Noma, deformed face of children’s poverty

Noma, a disease that leads to facial deformation in malnourished children in poor countries, affects about 30,000 to 40,000 people a year even though it is totally preventable. The majority of cases occur in sub-Saharan Africa.

Noma is a relatively neglected tropical disease, occurring mostly in countries struggling with poverty where children are acutely malnourished. The disease impacts children between the age of one and 16 but most often occurs amongst children aged between one and four.

The World Health Organization (WHO) has announced its intention to eradicate the disease by 2030. Nevertheless, Noma cases are still being recorded mostly in sub-Saharan Africa (with 1 to 7 cases per 1000 children) as well as in the US, south-east Asia, and South America. Although humankind worldwide has suffered with this disease for over 1,000 years, amongst other times, it emerged in Europe in concentration camps during the Second World War.

Consequences of Noma

Noma is a highly fatal disease and, according to WHO, about 90% of affected children die. However, they are able to survive provided they receive prompt medical assistance but their faces become deformed.

Noma begins with sores on the gums but then rapidly attacks the soft tissue, hard tissue, bones, and skin of the face, gradually destroying them. Even if children attend health facilities and are cured, the resulting facial deformations make it difficult for them to eat, drink and speak and plastic surgery is needed to regain those abilities.

Meanwhile, the disease is easily curable with antibiotics if it is detected during the early stages. Moreover, it could be entirely preventable if children had enough food and clean water as malnourishment and a lack of hygiene allow it to thrive.

“Noma is a canary in the coalmine indicator of where there are systemic problems with society. It’s a disease of poverty,” Dr. David Shaye of Massachusetts Eye and Ear hospital, who has operated on hundreds of Noma survivors in Nigeria, told The Guardian.

Dr. Bukola Oluyide, Deputy Medical Coordinator Nigeria for Médecins Sans Frontières, adds that Noma occurs in those areas affected by poverty and lacking health facilities which is why very often children receive assistance too late.

“It’s only when children are almost on their deathbed with another illness that they [are taken] to a healthcare facility … People do not know they can receive care in the early stages.”

What can be done to address Noma?

Noma is little-known because it affects children from marginalized communities and research and data concerning the disease is scarce. The WHO estimated in 1998 that there may have been up to 140,000 cases a year with 770,000 surviving the disease. Such a low degree of awareness does not help to establish funding to fight Noma which is why campaigners for the disease are seeking to persuade WHO to add Noma to the list of neglected tropical diseases. This year, World Health Assembly delegates asked WHO to develop a draft global strategy to tackle oral diseases, including Noma, by 2022 and to then implement the strategy into an action plan aiming to eradicate them.