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Risk factors for orofacial gangrene include certain feeding practices
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Researchers studied dozens of cases of noma, an orofacial gangrenous infection, and found that aspects of a patient’s home life, including their diet, could be risk factors for developing the disfiguring and often deadly disease, according to a recent study.
Noma causes a rapid disintegration of the hard and soft tissue of the face. It has a mortality rate of up to 90%, and those who survive have severe facial disfigurements, researchers reported in PLoS Neglected Tropical Diseases. Disfigurements can result in physical impairments such as difficulty speaking, swallowing, eating, seeing and breathing, which can lead to stigmatization in the community, they said. WHO estimates that 140,000 children contract noma annually worldwide.
“The disease is poorly understood,” Elise Farley, epidemiologist with Doctors Without Borders, and colleagues wrote in the study. “We aimed to estimate risk factors for diagnosed noma to better guide existing prevention and treatment strategies using a case-control study design.”
For their study, Farley and colleagues followed 77 patients aged younger than15 years, all admitted to the Noma Children’s Hospital in Sokoto between May 2015 and June 2016. Of the patients, 17 were diagnosed with acute noma, 57 had inactive noma, two were diagnosed with trismus and one had no diagnosis. They included a total of 74 cases and 222 controls matched to the patients based on their village of residency, age and sex for comparison.
Parents and caretakers of the participants were asked to complete a questionnaire about household sociodemographics, including living conditions, breastfeeding and other nutrition-related practices, employment, education and proximity to animals and water.
Researchers said they found many similarities between cases and controls but were able to pinpoint several risk factors.
For one, researchers determined that the diet and feeding practices of the children could contribute to noma. For example, children who were fed pap, a corn porridge, every day were at a higher risk for contracting noma, according to Farley and colleagues. They hypothesized that eating pap is a proxy for overall poor diet. Researchers also believe that children who were fed colostrum, the earliest breast milk after birth, were less likely to get noma. Breastfeeding for more than a year and feeding children their first solid food after the age of 12 months could also be contributing risk factors, according to the study.
Researchers discovered that children whose mother was the primary caretaker and whose caretaker was married, were less likely to get noma.
After analyzing information collected in the questionnaire, researchers determined that children in large households, with 10 or more residents, children in areas with low vaccination coverage and children who were heavy at birth were at a higher risk for noma.
Based on their findings, researchers suggested that intervention efforts could be more effective by focusing on access to health care, the benefits of breastfeeding and a varied diet.
“Our case control study suggests that infant and current feeding behaviors as well as caretaker demographics may affect the risk of developing noma,” the authors wrote. “Malnutrition and low vaccination coverage, high morbidity of infectious diseases along with low access to health care are all likely contributing factors. We recommend that further research is implemented to determine the true burden of noma, and that prospective studies are implemented to better understand the sequence of events contributing to the development of noma. Only with these sets of indicators will it be possible to better formulate and target prevention programs.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.
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