Noma is a bacterial disease that almost exclusively affects children in developing countries who suffer from lack of food and live in poor hygienic conditions. Most of the sick children are under 6 years old and have a weak immune system. Childhood diseases such as mumps and measles promote the development of noma, as they attack the children's immune system. Pregnant women also belong to the risk group. Although noma is a bacterial disease, no cases of transmission are known.
Noma proceeds in four painful phases. The disease usually starts at the cheek mucosa with the formation of ulcers and destroys the affected tissue. From there noma also attacks deeper tissue layers such as muscles and bones and spreads over the entire face. This can lead to an impairment of all physical functions such as eating, speaking, smelling, seeing and hearing.
The name noma is derived from the Greek word "nome", which literally means "willow", but here it can be translated as "ulcer that eats around itself". In Germany, the term "Wangenbrand" was often used. People in Europe also contracted noma before the discovery of antibiotics. In the Nazi concentration camps, the disease could also spread under the influence of hunger and lack of hygiene.
Reliable data on the prevalence of noma do not yet exist. However, the World Health Organization estimates that between 80,000 and 90,000 children die of noma every year. About 10,000 survive the disease with devastating consequences. Survivors are severely disfigured and are often rejected by their families and communities.
The immune system of noma patients is usually weakened by under- or malnutrition or infectious diseases. This allows bacteria in the first phase of noma to settle in the mucous membranes of the mouth and nose and cause inflammation. Those affected usually perceive these inflammations only as inconspicuous redness in the mouth.
At this point, the disease can still be controlled with mouthwashes and antibiotics.
In the second phase, red to purple-colored, hardened nodules develop in the affected mouth regions. The inflammation spreads to other soft tissue such as lips and cheeks. The affected tissue swells and turns black. The victim suffers from high fever, severe pain, pus and foul breath.
At this stage, it is imperative to intervene, as noma can still be stopped without causing permanent damage. It is therefore immensely important to sensitize people to the signs of the disease so that they recognize the symptoms of noma in time. Sick children can then be brought to the wards of Hilfsaktion Noma e.V. Here they are examined and medically treated. Antibiotics can now stop the further spread of the disease.
The disturbed blood supply leads to the separation of the diseased tissue from the facial bones. In many cases the bone itself dissolves slowly. The sick children can hardly eat because of all the pain and many starve to death.
Even at this stage, noma could still be controlled with antibiotics, better food and vitamins, even if disfigurement cannot be prevented. However, many families do not recognise the symptoms of noma. Medicines and food are often unavailable, and the distances to the hospital are long. The third phase of the disease is therefore not prevented in most cases.
After about one week, the affected tissue dies and detaches from the face. The children suffer unimaginable pain. Open wounds develop, scarring often leads to lockjaw: the children cannot open their mouth or can only open it very slightly. This makes eating extremely difficult or impossible. Many children starve to death during this phase. If the children have to vomit, they are at risk of choking on the vomit, because they cannot open their mouth. Even if no external damage is visible, bones often dissolve inside the mouth and muscle damage occurs.
Now only surgical intervention can help. Several, often highly complicated surgeries are almost always necessary to release the lockjaw, close the noma wound with skin transplants and rebuild the destroyed bones.
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