In a groundbreaking and pivotal move aimed at addressing one of the world’s most underrecognized health challenges, the World Health Organization (WHO) has officially included Noma, also known as cancrum oris or gangrenous stomatitis, in its prestigious list of neglected tropical diseases (NTDs).
This significant decision, endorsed by the 17th meeting of the Strategic & Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD), underscores the WHO’s unwavering commitment to expanding health services to the most vulnerable populations globally.
Noma, a severe gangrenous disease that primarily affects the mouth and face, disproportionately targets malnourished young children aged between 2 and 6 years in regions of extreme poverty.
The disease commences as an inflammation of the gums, rapidly progressing to destroy facial tissues and bones if not treated early. Sadly, Noma often culminates in death, leaving survivors grappling with severe disfigurement.
Accurately estimating the number of noma cases proves challenging due to the quick progression of the disease and the associated stigma, resulting in many instances going undiagnosed.
Although noma cases are predominantly found in sub-Saharan Africa, reports have indicated occurrences in the Americas and Asia.
Scientific evidence points to bacteria in the mouth as the root cause of Noma. Multiple risk elements contribute to the development of this devastating disease, including poor oral hygiene, malnutrition, weakened immune systems, infections, and extreme poverty. While Noma itself is not contagious, it tends to strike when the body’s defenses are compromised.
Early detection of Noma is paramount, as the most effective therapy occurs during the initial stages of the disease when severely swollen gums, known as acute necrotizing gingivitis, manifest.
Treatment typically involves antibiotics, guidance on practices to enhance oral hygiene using disinfectant mouthwash (such as salt water or chlorhexidine), and nutritional supplements. When diagnosed early, treatment can result in proper wound healing without long-term consequences.
However, in severe cases, surgery may be necessary. Children who survive the gangrenous stage often face severe facial disfigurement, difficulties in eating and speaking, social stigma, isolation, and a need for reconstructive surgery.
Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, emphasized, “Noma is more than a disease; it is a social marker of extreme poverty and malnutrition, affecting the most vulnerable populations.
By classifying Noma as a neglected tropical disease, we are shining a light on a condition that has afflicted marginalized communities for centuries. We are committed to working with affected countries and communities to address the drivers of Noma and alleviate the suffering it causes.”
The acknowledgment of Noma as an NTD aims to elevate global awareness, spur research initiatives, attract funding, and intensify efforts to control the disease through comprehensive, multi-pronged approaches.
Interventions targeting the burden of this devastating disease are poised to contribute significantly to achieving universal health coverage, specifically addressing underserved populations.
Oral health programs in endemic areas often oversee noma management, and collaboration with NTD programs at the operational level can be strengthened.
This integration could notably involve incorporating Noma within activities focused on detecting and managing skin-related neglected tropical diseases (skin NTDs).
The Government of Nigeria played a leading role in pushing for Noma’s inclusion in the NTD list. In January 2023, an official request was submitted to the WHO on behalf of 32 Member States.
The request was supported by a comprehensive dossier highlighting the burden and distribution of Noma, providing evidence to demonstrate compliance with the criteria set by the WHO. Numerous partner institutions contributed by sharing information and conducting advocacy.
The formal process for adding new conditions to the NTD list was established by the STAG-NTD in 2016. Since then, several diseases, including myeloma (2016), chromoblastomycosis and other deep mycoses (2017, merged with myeloma), scabies (2017), snakebite envenoming (2017), and now noma (2023), have been added.
With the inclusion of Noma, WHO’s NTD list now comprises 21 diseases or groups of diseases, solidifying its role as a guiding force in addressing neglected health challenges worldwide.
Press Release: WHO
