Maguire et al. - 'A systematic scoping review of the noma evidence landscape: current knowledge and gaps'

Abstract

Background Noma (cancrum oris) is a severe gangrenous disease of the mouth and oro-facial structures. Noma often affects young children living in extreme poverty, malnutrition and poor sanitation. Gaps remain in understanding its aetiology, pathogenesis, prevention and treatment.

Methods and findings We systematically searched databases for all primary research studies (clinical trials, cohort studies, case–control, cross-sectional, other observational studies, case studies/series) reporting noma patients of any age up to 7 December 2022. The 366 publications (published between 1839 and 2022) included in our scoping review describe 15 082 patients. Although 53 cohort and 29 cross-sectional studies were identified, enrolling 13 489 patients, interventional research remains extremely limited, with only six studies identified (101 patients, range: 7–26) and only one in the past decade, highlighting a critical gap in treatment evaluation. A total of 380 different treatment modalities were described, which underscores lack of a standardised practice. Disease aetiology remains unclear, with 117 microorganisms reported across 113 studies, yet none more consistently linked to noma development. Since 2000, 91.2% of cases have been reported in Sub-Saharan Africa, though occurrences outside the ‘noma belt’ and into Asia and the Americas suggest a broader risk. The 212 potential risk factors identified in 269 (73.5%) publications reflect substantial heterogeneity, complicating efforts to determine definitive causative factors. Additionally, the inconsistent definition and reporting of noma staging significantly hinder comparability across studies, with wide adoption of the WHO staging classification needed.

Conclusion This comprehensive review of the literature underscores the urgent need for robust, policy-driven research to address the vast knowledge gaps in the physiopathology of noma and the limited evidence currently available to guide therapeutic and preventive policies. Collective action and increased research investment are crucial, especially now that noma is officially recognised as a neglected tropical disease by the WHO.

Brittany J Maguire, Rujan Shrestha, Prabin Dahal, Roland Ngu, Lionel Nizigama, Sumayyah Rashan, Poojan Shrestha, Elinor Harriss, Paul Newton, Yuka Makino, Benoit Varenne, Philippe J Guerin - Systematic scoping review of the noma evidence landscape: current knowledge and gaps: BMJ Global Health 2025;10:e018023 https://gh.bmj.com/content/10/7/e018023

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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Group

PSYCHOLOGICAL IMPACT mental & emotional complications WITHDRAWAL LOST EDUCATION & LIFE CHANCES DEPRESSION PSYCHO-	malnutrition and poor sanitation PHYSICAL IMPACT LIMITED EVIDENCE - DISEASE KNOWLEDGE GAPS - AETIOLOGY  knowledge gaps in the physiopathology of noma
-SOCIAL MANAGEMENT SOCIAL IMPACT - LIFE CHANCES STIGMA SOCIAL EXCLUSION	extreme poverty, infrastructure NEED FOR POLICY-DRIVEN RESEARCH THERAPEUTIC - PREVENTIVE POLICIES RECOGNITION

Previously: 'neglected' : 'noma'

My source: https://x.com/benoit_varenne/status/1950955812915982487

Geneva Health Forum 2025 (May 20-23) - Register Now!

Dear HIFA team

Can you share in your network this information. Thanks for your help

Sincerely

[HIFA profile: Eric Comte is Executive Director, Geneva Health Forum, External Affairs Directorate, Geneva University Hospitals. eric.comte AT unige.ch ]

--------------------------------------------------

Geneva Health Forum 2025 (#GHF2025) is approaching quickly!

Bringing together global health leaders, researchers, frontline practitioners, and policymakers, the annual Geneva Health Forum event serves as a unique platform to exchange knowledge, present innovations, and advance equitable and sustainable solutions to the world’s most pressing health challenges.

We are present every year during the week of the World Health Assembly, at the end of May, to enable academic and civil society players to make their voices heard during the World Health Assembly.

This 2025 edition will focus on four thematic priorities: • Malnutrition • Climate Change and Health • Migration, Health, and Equity • Digital Health

Each theme will be addressed through evidence-based dialogue, multi-sector collaboration, and a strong emphasis on real-world practices with the potential for broader application and impact.

Please note: registration is free but required individually for each session or event. To secure your participation, visit the dedicated page for the event(s) of interest and click on the “Register” button.

To see the program and to register click on this link : https://conference2025.genevahealthforum.com/

We invite you to secure your spot for this important event by registering today!

We look forward to welcoming you to Geneva very soon!

If you have a question, contact us : contact AT genevahealthforum.com

My source: HIFA

Africa's Nutrition Movement: Seizing the Window with Primary Health Care

Africa's mission to eliminate malnutrition is more critical than ever. Bubbling down the high level commitments to strategic programmable goals will be critical at primary health care and community levels.

The continent has made significant progress in recent years, but the COVID-19 pandemic has highlighted the need for sustained efforts to address the complex issues surrounding malnutrition, particularly for women and children as we build traction to meet the sustainable development goals by 2030.

"The year 2025 will also be significant as it marks the end of the UN Decade of Action on Nutrition. N4G Paris will serve as a multi-stakeholder summit, advocating for ambitious financial and political commitments and fostering dialogue among diverse actors from around the world, including governments, international organizations, research institutions, civil society organizations, philanthropies, private sector entities, and more." - #N4G

Connecting dots is a a key imperative as we build Africa's nutrition movement. One of them is viewing nutrition from a programmable health systems lens. Have we given this enough traction ?

