Strides in Push to Include Noma in WHO list of Neglected Tropical Diseases
By Sharon Atieno
Tremendous progress has been made in the push to include noma, a preventable and treatable disease that leads to severe facial disfigurement, into the World Health Organization(WHO)’s list of neglected tropical diseases (NTDs).
According to Clair Jeantet, the Médecins Sans Frontières (MSF) Noma campaign manager, a dossier of evidence has been developed to show that noma meets the four criteria needed to for its inclusion in the list.
Speaking during an Africa Science Media Centre (AfriSMC) briefing, Jeantet said noma met the first criteria which show that the disease affects populations living in poverty, causes important morbidity and mortality, includes stigma and discrimination and justifies a global response.
If left untreated, research shows, that up to 90 percent of people affected with noma will die while those who survive are left with a severe facial disfigurement that can make it hard to eat, speak, see, or breathe.
The second criterion is that the disease mainly affects populations living in tropical and subtropical areas. In Africa, the disease is reported to be prevalent in several countries including Nigeria, Guinea Bissau and Senegal among other countries in the Western and Central parts of the continent.
She noted that the disease meets the third criterion as it is immediately amenable to broad control, elimination, or eradication.
“Noma is a treatable disease and can be treated with antibiotics and this improves the survival rate. On the same note, it can also be prevented and this is how we’ve seen noma disappearing from some countries’ contexts,” Jeantet said.
The other criterion is that the disease is neglected by research. This is the case with noma as many things concerning the disease remain unknown, she said.
So far, 31 countries globally, including 14 from the WHO African region are endorsing the request being led by Nigeria and supported by MSF.
The request for noma’s inclusion on the WHO’s list dates back to 2021 with the adoption of the resolution on oral health at the 74th World Health Assembly.
Among the recommendations in the resolutions was considering the disease in the NTD portfolio as soon as the list is reviewed in 2023.
Currently, the WHO list of NTDs includes 20 diseases namely, buruli ulcer, Chagas disease, dengue and chikungunya, dracunculiasis (Guinea worm disease), echinococcosis, foodborne trematodiases, human African trypanosomiasis (African sleeping sickness), leishmaniasis, leprosy, lymphatic filariasis, mycetoma, chromoblastomycosis and other deep mycoses, onchocerciasis (river blindness), rabies, scabies and other ectoparasitoses, schistosomiasis, soil-transmitted helminthiases, snakebite envenoming, taeniasis/cysticercosis, trachoma and yaws.
Noma starts as an inflammation of the gums but spreads rapidly and destroys facial tissues and bones. It affects about 140,000 people every year, according to WHO estimates.
According to Dr. Elise Farley, an epidemiologist working with MSF, though the risk factors for the disease are not clearly known, a study they conducted in northwest Nigeria showed that low coverage of childhood vaccination and low malnutrition are associated with the disease.
She notes that the disease has five main stages with the first stage being simple gingivitis, where the gum becomes red and swollen. This is followed by acute gingivitis which affects the commissure and the cheek resulting in inflammation, pain, and the presence of “punched-out” crater-like lesions.
The second stage is the oedema stage which affects the upper lip and nose while stage three affects the lower lip and chin (gangrene stage). The fourth stage is the scarring stage characterized by extensive facial defects involving large bone destruction while the last stage is the sequelae stage (inactive stage of noma).
According to Dr. Farley, the beginning stages of noma progress very rapidly. From the first stage to acute gingivitis to the gangrene stage it can be as little as two weeks.
“Noma prevention and control will require a concerted health systems approach and adding them to the WHO list of neglected tropical diseases will facilitate global attention for noma and allocation of much-needed resources to those countries where noma continues to be a public health problem,” Dr. Farley said.