Noma, the face of poverty

Noma is a rapidly spreading necrotizing infection in the face of children. It ‘eats away’ lips, a cheek, a part of the nose or upper jaw and sometimes even more, within a few weeks time. 90% of the noma victims die, while 10% survive with an often severely mutilated face, leading to social ostracism and speech and eating problems. Noma is caused by a combination of malnutrition and a debilitating disease like e.g. measles or HIV. The infection is caused by normal intraoral micro-organisms, that invade the face because of a failing immune system. This so called opportunistic infection was a common cause of death in earlier centuries but disappeared completely in the Western world when welfare increased and even the poorest in society were able to feed their children. The disease disappeared from medical textbooks and has been forgotten almost completely.

However in those parts of the world where extreme poverty and famine are present noma is still seen. The WHO estimates that world-wide 130,000 children die each year as a result of noma, and that many thousands survive to lead a life in social isolation, hidden in a hut, or even worse.

Medical treatment of noma is simple: antibiotics, food and treatment of concomitant diseases. However noma patients and their parents do not have access to these medical facilities due to lack of money, absence of facilities and ignorance. Moreover (health) authorities in countries where noma is present, generally neglect the disease and its victims. The same goes for those noma patients who survive. They need reconstructive surgical rehabilitation. Most efforts for those who are suffering from the sequelae of noma are given by small Western N.G.O.’s sending surgical teams to local hospitals.

The most important intervention is the prevention of noma, through the elimination of extreme poverty, immunizations and improved nutrition for the poorest children, which can lead to the eradication of this preventable childhood disease.


M. Leila Srour, MPH, DTM&H Health Frontiers, Muang Sing, Luang Namtha, Lao People’s Democratic Republic

Klaas Willem Marck, MD, PHD

Chairman Dutch Noma Foundation

Nederlandse Noma Stichting

Haven 8, 9084 BD Goutum Netherlands




American Society of Tropical Medicine and Hygiene

Annual Meeting Nov. 13-17, 2013

Washington, D.C., USA