Signs, Symptoms, and Stages of Noma
- Noma begins as an ulcer on the gums and rapidly spreads to the jawbone, cheek, and soft tissues of the face.
- It results in severe facial disfigurement, impairments in breathing, swallowing, speaking, and vision.
- Noma neonatorum is a severe infection affecting newborn children, spreading across the oral, nasal, and/or anal areas.
- Symptoms include painful, bleeding gums, facial edema, foul breath, and tissue destruction.
- Many patients die due to sepsis, while survivors are left with permanent scarring and disfigurement.
- The World Health Organization divides Noma into five stages: acute necrotizing gingivitis, edema, gangrenous, scarring, and sequelae.
- Stage I: Acute necrotizing gingivitis is characterised by red or reddish-purple gums, spontaneous bleeding, and painful ulcers.
- Stage II: Edema shows facial swelling, worsening gum ulceration, soreness, fever, and difficulty eating.
- Stage III: Gangrene leads to tissue destruction, holes in the face, and exposure of bones and teeth.
- Stage IV: Scarring includes trismus, scar formation, and setting of exposed teeth.

Epidemiology and Risk Factors of Noma
- Noma predominantly affects children between the ages of two and six in the least developed countries, primarily in sub-Saharan Africa.
- Accurate figures for Noma prevalence are not available, but in 1998, WHO estimated 140,000 new cases per year with a 90% fatality rate.
- Noma is associated with a high morbidity rate and a mortality rate of approximately 90% without treatment.
- With access to medical care, the mortality rate drops to under 10%.
- The disease is linked to extreme poverty, malnutrition, immunosuppression, underlying infections, and poor oral health.
- Predisposing factors include malnutrition, vitamin deficiency, immunodeficiency, poor oral hygiene, recent illness, and social/environmental factors.
- Noma primarily affects malnourished children between 2 and 6 years old, but cases have also been reported in malnourished or immunosuppressed adults.
- Concentration camps during the Second World War also reported cases of Noma.

Treatment and Prevention of Noma
- Early stages of Noma can be treated effectively with antibiotics and nutrition supplements.
- Proper wound healing can occur if diagnosed early enough.
- After recovering, patients with disfigurement require complex surgical rehabilitation.
- Reconstructive surgery is an option for patients in the sequelae stage.
- Education and community outreach programs can help counter the stigma, social isolation, and discrimination faced by Noma survivors.
- Treatment of noma involves a multidisciplinary approach, including surgical intervention, antibiotics, and nutritional support.
- Reconstructive surgery aims to restore facial function and appearance.
- Prevention strategies for noma include improving nutrition, promoting oral hygiene, and providing access to healthcare.
- Vaccination against diseases like measles and tetanus can reduce the risk of noma.
- Community education and awareness programs are essential for early recognition and prevention of noma.

History and Etymology of Noma
- Noma was known to physicians such as Hippocrates and Galen in antiquity.
- The first clinical description of noma was in 1595 by Carolus Battus.
- Dutch surgeon Cornelis van de Voorde coined the term 'noma' in 1680.
- Gabriel Lund attributed noma to poverty, cramped living conditions, and malnutrition in 1765.
- Surgical treatments for noma sequelae developed throughout the 1800s.
- The word 'noma' comes from the classical Greek word 'νομή.'
- 'Noma' was used to describe the continuing process of a fire or an ulcer.

Impact, Support, and Sociocultural Factors of Noma
- People with noma may face stigma and be avoided due to the misconception that it is contagious.
- Afflicted children may be hidden within the home due to social stigma.
- Some believe noma may be caused by witchcraft or a curse.
- Noma is a disease of shame, and children are sometimes hidden instead of receiving treatment.
- Traditional medicine may be sought instead of medical centers in Nigeria.
- Noma's physical effects are permanent and may require oral and maxillofacial surgery or reconstructive plastic surgery.
- Noma survivors may face stigma and discrimination.
- Roughly 770,000 people worldwide live with noma sequelae.
- Charitable organizations like Facing Africa and Winds of Hope provide support to noma survivors in Africa.
- The Noma Children Hospital Sokoto in Nigeria specializes in treating noma patients.