Rapid assessment of noma: Reporting on forgotten and neglected disease in Ethiopia

Noma is a rapidly progressing, invasive, and debilitating orofacial disease that primarily affects the most vulnerable and marginalised populations worldwide. The highest- risk group includes pre-school children, exposed to other risk factors, such as malnutrition and poverty-related diseases. Since 2010, Ethiopia has reported an increasing number of noma cases, primarily identified through medical missions. Data on the disease burden and epidemiology are essential for planning service delivery and developing effective disease prevention strategies. In this endeavour to document noma.s presence in Ethiopia, and assess the health system capacity for noma care, we have performed a rapid assessment.

We performed a rapid assessment including a desk and literature review, health sector capacity assessment and a retrospective analysis of hospital records to identify all confirmed cases of noma cases from 2015-2022, based on data from NGOs and health facility records.

The desk review revealed that Ethiopia lacks a national policy on noma. However, the national health policy emphasizes the prevention and control of poverty-related diseases. There is no formal oral health program within the primary healthcare, aside from the limited dental care availability in regional/referral hospitals and private sector. The retrospective assessment has extracted 69 noma cases record reported from January 2015 to December 2020, with 97% of case record came from two NGO's supporting surgical mission. Cases were reported from nearly every region of the country with a notable concentration in Amhara region. The trend of cases being cared has decreased from 2015 to 2020 and no record is found for acute cases of noma.

The rapid assessment highlights a critical lack of research and surveillance programmes for noma. Efforts to increase public awareness and educate community workers and primary health care professionals on identification of noma and referring patients for care are essential. As a first step toward eliminating noma, the disease should be added to the national list of neglected tropical diseases, followed by integrated control programmes through the existing health extension system to expand oral health service.