The face

The face

of poverty

This is the second issue of Noma contact.

In the year that has passed since the first is- sue cancrum oris- the disease called noma - has become much more widely known.

The disfigured faces of the young survivors of this deadly disease have shocked all who have seen them, prompting new groups to take action against noma. This issue of Noma contact reports on the work of some of those groups but it also makes clear that much more needs to be done before all the world's children have a future that is confidently free of the threat of noma.

An important step towards the elimination of noma is the recognition of it as a public health problem. In May 1998 the World Health Report provided the first ever global estimate of noma incidence and prevalence.

The facts and figures on this page speak for themselves: noma is a vicious gangrene that kills and maims the weakest and most de- fenceless members of society- young un- dernourished children of destitute families.

Where people are not poor, their children do not get noma. With 100,000 new cases every year, a high proportion of deaths and some 20,000 survivors with severe disfig- urement, noma truly is the face of poverty.

WHO's strategy against noma has five dis- tinct though overlapping elements: preven- tion and early detection; immediate care;

public information and education; epidemio- logical and etiological research; and refer- ral for treatment of sequelae.

The members of the International Action Network Against Noma are the ones who carry out these activities. In 1998 the net- work has grown. New members have joined in both developing and developed countries,

each committed in their own special way to doing what they can to eliminate the scourge of noma. WHO acts as facilitator where nec- essary and is directly involved in domains relevant to its competence such as epidemio- logical research, training, and raising sup- port for community intervention.

Noma kills, mutilates faces and brings shame on families and communities yet ac- tion against the disease should be seen in another light. Action against noma breaks down the barriers, such as those between members of different medical disciplines;

plastic surgeons, dentists, dermatologists, nurses and traditional healers all have a role to play and increasingly they are working together. It brings together established in- stitutions and social groups (such as gov- ernment ministries, the media, social work- ers, teachers, village leaders and traditional religious leaders). Action against noma also creates a link between clinical care and pub- lic health - two fields that are often seen as mutually exclusive. And international action against noma bridges the gap between scientific knowledge and traditional beliefs, between north and south, and between the fortunate and the unfortunate. It gives a prac- tical meaning to collective action, compas- sion and solidarity.

0 Noma: in Europe yesterday ... in Africa today 0 NGO focus-AWO Kinderhilfe in Nigeria 0 New partners against noma

0 Media workshop in Niger

0 Disease surveillance: keeping a watch on noma 0 Global etiological research programme 0 Africa's strategy to improve oral health 0 Resources

-~ WORLD HEALTH

~-

~

• Noma is a severe gangrene that eats away both soft and hard tissues of the mouth and face.

cancrum oris.

• Most noma sufferers are under six years of age.

• Over 100,000 children contract noma every year.

• Between 70% and 90% of children with noma die; the survivors are usually disfigured for life.

• Noma flourishes where poverty is greatest, nutrition is poorest, and hygiene is neglected.

• Noma will not occur in a well nourished child with good oral hygiene.

• In its early stages the gangrene can be easily prevented with antiseptic mouthwash.

Even those who are familiar with noma can- not fail to be moved by the young faces dis- figured by this disease. International action is growing, though not fast enough. Every day, noma kills and disfigures more young victims although we know how to prevent it, how to cure it, and to a certain extent how to repair the damage it causes. Noma is not inevitable, nor is it an evil curse. Joint ac- tion can ensure that future generations will bear the face of poverty no more.

Marie-Helime Leclercq Action Programme against Noma Noncommunicable Diseases World Health Organization