Abstract:
Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare,
but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, povertystricken
communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts
of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive
subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising
ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the
authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight
the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of
noma, which if used should improve the quality and value of future epidemiological data about noma.
