Several factors make exact numbers difficult to obtain, one problem being that children with noma are often hidden by their parents, since noma is considered a social stigma, the same way that leprosy victims are generally seen as a shame to their families.
Because of a lack of appropriate information for the population in general and mothers in particular, noma tends to be perceived as a curse or as shame on the family whose child contracts it. It is certainly a powerful taboo that causes families to sometimes hide or isolate their children whose faces are disfigured by this disease with [their] animals. Furthermore, experts in the field have reported that noma is ignored and neglected by political authorities.
Causes and predisposing factors
Despite the lack of certainty in respect to the microbiology and pathophysiology, there is a wide consensus among experts that noma results from the interaction between three main elements: malnutrition, intraoral infections and compromised immunity.
Protein-energy malnutrition in combination with deficiencies in vitamins (A and B) and minerals are putting children at a high risk for attracting noma. A weakening of the immune system, often due to diseases (such as measles, malaria, tuberculosis, typhus, HIV) and poor oral hygiene also contribute to the development of the disease. Other risk factors are lack of safe drinking water and generally poor sanitation.
The treatment of noma
The WHO identifies four stages of the disease; noma can reach its terminal phase in the extremely short time span of three weeks. In the early stage, when the gingiva is bleeding and has lesions, impending noma can be treated in a manner which is "simple, effective, low-cost" with disinfecting mouth-rinses and daily food with vitamins. During the next phase, involving swelling of the face and fever, mouth-rinses, administration of antibiotics and nutrients supplementation is essential. These have been shown to prevent the progression from the initial ulceration to the acute phases of the disease, which presuppose emergency care and reconstructive surgery.
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