Establishing Presence of Noma in Haiti: a preliminary national survery

Objectives: Noma, a polymicrobial opportunistic gangrenous infection of the oral and head-and-neck tissues which has a mortality rate of 70-80% in untreated cases, involves a complex interaction among malnutrition, immune dysfunction, and microbial infection. While the 2000 WHO global mapping of noma shows it to be present in under-developed countries in African, South Asian, and South America as well as in the Caribbean countries of Cuba and the Dominican Republic, the 2000 WHO map shows no reported cases in Haiti. The purpose of this preliminary national survey was to determine whether there is any evidence of the presence of noma in Haiti.

Methods: Dental students from the University of Haiti were trained in the administration of a short questionnaire with an accompanying set of photographs of noma cases. In addition, a set of photographs of cleft palate/lip were utilized to distinguish cleft lip/palate from noma. Dental students were dispersed to villages, towns and cities in 8 of the 9 geo-political Departments that comprise Haiti to conduct interviews, inquiring whether local health care providers, teachers, elders and other residents had ever seen any children or adults that resembled the noma cases as illustrated in the photographs.

Results: Between July-October 2006, a total of 32 dental students conducted 872 interviews in 116 villages, towns and cities in Haiti with the following results: 3.1 % of interviewees (n=27) reported positively having seen a noma case, with an additional 2.7% (n=24) reporting that they possibly had seen a noma case. The 27 positive IDs occurred in 6 different geographical Departments, while the 24 possible IDs also occurred in 6 different geographical Departments.

Conclusions: These preliminary findings provide strong evidence of the presence of noma in Haiti and provide the basis for conducting a more detailed and definitive national survey of noma in Haiti.