An Update on the Risk Factors of Noma (Facial Gangrene) in Ethiopia

Noma is a severely disfiguring and highly morbid mouth and facial region disease. The condition is most prevalent in developing countries and primarily affects children under the age of 10. The specific trigger of the disease is unknown. However, several risk factors are reported to favor the development of Noma. A cross-sectional and case-control study was conducted to determine the risk factors for Noma in Ethiopia between January and February 2021. The current study was conducted in February 2023 to update the previous study. Raw case data were obtained from three major noma treatment centers in Ethiopia. Three controls were selected for each individual case. Odds ratios (ORs) and chi-square tests were calculated. P values for each potential risk factor were also determined, considering a degree of freedom (df) of 1. A total of 64 cases were selected for the previous case-control study. Considering a 1:3 ratio between cases and controls, 192 matched controls were determined accordingly. This updated study included 73 cases and 219 controls, including the newly recruited 9 cases and 27 controls. Similar to the previous survey, this updated study identified malaria, helminths, measles, diarrheal diseases, and living with pets as predisposing factors for Noma with a respective p-value of <0.01. In contrast, vaccination was found to be a protective factor (OR = 0.30 & p < 0.01) for the absence of noma disease in both studies. However, unlike the earlier studies, drinking river water (p = 0.04) was found to be a risk factor for noma in this updated analysis. In general, all risk factors identified in both studies are predominantly associated with poor living standards due to poverty. Therefore, long-term economic development should be considered along with other health-related preventive measures to effectively and sustainably reduce the burden of the disease.