American Journal of Tropical Medicine and Hygiene
February 2017; 96 (2)
Noma: Time to Address a Collective Moral Failure
1Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Author’s address: Raffaella Ravinetto, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium, E-mail: firstname.lastname@example.org.
↵* Address correspondence to Raffaella Ravinetto, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. E-mail: email@example.com
In this issue of the journal, Srour and others1 give a comprehensive overview of the history, epidemiology, etiology, pathogenesis, microbiology, prevention, diagnosis, and treatment of noma, a devastating orofacial gangrene that affects malnourished children in tropical regions. Even if exclusively present in tropical regions, noma is better described as a “poverty disease” rather than as a “tropical disease,” because it has accompanied extreme poverty and poor nutrition for centuries.2,3 With the exception of cases occurred in concentration camps during World War II,2,4 noma disappeared from Europe and North America by the end of the nineteenth century, thanks to the economic development and improved access to nutrition and health care.1,3 Today, it is particularly present in the sub-Saharan Africa “noma belt,” stretching from Senegal to Ethiopia.
The victims of noma are so neglected that their deaths are not included in mortality statistics5 or in the Global Burden of Diseases.6 Noma incidence is estimated to 30,000–140,000 cases, and its mortality at 85%. In addition, the disease, which is named after a Greek word (νoμη) meaning “devour” and indicating a process that develops very rapidly,2,3 leaves survivors with devastating sequelae: severe facial disfigurement and functional impairment hinder interpersonal relationships and trigger stigma and rejection from societal life.1,3,4,7 The pharmacological treatment is empirical and has not been tested in clinical trials.5 The surgical treatment of sequelae requires tertiary health care that is often unavailable, and it is estimated that at least 770,000 noma survivors remain in need of reconstructive surgery.2…