Journal Article > ResearchFull Text
Facial Plast Surg Aesthet Med, Facial plastic surgery and aesthetic medicine, JAMA Facial Plastic Surgery. 26 July 2024; Volume 26 (Issue 4); 488-496.; DOI:10.1089/fpsam.2023.0079
Amirtharajah M, Olaleye M, Oluyide B, Lenglet A, Ariti C, et al.
Facial Plast Surg Aesthet Med, Facial plastic surgery and aesthetic medicine, JAMA Facial Plastic Surgery. 26 July 2024; Volume 26 (Issue 4); 488-496.; DOI:10.1089/fpsam.2023.0079
BACKGROUND
Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations.
OBJECTIVE
To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria.
METHODS
Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic.
RESULTS
Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, p = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001).
CONCLUSIONS
Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria.
Conference Material > Poster
Olaleye M, Farley ES, Karinja MN, Lawal AM, Muhammad S, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/dhIP6SLTf8
Conference Material > Poster
Ribes M, Atumane A, Adamuge M, Transval L, Intamo T, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/JeoRwqu
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 27 October 2023; Volume 17 (Issue 10); e0011508.; DOI:10.1371/journal.pntd.0011508
Farley ES, Karinja MN, Lawal AM, Olaleye M, Muhammad S, et al.
PLoS Negl Trop Dis. 27 October 2023; Volume 17 (Issue 10); e0011508.; DOI:10.1371/journal.pntd.0011508
INTRODUCTION
Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children.
METHODS
We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge.
FINDINGS
Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5–4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1–2.6%) (p = 0.008). Risk factors identified for having simple gingivitis include being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77–6.5; 7 to 12 yrs OR 5.0, CI 1.7–14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22–3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition.
CONCLUSION
Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children.
METHODS
We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge.
FINDINGS
Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5–4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1–2.6%) (p = 0.008). Risk factors identified for having simple gingivitis include being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77–6.5; 7 to 12 yrs OR 5.0, CI 1.7–14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22–3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition.
CONCLUSION
Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
Journal Article > ResearchFull Text
PLOS Glob Public Health. 1 September 2023; Volume 3 (Issue 9); e0001995.; DOI:10.1371/journal.pgph.0001995
Oluwalomola OV, Briskin E, Olaleye M, Samuel J, Oluyide B, et al.
PLOS Glob Public Health. 1 September 2023; Volume 3 (Issue 9); e0001995.; DOI:10.1371/journal.pgph.0001995
Noma is a rapidly progressing infection of the oral cavity, which can cause the disintegration of the cheek, nose and eye, in under a week. One of the most disabling sequelae is trismus, the restriction of mouth opening, which results in difficulties in speech, mastication, social feeding habits and maintenance of oral hygiene. Restriction of mouth opening among noma patients mostly begins during the transition between World Health Organisation (WHO) stage 3 (gangrene) and stage 4 (scarring) of the disease. This study aims to describe the impact of physiotherapy in noma patients hospitalised with stages 3 and 4 of the disease and to identify factors that influence change in mouth opening of noma patients. This study is a retrospective analysis of routinely collected data from patients admitted at Noma Children Hospital, Sokoto, Northwest Nigeria between 1 May 2018 and 1 May 2020. Eligible patients included stage 3 and 4 noma patients who had not undergone any surgical reconstruction or trismus release surgery but received physiotherapy assessment and treatment during initial hospitalization. Factors associated with a change in mouth opening were identified using paired t-test analysis, bivariate and multivariate analyses. The mean difference in the mouth opening from admission to discharge was 6.9mm (95% CI: 5.4 to 8.3, p < 0.0001). Increased number of physiotherapy sessions and patient age above three years were significant predictors of improvement in mouth opening (p-value 0.011, 0.001 respectively). Physiotherapy treatment received within an adequate number of physiotherapy sessions for stage 3 and 4 noma patients during the period of the first hospitalization is important and results in a significant increase in mouth opening. Hence, noma patients at these stages should routinely undergo physiotherapy as part of a holistic approach to treatment.
Conference Material > Video
Ajamah S
MSF Paediatric Days 2022. 1 December 2022; DOI:10.57740/95q8-ne84
Conference Material > Slide Presentation
Ajamah S
MSF Paediatric Days 2022. 1 December 2022; DOI:10.57740/427v-ph38
Conference Material > Video
Okanlawon M
MSF Paediatric Days 2022. 1 December 2022
English
Français
Conference Material > Abstract
Ajamah S, Tanaka M, De Vore K, Vogiazou Y, Joseph S, et al.
MSF Paediatric Days 2022. 26 November 2022; DOI:10.57740/142a-kn28
BACKGROUND AND AIMS
The Noma hospital in Sokoto State, Nigeria, provides specialised care for noma, a rapidly progressive and often fatal necrotising bacterial disease, which continues to be neglected. This project was initiated and is led by the Noma project team in collaboration with the Sapling Nursery fund (MSF UK) who provide resources and support. Through community-based exploratory assessments, it was found that caregivers do not have enough resources, knowledge and overall capacity to continue with the necessary treatment and care after discharge. Patients are too often re-admitted in worse condition than before. This highlights a serious gap in the continuity of care, which the Noma Discharge Toolkit (NDT) aims to improve.
