From Poverty to Prevention: Global Efforts Rise to Eliminate the Silent Threat of Noma

WHO’s latest technical brief highlights noma as a neglected tropical disease driven by poverty, malnutrition and weak healthcare systems, calling for stronger surveillance, early treatment and global partnerships. The report urges governments, development agencies and private-sector stakeholders to invest in integrated health, nutrition, sanitation and rehabilitation programmes to prevent deaths and lifelong disabilities.

The World Health Organization (WHO), with contributions from experts from the WHO Global Oral Health Programme, WHO Regional Office for Africa, Swiss Tropical and Public Health Institute, University of York, University of Oxford, Médecins Sans Frontières (MSF), University of Washington, Universidad Peruana Cayetano Heredia and several national health ministries, has called for urgent global action to address noma, a neglected tropical disease linked to extreme poverty, malnutrition and weak healthcare systems. The WHO technical brief highlights that noma is not only a severe health condition but also a warning sign of deep inequalities in nutrition, sanitation, healthcare access and social development. Following its inclusion in the WHO list of neglected tropical diseases in December 2023, governments and development partners now have a stronger framework to improve surveillance, treatment and prevention efforts.

Noma mainly affects children between 2 and 6 years old living in conditions of severe deprivation. The disease can rapidly destroy tissues of the mouth and face within weeks if not treated early, causing high mortality and lifelong disability among survivors. Those who survive often face permanent facial disfigurement, difficulty in eating, speaking and breathing, as well as stigma and social exclusion. WHO warns that the true scale of noma remains unclear because many cases go undiagnosed or unreported due to weak surveillance systems and limited awareness among communities and healthcare workers.

Noma reflects wider challenges in poverty, nutrition and healthcare

The WHO report shows that noma develops through a combination of health and social factors rather than a single cause. Severe malnutrition, poor oral hygiene, unsafe drinking water, inadequate sanitation, limited access to healthcare and weakened immunity due to diseases such as measles, malaria, tuberculosis and HIV increase vulnerability.

The disease often begins with simple gum inflammation but can progress rapidly through stages of tissue damage, facial swelling, gangrene, scarring and permanent disability. The transition from early manageable stages to severe irreversible damage can occur within just two weeks, making early detection extremely important. Since there is currently no laboratory test for noma, healthcare workers must rely on clinical examination, highlighting the need for better training and stronger primary healthcare systems.

For policymakers, noma demonstrates the importance of integrating oral health into broader public health programmes. Prevention requires coordinated action across health, nutrition, education, water and sanitation sectors. Investments in clean water access, hygiene facilities, child nutrition programmes, and vaccination coverage can reduce the risk of noma while also improving overall community health outcomes.

Global targets demand stronger government action and partnerships

WHO has set new global targets for noma control under its Neglected Tropical Diseases Road Map. By 2030, the organization aims to increase the number of countries integrating noma into national health policies and action plans from 9 to 35. It also aims to expand routine national surveillance systems from 10 to 35 countries and ensure that 95% of confirmed cases are detected during early, treatable stages.

Achieving these targets will require governments to strengthen disease monitoring, improve reporting systems and train frontline healthcare workers. Countries affected by poverty, conflict and weak health infrastructure will need additional support to build sustainable systems capable of identifying and treating cases before permanent damage occurs.

For international development partners, noma provides an opportunity to support multiple Sustainable Development Goals, including universal health coverage, poverty reduction, child health improvement and access to safe water and sanitation. Funding for community awareness campaigns, healthcare training, research and rehabilitation services can help countries develop long-term solutions rather than emergency responses alone.

Private sector can support innovation and inclusive healthcare

The private sector can play an important role in addressing noma through investments in healthcare innovation, digital health solutions, medical technologies, nutrition programmes and water and sanitation infrastructure. Pharmaceutical companies, healthcare providers and social impact investors can contribute to improving access to affordable treatments and strengthening healthcare delivery in vulnerable communities.

However, private-sector engagement must focus on affordability, accessibility and sustainable partnerships because noma primarily affects populations with limited financial resources. Responsible investment models that combine social impact with innovation can help expand healthcare reach while supporting broader development goals.

At the same time, several risks could slow progress. Climate change, armed conflicts, food insecurity, antimicrobial resistance and growing economic inequalities may increase the number of people exposed to noma risk factors. Low awareness and stigma against survivors can further delay diagnosis and prevent affected individuals from receiving timely care.

Integrated approach needed to eliminate a preventable disease

WHO recommends a comprehensive strategy combining early diagnosis, antibiotic treatment, wound care, nutritional support, rehabilitation and mental health services. Survivors require long-term assistance, including reconstructive surgery, physiotherapy, oral healthcare and social reintegration support.

The organization also emphasizes the need for more research, improved diagnostic tools and stronger global surveillance to understand the true burden of noma. Expanding community awareness and integrating noma prevention into existing maternal and child health programmes will be essential for achieving lasting progress.

Ultimately, noma is a reminder that health challenges cannot be separated from poverty and inequality. Eliminating the disease will require collaboration between governments, international organizations, communities and private-sector stakeholders. By investing in prevention, early treatment and stronger health systems, countries can prevent avoidable deaths, reduce disability and advance progress towards more inclusive and equitable healthcare systems.