High burden of noma in the Gambella region of Ethiopia: a 12-year retrospective study on noma cases from the Facing Africa database.

BACKGROUND: Noma, an infectious disease, mainly affects impoverished children. This study retrospectively assessed noma's prevalence in Ethiopia using data from the Facing Africa database and the 2022 United Nations Development Programme poverty index report. METHODS: A thorough review of medical records spanning 2007 to 2019 identified a total of 235 noma cases. A standardized data extraction template was employed to systematically gather pertinent clinical and demographic data for subsequent analysis. Prevalence rates were calculated nationally and regionally for both the general population and children aged ≤10 y. RESULTS: The analysis revealed estimated national prevalence rates of 0.65 per 100 000 individuals at risk and 1.9 per 100 000 children aged <10 y at risk. The Gambela region exhibited the highest prevalence rate (11.2 per 100 000), whereas the Benshangul Gumuz region had the lowest (0.25 per 100 000). Similar patterns were observed among children aged ≤10 y, with the Gambela and Benshangul Gumuz regions reporting rates of 32.9 and 0.74 per 100 000, respectively. CONCLUSIONS: The study highlights noma's significant impact on children aged <10 y in Ethiopia, especially in the Gambella region. It offers crucial baseline data to assist public health professionals, policymakers and healthcare providers in formulating evidence-based strategies to combat noma and improve affected individuals' well-being.

Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia.

Introduction: Noma, an overlooked infectious disease, inflicts severe facial tissue damage, posing substantial challenges in patient care. This study delves into surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. Materials and Methods: The research employed a cross-sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database. Results: The review encompasses 235 noma cases. Twenty-four cases (19 females and 5 males) experienced various complications, predominately major complications leading to subsequent revision surgeries. The identified complications included flap necrosis, abscess formation, tenderness, graft site infection, flap bulking, dental misalignment, corner of the mouth dehiscence, infected bone and plate, flap malpositioning, restricted mouth opening with ankylosis, neuropathic pain, recurrent flap infection, and offensive odor. Revision surgeries included wound cleansing, abscess drainage, skin graft removal, exploratory surgery, wound care, debulking, scar removal, debridement, trismus release, commisuroplasty, and flap repositioning. Conclusion: These findings illuminate the intricacies of noma surgery in Ethiopia, emphasizing the importance of understanding the nature and frequency of complications for optimizing treatment outcomes. Insights from this study can guide healthcare providers, especially novice surgeons, and policymakers, in refining surgical interventions and enhancing outcomes for noma patients. Improved knowledge in this realm is crucial for advancing patient care and developing targeted interventions. Level of Evidence: 5.

Noma is a facial disfiguring childhood disease: Insights from cases of Noma in Ethiopia.

OBJECTIVES: Noma is a neglected infectious disease that causes severe destruction of facial tissues and poses a significant public health threat. The disease reportedly affects individuals with a debilitating health condition. This study aimed to identify the most vulnerable age group affected by Noma disease and assess the severity of tissue damage among Noma cases in Ethiopia. METHODS: A cross-sectional study was conducted to determine the age group most susceptible to noma and assess the disease-associated severity of tissue damage. The research objectives were met by scrutinizing electronic medical records of noma cases treated in Addis Ababa, Ethiopia, from 2007 to 2019, obtained from the Facing Africa database. Data collection was carried out using a standardized survey form, while the severity of facial tissue damage was assessed using the NOIPTUS score. RESULTS: Among 164 Noma cases with documented data on disease onset, 92.7 % occurred during childhood, with 92.1 % of those cases being children aged ten years and younger. Approximately 11.6 % of all noma cases had mild tissue damage, classified as NOITULP grade 1, while 26.2 % had an intermediate level of tissue damage, classified as NOITULP grade 2. Severe tissue damage (NOITULP grade 3) was present in 37.2 % of cases, while 25 % had very severe tissue damage (NOITULP grade 4). CONCLUSIONS: The findings underscore the vulnerability of children, particularly those aged ten years and younger, to Noma disease, supporting the argument that Noma is a facial-disfiguring childhood disease. Targeted interventions and preventive measures during childhood can be vital in controlling Noma incidence.

