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Int Health. 2020 Jan 1;12(1):28-35. doi: 10.1093/inthealth/ihz066.

'I treat it but I don't know what this disease is': a qualitative study on noma (cancrum oris) and traditional healing in northwest Nigeria.

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Médecins Sans Frontières, Médecins Sans Frontières, Noma Children's Hospital, Mamarun Nufawa, Sokoto, Nigeria Sokoto, Nigeria.
Department of Public Health Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, South Africa.
Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands.
Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, South Africa.
Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London, UK.
Médecins Sans Frontières-Operational Centre Brussels, Medical Department, 68 Rue de Gasperich, 1617, Luxembourg Operational Research Unit (LuxOR).
Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.



Noma, a neglected disease mostly affecting children, with a 90% mortality rate if untreated, is an orofacial gangrene that disintegrates the tissues of the face in <1 wk. Noma can become inactive with early stage antibiotic treatment. Traditional healers, known as mai maganin gargajiya in Hausa, play an important role in the health system and provide care to noma patients.


We conducted 12 in-depth interviews with caretakers who were looking after noma patients admitted at the Noma Children's Hospital and 15 traditional healers in their home villages in Sokoto state, northwest Nigeria. We explored perceptions of noma, relationship dynamics, healthcare practices and intervention opportunities. Interviews were audiorecorded, transcribed and translated. Manual coding and thematic analysis were utilised.


Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers.


Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. This collaboration could save lives and reduce the severity of noma complications.


cancrum oris; noma; operational research; traditional healers; traditional healing

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