Prevention and Integrated Management of Noma and Maxillofacial Diseases in Burkina Faso, Mali, Madagascar and Togo (2018 – 2028) – Lessons Learnt and Challenges – Preliminary Results

Noma is a rapidly progressive, preventable orofacial gangrene affecting malnourished children in low-resource settings. La Chaîne de l’Espoir has implemented a multi-country programme on Noma and maxillofacial conditions (PMF) in three phases: 2018–2021 (phase 1), 2021–2024 (phase 2) in Burkina Faso and Mali, and 2025–2028 (phase 3) expanding to Togo and Madagascar. We synthesise phase-2 implementation (2021–2024) and report the 2024 mixedmethods endline evaluation. Quantitative surveys included 454 respondents (227 patients; 227 caregivers). Qualitative enquiry comprised 162 interviews/focus groups with health workers, community relays, traditional healers, civil-society partners and officials. Quantitative data were analysed in IBM SPSS Statistics; qualitative data underwent thematic analysis. The programme trained 659 community relays (219.7% of a 300person target), 613 health workers and 483 community health agents, and supported surgical care with postoperative follow-up. Knowledge increased by 38% among health workers and 35.5% among traditional healers. Overall, 87.2% of patients reported improved health and 72.2% of respondents reported increased awareness of Noma and maxillofacial conditions. Stakeholders described reduced stigma and stronger collaboration between traditional and biomedical providers. Key gaps included patient traceability and continuity of follow-up. In Mali, loss of funding in 2022 halted reconstructive surgery. An integrated, communityanchored model linking prevention and awareness, early case-finding, and surgical care delivered meaningful health and system gains. Priorities are to standardise registries and longitudinal outcome tracking, secure multi-year financing (including for complex reconstruction), strengthen mentorship and decentralised skills, and restore interrupted services to sustain equitable, timely care.