Noma: Epidemiology and Microbiology at Wits Oral Health Centre

Background: Noma is a largely preventable, yet devastating, disease that mainly afflicts malnourished and immunocompromised young children. There is paucity of epidemiological data on Noma. In particular, the exact aetiopathogenesis, risk factors and factors affecting treatment outcomes await further elucidation. Objective: To evaluate epidemiological factors of Noma patients treated at Wits Oral Health Centre (WOHC). Methods: To address the challenges posed by the paucity of data on Noma, the authors designed this retrospective descriptive study on patients with Noma disease treated at WOHC for the period January 1, 2014 to December 31, 2020. Data were collected through a data collection that had patients’ records such as sex, age, weight, staging, comorbidities, location, risk factors and complications. The statistical significance level for association tests was set at P <0.05, and estimates were reported at the 95% CI. Results: A total of 20 patients (13 males, 7 females) were included in the study with age ranging from 3 to 57 years. Majority of the patients presented with stage 3 disease. Respectively the cheeks and the lips were the most affected sites. Twenty-nine different microorganisms were identified, with E. Coli and Klebsiella species dominating. Nineteen patients were HIV positive, most of them having defaulted on their HIV treatment. Most of the patients were malnourished, with a total median body weight of 32.7 kg and total median albumin level of 25 g/L. Functional and esthetic complication were seen in 8 patients after treatment. Conclusion: Immunocompromised status, poverty and malnutrition appear to be significant risk factors for the development of Noma. It is hoped that designation of Noma as a neglected tropical disease (NTD) by the WHO will raise public awareness about Noma and give rise to programmes that will promote prevention, early diagnosis and prompt treatment.