Estimation of the Prevalence of Noma in Ethiopia, 2007-2019: A Retrospective Study.

Noma is a rapidly advancing and frequently deadly infection affecting the oral and facial regions. The condition causes severe destruction of the soft and osseous tissues of the face. Noma primarily affects impoverished children with weakened immune systems, yet epidemiological data on the disease are lacking. This cross-sectional study aimed to fill this knowledge gap by estimating the prevalence of noma in Ethiopia. A retrospective review of patients' medical records was conducted using data from the Facing Africa database, spanning from 2007 to 2019. The prevalence of noma was calculated for the general population and for children under 10 years old at national and regional levels. The estimation process involved analyzing raw data and referring to an expert consultation report organized by the Oral Health Division of the WHO, which used the Delphi method. Based on the analysis of 235 medical records, the study revealed an estimated prevalence of 16 cases per 100,000 population and 0.47 case per 1,000 children under 10 years old nationally, with approximately 1,446 and 1,237 new cases diagnosed annually, respectively. The Gambela region had the highest prevalence of noma, with 276.2 cases per 100,000 population, whereas the Benshangul Gumuz region had the lowest rate at 6.2 cases per 100,000 population. Similarly, the Gambela and Benshangul Gumuz regions exhibited the highest and lowest prevalences per 1,000 children under 10 years old, estimated at 8.12 and 0.18 cases per 1,000, respectively. The findings underscore the public health impact of noma in Ethiopia and the need for effective prevention and treatment strategies.

The severity of psychosocial and functional morbidity among facially disfigured untreated noma cases in Ethiopia.

OBJECTIVES: Noma is a facially disfiguring disease that affects the oral cavity and midface structures. If left untreated, the disease is fatal. Noma causes severe cosmetic and functional defects in survivors, leading to psychiatric and social problems. However, there are limited data on psychosocial and functional sequelae associated with this disease. This cross-sectional study aimed to investigate psychosocial and functional morbidity among facially disfigured untreated Noma cases. Study participants were volunteer patients diagnosed with noma and awaiting surgery at two noma treatment centers in Ethiopia. A questionnaire derived from the APA's DSM-5, the DAS59, and the Appearance Anxiety Inventory protocol was used to measure the psychosocial and functional morbidity of the cases between September 16 and October 10, 2022. RESULTS: A total of 32 noma cases (19 women and 13 men) awaiting the next surgical campaigns were involved in the study. Study participants reported severe social (Likert score = 2.8) and psychological (Likert score = 3.0) morbidity. Functional limitation was moderate (Likert score = 2.9). This study has shown that psychosocial and functional morbidity in untreated noma cases in Ethiopia is substantial. Therefore, policymakers, clinicians, and researchers need to pay sufficient attention to providing adequate health care and preventing the occurrence of the disease in the long term.

An update on oral clinical courses among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: A clinical follow-up (a prospective prevalent cohort) study.

INTRODUCTION: Contemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations. MATERIALS AND METHODS: A prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted toat the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study consisted of two follow-up phases: Hospital and patient-home-based. RESULTS: A total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n = 10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n = 6), xerostomia (n = 5), and thickening of saliva (n = 1). The oral mucosal lesions per se consisted of aphthous lesions (n = 3), candidiasis (n = 1), geographic tongue (n = 1), and localized gingivitis (n = 1). The four weeks' home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n = 10) to 29% (n = 16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up. DISCUSSION: The study's findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.

A retrospective clinical, multi-center cross-sectional study to assess the severity and sequela of Noma/Cancrum oris in Ethiopia.

INTRODUCTION: Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal. MATERIALS AND METHODS: A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,-the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score. RESULTS: A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25-50%), Grade-3 (50-75%), Grade-1 (0-25%), and Grade-4 (75-100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma. DISCUSSION: The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one's family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.