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PLoS Negl Trop Dis. 2018 Aug 23;12(8):e0006631. doi: 10.1371/journal.pntd.0006631. eCollection 2018 Aug.

Risk factors for diagnosed noma in northwest Nigeria: A case-control study, 2017.

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Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands.
Department of Public Health Medicine, University of Cape Town, Cape Town, South Africa.
Centre for Medical Education, Cardiff University School of Medicine, Cardiff, United Kingdom.
Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Department of Plastic Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Department of Clinical Services, Noma Children's Hospital, Sokoto, Nigeria.



Noma (cancrum oris), a neglected tropical disease, rapidly disintegrates the hard and soft tissue of the face and leads to severe disfiguration and high mortality. The disease is poorly understood. We aimed to estimate risk factors for diagnosed noma to better guide existing prevention and treatment strategies using a case-control study design.


Cases were patients admitted between May 2015 and June 2016, who were under 15 years of age at reported onset of the disease. Controls were individuals matched to cases by village, age and sex. Caretakers answered the questionnaires. Risk factors for diagnosed noma were estimated by calculating unadjusted and adjusted odds ratios (ORs) and respective 95% confidence intervals (CI) using conditional logistic regression.


We included 74 cases and 222 controls (both median age 5 (IQR 3, 15)). Five cases (6.5%) and 36 (16.2%) controls had a vaccination card (p = 0.03). Vaccination coverage for polio and measles was below 7% in both groups. The two main reported water sources were a bore hole in the village (cases n = 27, 35.1%; controls n = 63, 28.4%; p = 0.08), and a well in the compound (cases n = 24, 31.2%; controls n = 102, 45.9%; p = 0.08). The adjusted analysis identified potential risk and protective factors for diagnosed noma which need further exploration. These include the potential risk factor of the child being fed pap every day (OR 9.8; CI 1.5, 62.7); and potential protective factors including the mother being the primary caretaker (OR 0.08; CI 0.01, 0.5); the caretaker being married (OR 0.006; CI 0.0006, 0.5) and colostrum being given to the baby (OR 0.4; CI 0.09, 2.09).


This study suggests that social conditions and infant feeding practices are potentially associated with being a diagnosed noma case in northwest Nigeria; these findings warrant further investigation into these factors.

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