Noma (Cancrum oris)
Noma usually begins as a small ulcer of the gingiva and develops into a rapidly spreading gangrenous condition of the oral and facial tissues. Seen mainly in debilitated and malnourished children, it is disfiguring and deadly. The condition is reported in developing countries in several regions of the world, particularly in Sub-Saharan Africa (Enwonwu, Falkler, and Idigbe 2000; Naidoo and Chikte 2000; Petersen 2003). Noma disappeared from the industrial world in the 20th century except during World War II. In contrast, risk factors such as poverty, poor hygiene, and malnutrition, eventually in combination with infectious diseases such as HIV and AIDS, may have recently increased the prevalence of this disease in Sub-Saharan Africa (Enwonwu 1995; Naidoo and Chikte 2000). Most important, 90 percent of infected children die without having received any care.
Although the specific etiologic factors for noma are not known, poverty has been identified as the single most important risk indicator. Accordingly, improving the overall socioeconomic conditions can prevent noma. Public health approaches such as providing a high-protein diet, clean water, and sanitation and preventing communicable diseases such as diphtheria, dysentery, and tuberculosis would be needed for effective prevention of noma in Africa. Prognosis of noma is considerably better with timely administration of antibiotics.