Estimated incidence and clinical presentation of Noma in Northern Nigeria (1999–2024)

Noma (Cancrum Oris), a recent addition to the WHO list of neglected tropical diseases, is a severe, rapidly progressing necrotizing disease of the oral cavity and facial complex with a case fatality rate of 90% if untreated. Active disease is common among children between two and six years in Sub-Saharan Africa while noma sequelae may be seen in individuals at any age. Though most cases have been reported in northern Nigeria, little research is available on the incidence of noma and its clinical presentation in this region using comprehensive data. Therefore, this study aims to estimate the incidence of noma and its clinical presentation in Northern Nigeria among different age groups. We collected retrospective data of 1,383 consecutive patients managed at Noma Children's Hospital, Sokoto, Nigeria between 1999 and 2024 for incidence estimation and description of the clinical presentation of noma. Incidence calculation was done using the WHO Oral Health Unit strategy designed with the Delphi method. Our results showed that patients were between 8 months and 80 years old with a median age (IQR) of 6 years (3-15). More patients presented with acute noma than arrested noma (67.3% vs 32.7%). The estimated incidence of noma in northern Nigeria during the study period was 87.8 cases per 100,000, with Sokoto state having the highest incidence of 691.4 cases per 100,000, while Adamawa state had the lowest incidence of 11.2 cases per 100,000. The annual average and median incidence of noma across all years was 3.4 and 1.6 cases per 100,000 (range: 0.2-16.6 cases per 100,000), although between 2020 and 2024, the annual average and median incidence estimates were 12.0 and 12.6 cases per 100,000. Also, this study found the incidence of noma cases with gangrene to be higher than cases with oedema or acute necrotizing ulcerative gingivitis. These findings confirm the high incidence and impact of noma in northern Nigeria in the last two and half decades and highlight the need to intensify awareness of risk factors and early signs of noma within communities in the region and to conduct community-based screening to promote the identification and cost-effective treatment of reversible early noma disease.