Assessment of knowledge and clinical experience with noma among healthcare professionals in Latin America: A cross-sectional survey

Background Noma (cancrum oris) is a rapidly progressive necrotizing orofacial disease with high mortality and severe sequelae. Despite historical reports in Latin America, current awareness among healthcare professionals and case detection remain unknown. Objective To assess the knowledge of noma among healthcare professionals, and explore reported clinical experiences, including suspected case encounters, differential diagnoses, outcomes, and barriers to care in Peru, Bolivia, Colombia, Brazil, and Mexico. Methods A cross-sectional online survey was conducted for six months in 2025 and targeted physicians, oral health professionals, nurses, public health professionals, and community health workers. The questionnaire assessed demographics, noma knowledge (0–9 score), prior case encounters, differential diagnoses, comorbidities, treatment, and barriers. Open-ended responses underwent thematic analysis. Results Of 401 respondents, 35% reported prior awareness of noma. Among these respondents, the median knowledge score was 70% (6.3/9), and 43% achieved an optimal knowledge level of 75%. Only 37% were aware of the high mortality rate of noma; 46% of the rapid progression, 40% knew the appropriate treatment and only 18% the associated risk factors. Participants reported having attended, between 1985 and 2025, a total of 43 potential cases in children and adults (ages 4–79), between stages 1–3. Undernutrition was the predominant comorbidity in children, while adults frequently presented with immunosuppression. Key barriers for diagnosis and treatment included limited training, misdiagnosis, weak healthcare infrastructure, delayed access to care, and cultural beliefs influencing help-seeking. Conclusions In Latin America, there are critical knowledge gaps on noma among frontline healthcare providers. Reported suspected cases in recent years occurred predominantly in adults, although pediatric cases were also described. These findings highlight the need for strengthened regional medical education, particularly in Spanish and Portuguese. Integration of noma-related content into existing skin-neglected tropical disease and oral health programs may improve clinical awareness and support earlier identification of suspected cases, contributing to improved clinical guidance and health policy development in the region.