addition to the list of now 21 neglected tropical diseases could open new doors for funding research programs to better understand Noma. It is also hoped that the official commitment of the WHO can improve the control and elimination, prevention and treatment of noma in affected areas. Nobody should have to suffer and die from this treatable disease. All that is needed is food security and minimally functioning health systems that also reach isolated population groups.

See here a sequence on Noma in an affected population:

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