A child's face can be destroyed in days. Caught early, it heals for a few dollars.
Noma is a gangrene of the mouth and face that strikes young children in extreme poverty, mostly across Africa's Sahel. Untreated, it has been estimated to kill about 9 in 10 of the children it reaches. Survivors live with severe disfigurement. Early treatment with common antibiotics, oral hygiene and nutrition stops it.
The window is the first days
WHO stages Noma by what a health worker can see. There is no lab test, so recognition is everything.
- 0Simple gingivitisInflamed gums
- 1Acute necrotizing gingivitisPainful, bleeding gum ulcers. Cheap, effective treatment works here.Treatment window
- 2EdemaSwelling of the cheek or lip
- 3GangreneDead tissue, often a hole through the face
- 4ScarringHealing with heavy scar tissue, often a locked jaw
- 5SequelaeLasting disfigurement and trouble eating, speaking and breathing
The Noma belt
Noma is concentrated in a band of Africa from Mauritania to Ethiopia. Nigeria reports the most cases, largely because it has a specialist hospital in Sokoto, where MSF teams performed 1,645 reconstructive surgeries on 1,078 patients between 2014 and 2025. Most cases elsewhere are never recorded: children die before reaching a clinic, families hide survivors, and many health workers do not know the early signs.
What parliaments can do
- Make Noma a notifiable disease, so cases are counted.
- Add Noma screening to programmes that already reach young children: malnutrition clinics, immunisation days, routine child visits.
- Fund first-line antibiotics, antiseptic mouthwash and nutrition supplements at primary care level.
- Back training for community health workers and referral routes to surgical care.
Noma in Africa: A Neglected Disease of Poverty
The full briefing: how Noma progresses, the burden across Africa, the response since WHO's 2023 listing, the gaps, and recommendations for governments, donors, NGOs and health systems.
Read the white paper (PDF)An oral biofilm cleanser for early-stage Noma
Early Noma is a gum infection driven by biofilm, a dense layer of bacteria that antibiotics struggle to clear. The cleanser we propose to evaluate pulls water out of biofilm and dead tissue in seconds, so it can be rinsed away. It is not an antibiotic, so it does not add to antibiotic resistance.
Why it could fit the Noma belt
- Needs no electricity, suction or special instruments.
- Takes 10 to 30 seconds and rinses off with clean water.
- Could be applied by trained nurses and community health workers at the first sign of gum ulcers, before referral.
The proposed next step: a small pilot
A study of 20 to 40 children with early-stage Noma, hosted by any African country where Noma remains a burden. Each pilot would run under that country's ethical review, with its ministry of health, local hospitals and university teaching hospitals as partners. The cleanser would be added to standard treatment, not replace it.
- Healing of gum lesions and spread of dead tissue
- Pain, and time to referral
- Antibiotic use
- Safety events
We are looking for ministries, hospitals and NGOs in countries where Noma remains a threat to host or support this work.
P.S. Beyond dentistry, clinicians have used the same cleanser to clear biofilm and dead tissue from hard-to-heal wounds. Reported uses include:
- Diabetic foot ulcers
- Venous leg ulcers
- Gangrenous foot lesions
- Chronic wounds that would not heal after injury
In a published review of 54 serious foot and leg wounds, 92.5% grew healthy new tissue and 74% closed fully after a single application. These are early results without a comparison group, and wound care is not yet a cleared use. That is why we propose a careful pilot rather than claim a treatment.
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