Estimated incidence of noma \"A biologic indicator of poverty\" in north central Nigeria: A retrospective cross-sectional study

Abstract

BackgroundNoma is a spreading and devouring disease which is believed to be native to Sub-Saharan Africa over the last decade due to poverty. Within this noma belt, most epidemiological reports regarding the disease have emanated from the north western region of Nigeria. However, our indigenous surgical mission encountered a substantial number of cases noteworthy of epidemiological representation in north central Nigeria. MethodsAll facial cleft and noma cases encountered within the 8 year study period were included into this study. Estimated incidence of the noma in the zone was calculated using the existing statistical model of Fieger et al (2003), which takes into account the expected differences based on age and location of the two patient groups using the multinomial logistic regression analysis. Period prevalence of noma was also calculated by simple division considering the population at risk of the disease in the zone. FindingsA total of 770 subjects were included in this study (orofacial cleft - 692, noma - 78). The incidence estimate of noma in the north central zone was 3.2 per 1000 with a range of 2.6 - 3.7 per 1000. The period prevalence of noma was1:125,000 children. The median age of noma patients was comparatively higher than the median age of facial cleft patients. The mean age of onset of noma was 5.9 {+/-} 8.08 years which was lower than the average age of individuals in the noma group - 29.6 {+/-} 18.84 years. ConclusionAlthough noma may be more prevalent in the north western region of Nigeria; substantial number of cases is still being encountered in the north central zone which calls for urgent attention of relevant health stakeholders regarding the management and rehabilitation of individuals affected. AUTHOR SUMMARYNoma, a devouring facial disease, is commonly associated with poverty and impoverished regions of the world especially Sub-Saharan Africa which is being termed the noma belt region of the world. Although literature established that noma is indeed a neglected disease, the degree of this neglect in north central Nigeria compared to other sub-regions is in fact alarming, as no report on the disease burden have been published till date. In this light, a retrospective, cross-sectional was conducted to provide epidemiological representation to the cases encountered within an eight year period at the Cleft and Facial Deformity Foundation (CFDF), an indigenous surgical mission. The incidence of noma was estimated from the known incidence of orofacial cleft using an existing multinomial logistic regression model while the period prevalence was calculated considering the population living below poverty line in the sub-region. This study extrapolates an incidence of 3.2 per 1000 and a period prevalence of 0.05 per 1000 persons. Notable is the finding that most individuals with noma were above thirty years of age and suffered varying degree of facial disfigurement resulting from the acute phase of the disease which started in their childhood. Therefore, we advocate public awareness on the disease presentation, risk factors and sequelae in the sub-region and identify the need to bolster the efforts of existing health facilities and indigenous surgical missions in the management and rehabilitation of individuals affected.