Wherever there is poverty - active and passive case finding to address neglect of noma in Mozambique

Noma is a rapidly progressing, disfiguring orofacial necrotising infection that primarily affects children living in poverty. To date, there are no primary data reporting noma in Mozambique. Our aim was to collect empirical evidence on the ongoing presence of noma in Zambezia Province, Mozambique, for the first time.

We used a passive case search approach at the maxillofacial and paediatric wards of the reference hospital to identify acute noma cases. To find noma survivors, we conducted a community-based active case search, showing posters of noma sequelae to crowds of potential informants. We visited 12 of the 22 districts in the province and administered a questionnaire to each confirmed noma case.

Over a 5-week period, two acute noma cases and 21 survivors having had noma between 1971 and 2015 were identified. Using a cohort-estimated healthcare-seeking proportion of 18.75% and assuming a survival rate of 10%, the annual incidence in rural areas of Zambezia was estimated at 13.7 per 100 000 children under the age of nine years, suggesting that at least 213 noma cases occur yearly in the region.

The total lack of data does not mean noma is non-existent in Mozambique. This study provides a simple methodology to rapidly identify noma cases in high-risk areas and populations. Noma is likely present wherever there is poverty. Increased awareness, reporting and public health interventions are urgently needed worldwide to stop the consequences of this preventable and treatable disease.