Intended for healthcare professionals


Campaigners draw attention to disfiguring childhood disease

BMJ 2008; 336 doi: (Published 08 May 2008) Cite this as: BMJ 2008;336:1038
  1. Peter Moszynski
  1. 1London

A campaign has been launched to combat a childhood oral disease that occurs in areas of extreme poverty and malnutrition.

The World Health Organisation estimates that there are about 100 000 cases a year worldwide of noma (cancrum oris), an opportunist infectious childhood oral disease, with an 80% fatality rate. Its survivors are left so badly scarred that often they are ostracised from their communities. It mainly affects young children with micronutrient deficiencies and starts as gingivitis that turns into necrotising ulcerative tissue or an undetected oedema in the cheek. The infection develops rapidly in a few days before becoming irreversible because of weakening natural defences.

The No Noma Federation, a coalition of charities and organisations united to fight the disease, has been set up to improve prevention, detection, research, and medical and surgical management.

The Swiss consultant psychiatrist Bertrand Piccard, president of the No Noma Federation, previously established the Winds of Hope Foundation to tackle the underlying causes of the disease.

“Noma is a disease that not only leaves indelible scars on the faces of its very young victims but also on the soul of those who witness it—the shame of not knowing about it sooner; the horror of it happening in the 21st century; the incomprehension of so little involvement by humanitarian organisations,” he said.

During the first few days, he said, common antibiotics would halt the progression of the disease. “But no one knew . . . The child is now condemned to see a gangrenous infection ravage his face, destroying soft and hard tissue.”

Luis Sambo, director of WHO’s regional office for Africa, said, “We must look at Noma in all of its facets and address the significance of the other risk factors, like poverty, malnutrition, and hygiene. Although eradication is the ultimate goal we must also look at those already affected.”

Dr Piccard maintains that not only is research urgently needed but there is tremendous need for public awareness because once secondary symptoms set in the disease seldom responds to treatment. “Education of primary health workers is the key. If you detect the first symptoms early enough you can save the child.”

The horrific scarring among people who have had noma has led to it being called “the face of poverty.” Dr Piccard said, “It shows what extreme poverty looks like. Children living in the poorest regions of Asia, South America, and sub-Saharan Africa pay an unacceptable price for malnutrition, poor hygiene, and ignorance.”

The federation, in association with WHO and the World Dental Federation, under the patronage of former secretary general of the United Nations Kofi Annan, will be convening an international symposium in Geneva from 22 May. See

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