ABSTRACT
OBJECTIVES: Noma is a gangrenous affliction that destroys the soft and hard tissue of the face. It affects exclusively young children from developing countries. Although the risk factors (malnutrition and debilitating diseases) are known, the cause remains a topic of debate. Etiological studies have tried to identify bacterial or viral agents responsible for the illness. We examine for the first time the possibility of a link between this illness and the social practices surrounding childbirth. METHODS: This study took place in Niger, where we conducted 18 ethnographic interviews with mothers from four villages. Noma was known in two villages, but unknown in the other two. RESULTS: Our results show that inadequate practices related to breastfeeding, weaning, and nutritional supplementation practices are by themselves insufficient to initiate the disease, insofar as most of these practices, paradoxically, were found in the villages not affected by the disease. CONCLUSION: The results indicate that these practices are not sufficient to explain noma. They suggest, however, that poor maternal health and nutritional status before and during pregnancy may have an irreversible negative impact on the child's overall health.