"The N4G conference presents a crucial opportunity for Africa to gain traction on its mission to eliminate malnutrition. The conference aims to mobilize ambitious financial and political commitments, foster dialogue among diverse stakeholders, and put nutrition at the center of the sustainable development agenda." - United Nations SDGs Professional Support Group for Africa

One of the key lessons from COVID-19 is the importance of strengthening health systems, particularly at the primary healthcare level. The pandemic has exposed weaknesses in many health systems, highlighting the need for increased investment in health care infrastructure, workforce, and services which will ultimately impact on nutrition delivery at the base of the health system.

The upcoming Africa Primary Health Care Forum , scheduled for Abuja on July 14-15, 2025, will provide a platform for stakeholders to discuss the importance of primary health care(PHC) in achieving universal health coverage (UHC) and health security, as well addressing malnutrition in PHC systems. The forum will also explore the role of digital health, digitised workforce, partnerships and financing in strengthening primary healthcare systems and improving general health outcomes.

More details continued at: https://www.phc.africa/

Southern Sudan Medical Journal: May 2019 issue on Primary Health Care

Dear SSMJ Reader,

 

The special May 2019 issue on Primary Health Care is now online here and includes items on support for PHC in refugee camps, approaches and strategies for PHC, charging for health care, literacy and health, community screening for diabetic retinopathy, vaccination coverage and CHWs treating malnutrition.  See details below.

Send us your feedback, your manuscripts (which we can help you prepare), encourage colleagues to join the mailing list here, follow us on twitter: @SSMedJournal and our Facebook Group, and find previous SSMJ articles at African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ).

 

The SSMJ Editorial team

admin AT southernsudanmedicaljournal.com.

In the May 2019 issue:

EDITORIAL

• Forty years of primary health care programming and its future in South Sudan Dr Ayat Jervase 

ORIGINAL RESEARCH

• Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda Dominic Odwa Atari and Kevin McKague 

MAIN ARTICLES

• Integrated Primary Health Care (iPHC) for developing countries: a practical approach in South Sudan Victor Vuni Joseph and Eluzai Hakim 
• Addressing high vaccination coverage in primary health care setting: challenges and best practices Bobby Paul and Indranil Saha 
• Preventing blindness from diabetic retinopathy through community screening Wani G Mena 
• UK-South Sudan Alliance: a strategy for increasing capacity and access to primary care and public health Rich Bregazzi 
• What is the best way for healthcare systems to charge sick patients? Alfred Lumala, Lucien Wasingya-Kasereka, Martin Opio, Jenard Ntacyo, Samuel Mugisha, John Kellett 
• How can we bridge the gap between literacy and health in South Sudan? China Mayol Kuot 

SHORT ITEMS

• The Evidence for Contraceptive Options and HIV Outcomes (ECHO)
• Performance of low-literate community health workers treating severe acute malnutrition in South Sudan Elburg Van Boetzelaer, Annie Zhou, Casie Tesfai, and Naoko Kozuki 
• Martha Primary Health Care Centre: how resilience and international collaboration is transforming a community Poppy Spens 
• Point Of Care Ultrasound (POCUS) is saving lives Achai Bulabek 
• Juba College of Nursing and Midwifery milestones in 2018 Anna Modong Alex 
• Obituary: Dr Joy Theophilus and Dr Emmanuel Kenyi

LETTER TO THE EDITOR

• What South Sudan must do to reduce high maternal and infant deaths? Janet Mugo and Munawwar Said 

BACK COVER

• The Ten Steps to Successful Breastfeeding WHO

We thank all the authors, reviewers and editors who helped to produce this special issue.

Person-centred care and semantic inflation

Time laughs at us, with us and has the last laugh. If you are ever complacent and by virtue of your years you venture to think to yourself:

Well we've been working on this now for 20-30 years look at the progress we've made. ...

Time is always there to remind you:
Hey, just who are you trying to fool?
You are a lifelong learner!

The number of personnel and services that describe themselves as person-centred is an ongoing theme of so many CVs, policies, SLAs, commissioning and consultant's presentations and lectures. ...

Whether in a ward, service, or organisation's philosophy, person-centred is a term that is being diluted to the extent that semantic inflation devalues what is supposed to be the main currency? Or are we admitting that this is the cost of the political games that people play? Whatever your view, there are insights of progress won, but also reminders on how much remains to be done.

Health and social care being multicontextual demands the existence of multiple currencies. One additional currency begs that we compare A, B, C with the evidence base.

If this is the crucible of our person-centred times then what is burning?

• Nursing ethics?
• Nursing education?
• Idealistic aspiration? (Yes, we will get there!)
• New Age incense?
• Policy initiatives?
• Funding allocations?
• Nursing activism (Or, are there any balls in the house)?
• Service infrastructures?

Although the media temperature is rising here in the UK, as health, itself economically recumbent is moved to ICU being so politicised; the Francis Report provides evidence of a dire lack of person-centred care. Recalling my basic nurse training: what can be more person-centred than ensuring that a patient has the necessary fluids and diet?

For women who suffer a miscarriage - where should they be nursed as debated in today's Guardian newspaper? What is person-centred care in maternity and gynaecology services?

In-patient provision and transitions from child-youth-adult provide other opportunities and major challenges for health and social care to demonstrate their person-centredness.

There are so many ways to be person-centred, so many levels, some may even be contradictory(?).


I wonder how many of those people highlighted in the Francis Report also had a form of dementia - whether diagnosed or not? Personhood and the need to acknowledge and sustain the person are not new.

Even if a service is person-centred in terms of the environment, meal choices, therapeutic options, belongings, personal space, proximity to home and relatives ... the crux at the center is the attitude of staff, and their having the time and space:

"to be"

person-centred

Additional links:

Mumsnet

Atkins, L. (2010) NHS 'must lessen trauma of miscarriages' Parents web forum Mumsnet calls for new code of practice to help women who lose their babies, The Guardian, Tuesday 2 March.