Noma, also known as cancrum oris, is a severe and gangrenous disease primarily affecting children aged 2 to 6 years. The World Health Organization classified it as a neglected tropical disease in December 2023. Noma predominantly affects children suffering from malnutrition and those living in extreme poverty. It can also occur in immunocompromised adults, particularly those with HIV or leukaemia. The disease is most prevalent in sub-Saharan Africa, but cases have been reported in Asia and beyond.
History of Noma
Noma has a long history, with references dating back to classical and medieval literature. The term ‘noma’ originates from the Latin word ‘nomē’, meaning to feed or devour. In 1649, it was included in the first book on neglected diseases. By the end of the 19th century, improvements in public health led to its decline in Europe and the United States. Research in 1912 identified noma as an opportunistic infection rather than a specific one.
Risk Factors for Noma
Noma is a clear indicator of absolute poverty. Key risk factors include malnutrition, underlying infections, immunosuppression, and poor oral hygiene. Children who are preterm or of low birth weight are particularly vulnerable. The disease often arises during the weaning period, coinciding with nutritional vulnerabilities. Associated diseases include malaria, measles, and HIV, with polymicrobial bacteria identified as the primary causative agents.
Development of Noma
Noma is non-contagious and progresses through five stages according to the WHO. These stages are – 1. Stage 0 – Simple gingivitis 2. Stage 1 – Acute necrotising gingivitis 3. Stage 2 – Oedema 4. Stage 3 – Gangrene 5. Stage 4 – Scarring 6. Stage 5 – Sequelae The disease often begins with intraoral ulcers or canker sores. If untreated, it can rapidly destroy facial soft tissues and extend to hard tissues and skin.
Treatment Options
Early detection is essential for effective treatment. At the acute necrotising gingivitis stage, interventions include improved oral hygiene, antibiotics, and nutritional supplements. If caught early, treatment can lead to proper healing without long-term consequences. Unfortunately, only about 15% of children survive acute noma, with many facing facial deformities, eating difficulties, and social isolation. Survivors may require reconstructive surgery.
Future Directions
Estimating the number of noma cases is challenging due to rapid progression, high fatality rates, and weak health systems. The WHO advocates for strategies to combat noma, such as ensuring food security, vaccinating against measles, and treating concurrent illnesses. Surveillance programmes targeting marginalised populations are essential for effective prevention and intervention.
Questions for UPSC:
- Examine the socio-economic factors contributing to the prevalence of neglected tropical diseases in developing countries.
- Discuss the impact of malnutrition on child health and its relation to infectious diseases.
- What is the significance of early detection in the treatment of gangrenous diseases? How does it affect patient outcomes?
- Critically discuss the role of public health initiatives in preventing diseases associated with poverty and malnutrition.
Answer Hints:
1. Examine the socio-economic factors contributing to the prevalence of neglected tropical diseases in developing countries.
- High levels of poverty lead to inadequate healthcare access and resources.
- Malnutrition weakens immune systems, increasing susceptibility to diseases.
- Lack of education results in poor health literacy and awareness of disease prevention.
- Weak health systems struggle with disease surveillance and treatment capabilities.
- Environmental factors, such as poor sanitation and housing, exacerbate the spread of diseases.
2. Discuss the impact of malnutrition on child health and its relation to infectious diseases.
- Malnutrition directly weakens immune responses, making children more vulnerable to infections.
- Underweight children are at higher risk for severe outcomes from diseases like noma.
- Malnutrition can lead to stunted growth and cognitive impairments in children.
- Infectious diseases can further exacerbate malnutrition, creating a vicious cycle.
- Addressing malnutrition is crucial for improving overall child health and reducing disease prevalence.
3. What is the significance of early detection in the treatment of gangrenous diseases? How does it affect patient outcomes?
- Early detection allows for timely intervention, which can prevent disease progression.
- Effective treatment at initial stages can lead to better healing and fewer long-term complications.
- Reduces the risk of high mortality rates associated with advanced stages of disease.
- Improved patient outcomes include reduced need for reconstructive surgeries and better quality of life.
- Awareness and education on early signs can enhance community health responses.
4. Critically discuss the role of public health initiatives in preventing diseases associated with poverty and malnutrition.
- Public health initiatives can improve access to nutritious food, reducing malnutrition rates.
- Vaccination programs can prevent infectious diseases that exacerbate malnutrition effects.
- Health education campaigns can enhance awareness about hygiene and disease prevention.
- Strengthening healthcare systems improves disease surveillance and response capabilities.
- Collaboration with communities can encourage sustainable practices that address root causes of poverty.
