Sokoto, 21 March, 2023 - Mohammadu Usman a 22-year-old noma survivor has found a home at the Sokoto Noma Children’s Hospital in Sokoto State, located in the northwest region of Nigeria.
Although he hails from Yobe, a state in Northeast Nigeria, he was brought in for treatment at the Noma Children’s hospital Sokoto by his father in 2017. 

“My face now looks better. When I first got here, my face had a hole in it, and eating or drinking water was a challenge. Anything I put inside my mouth was pouring out through the hole.

I found acceptance here in the hospital and in the Sokoto community, which is why I told my father I want to stay back after my treatment. They do not discriminate or stare at us strangely because of our disfigured faces”, explains Mohammadu in the Hausa Language. 

Moving on with life after treatment and multiple reconstructive surgeries, Mohammadu now works as a cleaner in the health facility and attends school during the day. He wants to be a hygiene officer to educate others on the importance of good oral hygiene and sanitation. 

Fast killing disease
Known scientifically as “Cancrum Oris, Noma borrows its name from a Greek term “to devour”.  It has also been described as “the face of poverty” because it affects the poorest in society. 

Mohammadu is fortunate to survive noma as it kills 9 out of 10 people infected with the disease if treatment is not instituted early.  Sadly, he has to live with disfigurement for the rest of his life despite medical intervention. Unfortunately, survivors like Mohammadu suffer in some cases discrimination and stigmatization in their communities. 

Noma is an infectious yet non-contagious disease that destroys the soft and hard tissues of the face in children primarily under age seven. It starts as a lesion (a sore) in the gums, inside the mouth which then turns into ulcerative, necrotizing gingivitis that progresses rapidly, destroying the soft tissues and bones of the mouth. It further progresses to perforate the hard tissues and skin of the face. In the absence of any form of treatment, noma is fatal in 90% of cases.

The disease remains a burden in low- and middle-income countries, especially those along the “Noma belt”, including Nigeria.  Several factors foster the breeding ground for Noma including poor hygiene especially oral and environmental hygiene, malnutrition, no immunization, and infectious diseases such as measles, malaria, and HIV/AIDS amongst others.

Preventable and treatable 
“The good news is that Noma can be prevented through good oral hygiene, proper sanitation, up-to-date immunization, and good nutrition,’ says Dr Abubakar Abdullahi Bello, Chairman of the Medical Advisory Committee (CMAC), at Sokoto Noma Children's Hospital. 

Dr Bello explains that Noma can kill within two weeks after a child gets infected.

 “Many children present very late to the health facilities with some already disfigured, coupled with impairments in breathing, swallowing and speaking, blurred or loss of vision, and mouth closure. Sometimes the delay in presenting to the facilities as well as the delay in diagnosis at the health facilities lead to fatal consequences for the patients, says Dr Bello.

He advocates for rigorous sensitization campaigns in the communities to raise awareness about the disease to encourage Noma prevention and identification, encourage parents or caregivers to present to the facility as soon as possible and also build capacities of health care workers to diagnose, institute treatment and refer severe cases promptly.

Fighting the disfiguring and debilitating disease 

Since 1999, the Noma Children’s Hospital provided free treatment including surgeries for Noma patients in Nigeria. In collaboration with Medicins Sans Frontieres (MSF), the centre in 2014, started carrying out free surgeries and rehabilitation for victims of Noma four times a year.

As Noma mostly affects the poor, the most affected population cannot afford treatment and usually presents to the health facilities with stage 3 or 4 diseases requiring resuscitation, several surgeries, and rehabilitation.
In 2022, the Federal Ministry of Health (FMOH) in collaboration with Hilfsaktion Noma e.V and Noma Aid Nigeria Initiative began setting up a second noma centre expected to provide surgical and rehabilitative service within the National Hospital, Abuja.

With funding support from Hilfskation Noma e.V., the World Health Organization (WHO)  AFRO Regional Noma Program through the country office,  supported the FMOH Nigeria and other key stakeholders to develop and implement the 2019-2021 National Noma Triennial Plan. The plan serves as a road map for the country to move towards noma prevention and control it has been reviewed and extended to 2025. 

Meanwhile, the WHO continues to support the FMOH to foster strong collaboration in the fight against Noma by building the capacity of health workers, surveillance officers, community mobilization officers, traditional rulers and dental nurses in the prevention and control of noma in Sokoto, Kebbi, Kano, and Adamawa states.  
A national Noma Technical Working Group was established and meets regularly.

With World Oral Health Day celebrated every year, on the 20 March 2023, the WHO Country Representative, Dr Walter Kazadi Mulombo, says “lots of oral health conditions are preventable and treated when diagnosed early”. 

“Oral diseases cause pain, discomfort and a lot of times are linked to other serious health issues. Good oral health is therefore very important at all stages of our lives, irrespective of our age”.

I, therefore, enjoin you to practice good oral hygiene, eat a balanced, low-sugar diet, visit the dentist regularly and be more intentional with your oral health, he says.

The theme for this year’s World Oral Health Day is “be proud of your mouth”. 

Technical Contacts:
Dr Kelias Msyamboza; Email: mysambozak [at] who.int (mysambozak[at]who[dot]int)
Dr Mary Dewan; Email: dewanm [at] who.int (dewanm[at]who[dot]int)