METHODS
Person-centered design methodologies aiming to improve quality of care were central to toolkit development. Individual interviews and group sessions led to the identification of needs and challenges, while also exploring potential solutions. The resulting NDT contains four components to support care after discharge:
--Locally sourced food items (Kwash-pap) and RUTF (Plumpy-nut);
--Non-food items for hygiene and transport/storage;
--Medication and treatment;
--Knowledge/engagement booklet.
The feasibility of the NDT was investigated using qualitative data collection methods to understand the perceived benefit by caregivers and hospital staff.
RESULTS
The pilot is in an early stage and distribution data will be gathered and analysed in autumn 2022, but the NDT’s preliminary results are promising. It has been welcomely integrated within the team’s regular processes. Initial feedback is positive, highlighting how the kit gives necessary resources, while increasing engagement, knowledge and focus on quality of care. For the upcoming distribution data collection and analysis, formal ethics approval will be sought.
CONCLUSIONS
The process is this project’s strength – it demonstrates what can be accomplished when co-designing with community and hospital staff, while concretely showing the potential of person-centred design methodologies.
The Noma hospital in Sokoto State, Nigeria, provides specialised care for noma, a rapidly progressive and often fatal necrotising bacterial disease, which continues to be neglected. This project was initiated and is led by the Noma project team in collaboration with the Sapling Nursery fund (MSF UK) who provide resources and support. Through community-based exploratory assessments, it was found that caregivers do not have enough resources, knowledge and overall capacity to continue with the necessary treatment and care after discharge. Patients are too often re-admitted in worse condition than before. This highlights a serious gap in the continuity of care, which the Noma Discharge Toolkit (NDT) aims to improve.
METHODS
Person-centered design methodologies aiming to improve quality of care were central to toolkit development. Individual interviews and group sessions led to the identification of needs and challenges, while also exploring potential solutions. The resulting NDT contains four components to support care after discharge:
--Locally sourced food items (Kwash-pap) and RUTF (Plumpy-nut);
--Non-food items for hygiene and transport/storage;
--Medication and treatment;
--Knowledge/engagement booklet.
The feasibility of the NDT was investigated using qualitative data collection methods to understand the perceived benefit by caregivers and hospital staff.
RESULTS
The pilot is in an early stage and distribution data will be gathered and analysed in autumn 2022, but the NDT’s preliminary results are promising. It has been welcomely integrated within the team’s regular processes. Initial feedback is positive, highlighting how the kit gives necessary resources, while increasing engagement, knowledge and focus on quality of care. For the upcoming distribution data collection and analysis, formal ethics approval will be sought.
CONCLUSIONS
The process is this project’s strength – it demonstrates what can be accomplished when co-designing with community and hospital staff, while concretely showing the potential of person-centred design methodologies.
Journal Article > ReviewAbstract Only
Curr Opin Otolaryngol Head Neck Surg. 5 July 2022; Volume 30 (Issue 4); 219-225.; DOI:10.1097/MOO.0000000000000819
Farley ES, Amirtharajah M, Shaye DA
Curr Opin Otolaryngol Head Neck Surg. 5 July 2022; Volume 30 (Issue 4); 219-225.; DOI:10.1097/MOO.0000000000000819
PURPOSE OF REVIEW
There is a need for concerted effort to increase global awareness about noma (cancrum oris). This paper aims to summarize the recent literature on noma and provide suggestions that could be implemented to raise awareness about this neglected disease.
RECENT FINDINGS
Noma has been recognized, diagnosed and reported for centuries. Despite significant progress in scientific methods over time, the published literature on noma has predominantly been of low level clinical and scientific evidence. Recent studies have reported on noma's global distribution and its predisposing risk factors, its treatment, its knowledge and beliefs and has included a number of literature reviews. Noma cases are being reported from an increasingly diverse set of geographical locations.
SUMMARY
Noma has largely been neglected in the research sphere. Noma is a preventable disease and its progression can be halted if patients are recognized and treated in the early stages of disease. Treatment for late stage noma survivors remains complex and time consuming, requiring substantial human and financial resources most commonly not achieving functional and cosmetic anatomy. The ultimate aim is therefore prevention, initiatives should be integrated into existing health programs.
There is a need for concerted effort to increase global awareness about noma (cancrum oris). This paper aims to summarize the recent literature on noma and provide suggestions that could be implemented to raise awareness about this neglected disease.
RECENT FINDINGS
Noma has been recognized, diagnosed and reported for centuries. Despite significant progress in scientific methods over time, the published literature on noma has predominantly been of low level clinical and scientific evidence. Recent studies have reported on noma's global distribution and its predisposing risk factors, its treatment, its knowledge and beliefs and has included a number of literature reviews. Noma cases are being reported from an increasingly diverse set of geographical locations.
SUMMARY
Noma has largely been neglected in the research sphere. Noma is a preventable disease and its progression can be halted if patients are recognized and treated in the early stages of disease. Treatment for late stage noma survivors remains complex and time consuming, requiring substantial human and financial resources most commonly not achieving functional and cosmetic anatomy. The ultimate aim is therefore prevention, initiatives should be integrated into existing health programs.