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After several years of struggle – Noma has earned its place on the WHO list

After several years of struggle – Noma has earned its place on the WHO list

Noma is a serious gangrenous disease that mainly affects children between the ages of 2 and 6 years. It begins as an infection in the gums, then spreads and begins to destroy facial tissues and bones. 90 percent die within a few weeks without treatment.

Although the disease is very serious and relatively common in low-income sub-Saharan countries, it has received little attention.

Noma is not just a disease, it is a social sign of extreme poverty and malnutrition, which affects the most vulnerable population groups, says Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, In a press release.

We are determined to work with affected countries and communities to address the causes of the disease and alleviate the suffering it causes.

Plastic surgeon Dr. Muhammad Abubakar Lawal practices at Noma Hospital in Sokoto, Nigeria. Photo: Fabrice Caterini/Enedis/MSF

The Nigerian government is seeking to include the disease on the list of neglected tropical diseases. In January 2023, a formal request was submitted to the World Health Organization, supported by 32 member states. MSF has been working towards the same goal for several years. The organization is now happy with this news and hopes that it will lead to more attention being paid to the disease, and that more resources will be allocated to preventing and treating the disease.

MSF runs a noma project in northwestern Nigeria, in partnership with the Nigerian government and the Ministry of Health. Since 1999, there has been a special hospital for Noma. Emergency treatment, reconstructive surgery, physical therapy and psychological support are all offered to those who survive the disease. There is also health promotion education for patients and their families, outreach to educate the population about disease and risk factors, and disease surveillance and research.

Why is it important to include Noma on the World Health Organization's list of neglected tropical diseases?

– It's very important even if it doesn't solve everything. But the WHO's recognition sheds light on the disease. It makes it easier to get funding for research and other important efforts, says Dr. Mark Sherlock, who points out that there is still a lot of work to do. He is responsible for MSF's work with the disease.

Noma is not contagious, and if caught early, it is treated with antibiotics (metronidazole and amoxicillin), improved oral hygiene and nutritional supplements. The few who survive are forced to live with them

Mark Sherlock. Photo: Fabrice Caterini/Enedis

Severely disfigured faces that make it difficult to eat, drink, talk and breathe. Disfigurements also carry severe social stigma.

– In the irreversible stage, reconstructive surgery, physical therapy and psychosocial support are offered, says Mark Sherlock.

The causes of noma are still somewhat mysterious.

Bacteria are those that can be found as part of the normal mucous membrane of the mouth. But we know there are some risk factors that contribute to this, says Mark Sherlock.

Risk factors for being affected include malnutrition, poor oral hygiene, extreme poverty, low socioeconomic status, and lack of clean water and vaccines. Having recently had malaria or measles and a weakened immune system present additional risks, in addition to not breastfeeding.

MSF will continue to put pressure on actors to ensure that those affected by the disease receive assistance.

We have a long way to go to eradicate the disease. The most important thing now is that we come together globally and work together to achieve this goal. We also need to do more research into the causes of the disease, says Mark Sherlock.

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