Nigeria’s Efforts At Eliminating Noma Stressed
By Princess-Ekwi Ajide, Abuja
Reports say, Noma, a gangrenous disease that attacks facial tissue and bone.has killed around 90% of its victims, mostly those who live in hard-to-reach rural areas, within a few weeks
This came to the fore, as the Chief Medical Director at the Sokoto Noma Children’s Hospital in the northwest region of Nigeria, Dr Shafiu Isah dedicates his days to treating children suffering from the neglected disease that few people have even heard of.
Dr. Isah, said, without treatment, usually due to extreme poverty and lack of awareness, a lot of the children die at home without even making it to the hospital, which according to him, in turn exacerbates the substantial knowledge gaps regarding the preventable and treatable disease.
A 1998 World Health Organization (WHO) global report had estimated 140,000 new cases yearly especially in the absence of reliable epidemiological data, which makes it the most widely cited source on noma whose cases are majorly found in sub-Saharan Africa in children between the ages of two and six.
Some survivors of the disease, who are left with severe facial disfigurements that make it hard to eat, speak, see or breathe are often stigmatised within their communities with a range of accompanying human rights violations.
Dr Abubakar Abdullahi Bello, Chairman of the Medical Advisory Committee at Sokoto Noma Children’s Hospital, said they’ve had cases where the patient is presented to the hospital, with the whole of the lower jaw already gone, or the whole of their nostril pathway is gone, saying that if the cases present to the hospital early, they don’t have such issues hence the advocacy for early admission so as to reduce the duration of the stay in the hospital and the patients will not require surgical intervention.
He noted Noma can be prevented by basic public health interventions such as improving nutrition and oral hygiene; controlling comorbidities such as measles, malaria and HIV infection; and improving access to routine vaccinations.
Nigeria has in recent years, sought to increase awareness of noma and scale up its response activities as part of a commitment to eliminate the debilitating disease and had since 2016, been amongst10 priority countries to form part of the World Health Organization’s (WHO) African Regional Noma Control Programme.
Nigeria has developed and implemented the programme’s national action plan for noma prevention and control in collaboration with WHO and other partners with the Nigerian Ministry of Health integrating noma into its existing surveillance system and incorporated it into the curricula of all national and district health professional schools, while the country now commemorates an annual National Noma Day in November each year.
741 have received training on noma in 2021 and the first half of 2022 with funding from WHO, and Médecins Sans Frontières (MSF), which helped the Ministry to scale up training of primary care workers.
WHO had on 28 July 2022, launched the OpenWHO, a new free and interactive online noma course to host unlimited users during health emergencies. The course will be a useful self-learning tool for health workers to increase their capacity to prevent, identify, treat and refer noma considering both public health and human-rights aspects.
Officers in charge of noma at the national and district level can also utilize the course material to train primary care workers,” says Yuka Makino, a technical officer for oral health at the WHO Regional Office for Africa.
Meanwhile, in Sokoto Noma Children’s Hospital, Dr Isah, is encouraged by the country’s increased focus on noma after so many years of neglect. “This disease is still not very well known in our communities, including among health care workers, who often mistake it for cancer or other illnesses. But I am optimistic that this is beginning to change,” he says. “With the help of other stakeholders, I think we are getting there.”
Isah’s optimism is not ill-founded. Since the hospital opened its doors in 1999, it has been the only specialized noma facility anywhere in Nigeria. But in May this year, Nigeria Aid Noma Initiative (NANI) began the construction of a new 100-bed national noma treatment centre, funded by German non-profit Hilfsaktion Noma e.V, within the National Hospital grounds in the country’s capital, Abuja.
Noma patients continue to visit Sokoto from all over the country in search of treatment, often after having been identified by the hospital’s outreach teams.
Mulikat Okanlawan was one of the first such patients. More than 20 years ago, after many years of referrals and failed operations at other facilities, she travelled all the way to Sokoto from Lagos, some 1000kms away, to seek specialized care and finally found hope.
Mulikat said she used to cry every day, didn’t associate with anyone due to the stigma so, was alone but after she was treated, everything changed and she began to admire herself, relate with other people even continued her schooling and started doing all those things she couldn’t do before.
She has completed her tertiary education at the local Gwadabawa School of Health Technology, and now works as a hygiene officer at Sokoto Noma Children’s Hospital, where she also provides psychosocial support to noma patients.
According to her, the patients that come to the hospital, can see that she was like them but now better and working and as such, help to give them courage.
