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Int J Environ Res Public Health. 2019 Nov 19;16(22). pii: E4587. doi: 10.3390/ijerph16224587.

Sociodemographic Characteristics of Traditional Healers and Their Knowledge of Noma: A Descriptive Survey in Three Regions of Mali.

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Service of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland.
Geneva Study Group on Noma (GESNOMA), University of Geneva, 1205 Geneva, Switzerland.
Centre Hirzel, 91093 Bamako, Mali.
Service of Clinical Epidemiology, Geneva University Hospitals, 1205 Geneva, Switzerland.
Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland.
Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, 1004 Lausanne, Switzerland.


Background: Noma can be a lethal disease and causes disfigurement in young children in low-resource countries, particularly in Africa. In these settings, 80% of the population mainly consult traditional healers for healthcare problems. Our study aimed to describe the sociodemographic characteristics of traditional healers and to assess their knowledge of noma. Methods: We conducted a survey among traditional healers in three Malian regions from May 2015 to January 2016 and collected data on sociodemographic characteristics, professional activity, knowledge, and experience of noma and collaboration with modern medicine. Results: Among 770 traditional healers invited to participate, 732 responded (95%) (mean age, 54.5 years). Most were illiterate (66.3%), which was associated with older age (p < 0.001). Although they treated all types of disease, only 10.5% had some knowledge of noma, with regional differences (p < 0.001). Conclusion: Noma is poorly known among traditional healers, especially in remote areas. Our findings suggest a lack of interest among young people for traditional medicine, implying an imminent decrease of healers, and thus the need for national health systems to strengthen and promote access to modern health care. Training programmes to improve the early diagnosis referral of noma patients should include all types of primary health workers.


Noma; access to health; cancrum oris; traditional healers; traditional medicine; west Africa

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