Healthcare workers' knowledge, attitudes, perceptions and practices of noma in Northwest Nigeria: a cross-sectional...

Noma is a rapidly progressing oral infection with a 90% mortality rate if untreated. Early identification by healthcare workers is critical, but limited knowledge can delay diagnosis and timely treatment, leading to severe outcomes. This study assessed healthcare workers' knowledge, attitudes, perceptions and practices related to noma in northwest Nigeria to inform training and strengthen early detection and response.

We conducted a cross-sectional study via interviewer-administered questionnaire in randomly selected health facilities across Sokoto and Kebbi states, Nigeria. Healthcare workers were recruited via convenience sampling. Noma knowledge was assessed using 15 questions, and respondents were categorised based on their scores: very poor (<25%), poor (25-49%), fair (50-74%) or good (≥75%).

A total of 419 healthcare workers participated in the study. The majority of respondents (n=231, 55%) worked in secondary healthcare facilities. Most of the 419 respondents were community health officers/community health extension workers (n=203, 48%) or nurses (n=177, 42%). Almost all (n=405, 96%) respondents were interested in learning more about noma.Of those who had heard about noma before the study (n=280, 66%), most had poor (25-49% score, n=165, 59%) or fair (50-74% score, n=100, 36%) knowledge about noma. Few (n=55, 19%) respondents reported ever treating noma patients. Most healthcare workers reported that early-stage noma treatments were available in their facilities: antibiotics (n=255, 91%), nutritional support (n=213, 76%) and wound debridement (n=199, 71%).

Our study highlights a significant knowledge gap about noma among healthcare workers in northwest Nigeria, despite limited clinical experience. Encouragingly, there is strong interest in learning and acceptance of educational tools. This presents a valuable opportunity to enhance training and early detection. Strengthening awareness and capacity is crucial, as timely intervention during the early, reversible stages of noma can greatly reduce associated morbidity and mortality.