01576nas a2200181   4500000000100000008004100001260004400042653002400086653005700110100001800167700001300185700001300198245002700211856008500238490000700323520105000330022001401380       2022                            d  bSpringer Science and Business Media LLC10aInfectious Diseases10aPublic Health, Environmental and Occupational Health1 aKhammissa RAG1 aLemmer J1 aFeller L00aNoma staging: a review  uhttps://tropmedhealth.biomedcentral.com/track/pdf/10.1186/s41182-022-00431-6.pdf0 v503 a<p>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, poverty-stricken 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.</p>
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