Proportion of paediatric admissions with any stage of noma at the Anka General Hospital, northwest Nigeria
Authors: Farley Elise Sarah , Karinja Miriam Njoki , Lawal Abdulhakeem Mohammed , Olaleye Michael , Muhammad Sadiya , Umar Maryam , Gaya Fatima Khalid , Mbaeri Shirley Chioma , Sherlock Mark , Kabila Deogracia Wa , Peters Miriam , Samuel Joseph , Maloba Guy , Usman Rabi , van der Kam Saskia , Ritmeijer Koert , Ariti Cono , Amirtharajah Mohana , Falq Grégoire 
Published: July 2023

Introduction

Noma is a rapidly spreading infection of the oral cavity which mainly affects young children, and without early treatment, can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to gather evidence on the epidemiology of noma and its association with malnutrition for use in program planning.

Methods

We conducted a prospective observational study enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting caregivers of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge.

Findings

Of the 2346 participants, 58 (2.5%) were diagnosed with simple gingivitis and six (n=0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n=37, CI 2.5 - 4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n=21, CI 1.1 - 2.6%) (p=0.008). Risk factors identified for having simple gingivitis include being aged over two years (2 to 6yrs old, odds ratio (OR) 3.4, CI 1.77 - 6.5; 7 to 12 yrs OR 5.0, CI 1.7 - 14.6; p=<0.001) and being admitted to the ITFC (OR 2.1; CI 1.22 -3.62).

Conclusion

Our study showed a small proportion of those admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Those admitted to the ITFC were more likely to have simple gingivitis. The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.

Author summary

Noma is a rapidly spreading infection of the oral cavity which mainly affects young children and without early treatment, can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. We aimed to gather evidence on the epidemiology of noma and its association with malnutrition by conducting a prospective observational study enrolling 2346 patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting caregivers of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge. Our study showed a small proportion of those admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Those admitted to the ITFC were more likely to have simple gingivitis. The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.