Your Guide to
Neglected Tropical Diseases

Noma is a severe bacterial infection that destroys mouth and facial tissue. It starts as inflammation of the gums and, without early treatment, rapidly spreads to destroy facial tissues and bones within days. Noma mainly affects young children aged 2 to 6 years living in extreme poverty. The disease is linked to severe malnutrition, poor oral hygiene, weakened immune systems from infections, and lack of access to healthcare. Noma is not contagious; rather, it is caused by common bacteria that take advantage when a child's body defenses are down.

Without treatment, approximately 90% of children die within two weeks of onset. Survivors face severe facial disfigurement and difficulty eating, speaking, and breathing. If caught early, Noma can be stopped with basic antibiotics, proper nutrition, and mouth hygiene.

Noma is not contagious and does not spread from person to person. Rather, it is an opportunistic infection caused by multiple types of bacteria that normally live in the mouth. When children suffer from severe malnutrition, their immune systems become too weak to control these bacteria, which multiply and invade tissues.

Noma often develops after a child has recently been sick with measles, malaria, diarrhea, or other infections that further weaken immunity. Poor oral hygiene allows bacteria to build up on teeth and gums. Noma usually begins with painful, bleeding gums. If not treated at this early stage, the infection rapidly spreads over days, destroying soft tissues and bones of the cheeks, jaw, lips, and nose, leaving visible holes in the face.

Geographic scope:

• Noma occurs primarily in sub-Saharan Africa, particularly in countries within the "noma belt" stretching from Mauritania to Ethiopia; some cases are also reported in parts of Asia, Latin America, and the Middle East.
• Nigeria has one of the highest numbers of reported cases.
• About 30,000-40,000 new cases occur annually, although the true numbers are likely higher due to underreporting.
• The disease was once common in Europe and North America until the early 20th century, but has largely disappeared as living conditions improved.

Population affected:

• 75% of cases occur in children aged 2-6 years, with some cases in older children and immunocompromised adults.
• Without treatment, 90% of children die within days or weeks from sepsis, starvation, or pneumonia.
• With early treatment, mortality drops to under 10% in many reports.
• The disease disproportionately affects children from remote rural areas without access to healthcare, with some studies suggesting a slight predominance in girls.

Early detection is critical because Noma progresses from gum inflammation to life-threatening tissue destruction within days. Early-stage treatment includes antibiotics (amoxicillin and metronidazole), mouth hygiene with chlorhexidine mouthwash or salt water, wound cleaning with hydrogen peroxide, and high-protein nutrition. These simple interventions can stop disease progression in most cases.

Advanced stages require stronger antibiotic combinations including ampicillin and gentamicin, plus vitamin A supplements, hydration, and electrolyte correction. Honey dressings may be applied for antibacterial action. Survivors often need extensive reconstructive surgery and physiotherapy to restore eating, speaking, and jaw movement, typically delayed one year to allow scarring to stabilize.

Prevention addresses root causes: improving childhood nutrition, ensuring measles vaccination, promoting oral hygiene, providing clean water and sanitation, and strengthening early detection systems. Malnutrition feeding programs are ideal screening sites. Community education combats stigma and encourages immediate medical care when children develop gum inflammation.