Noma: a neglected enigma.

Noma is a disease surrounded by riddles. It manifests itself only in the poorest populations in developing countries, enclosed by ignorance and extreme poverty. The worldwide prevalence of noma is unknown—estimates range from 30 000 to 140 000 cases.¹ Most cases of noma worldwide occur in the so-called noma belt, which is situated directly south of the Sahara and runs across Africa from Senegal to Ethiopia. Another puzzle is that child mortality and malnutrition are prevalent on the Indian subcontinent, but noma is not reported there.