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Noma in Laos: Stigma of Severe Poverty in Rural Asia

Noma, or cancrum oris, is a debilitating necrotizing ulcerative stomatitis that destroys the mouth and face. It usually starts in early childhood and is associated with severe poverty, malnutrition, and infections. It is most frequently described from sub-Saharan Africa but is under-reported. There have been very few reports from Asia. We describe the clinical and social features of a series of 12 patients with noma from remote poor villages in rural Lao People’s Democratic Republic (Laos). Noma is an ominous stigma of severe poverty and the description of this disease emphasizes the importance of poverty reduction and nutritional improvement in Lao development. In the meantime, more awareness of the problem and the importance of early therapy in acute noma by primary health care workers may reduce mortality and prevent progression to severe disfigurement.

Received December 3, 2007. Accepted for publication December 5, 2007.

Acknowledgments: The authors thank Bounphasit Sayavong for translations. Leila Srour thanks Mr Sisamone and Mr Moe in Nalae for the wonderful help during treks to remote Lao villages to visit noma patients. The authors thank all who have helped with discussions and information, especially the patients and their families and Mayfong Mayxay. J. Wiebe Mulder and his colleagues of Bridge the Gap, The Netherlands, provided surgical care for noma survivors in Lao. Jon Cermin provided photographs of two noma patients, and Kaying Yang provided translation and support for Hmong patients.

Financial support: There was no specific funding for this study. Paul Newton is supported by the Wellcome Trust of Great Britain. The Wellcome Trust of Great Britain supported travel to find noma patients.

Disclaimer: The authors declare that they have no competing interests.

^* Address correspondence to M. Leila Srour, POB 2548, Vientiane, Lao PDR. E-mail: srourleila{at}gmail.com

Note: The supplementary table, "Social and clinical details of ten patients with a clinical diagnosis of noma from Laos," appears online at www.ajtmh.org.

Authors’ addresses: M. Leila Srour, POB 2548, Vientiane, Lao PDR, Telephone: 856-020-5797111, E-mail: srour{at}silcom.com. Bryan Watt, POB 2548, Vientiane, Lao PDR, Telephone: 856-020-5526000, E-mail: watt{at}bryanwatt.com. Bounthom Phengdy, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR, Telephone and Fax: 856-020-5618246, E-mail: bphengdy{at}yahoo.com. Keutmy Khansoulivong, Ear, Nose and Throat Department, Mahosot Hospital, Vientiane, Lao PDR, Telephone: 856-020-5602631. Jim Harris, UXO Awareness, Phoenix Clearance Ltd., Vientiane, Lao PDR, Telephone: 856-020-2449165, E-mail: jim1833{at}aol.com Christopher Bennett, Interplast, Melbourne, Australia, Telephone: 613-94192011, E-mail: chrisben{at}bigpond.net.au. Michel Strobel, Francophone Institute of Tropical Medicine, Vientiane, Lao PDR, Telephone and Fax: 856-21-219346, E-mail: michel.strobel{at}auf.org. Christian Dupuis, Amade Foundation, Brussels, Belgium, Telephone: 32-2-770-24-53, E-mail: CC_MC_Dupuis{at}skynet.be. Paul N. Newton, Wellcome Trust–Mahosot Hospital–Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic, Telephone and Fax: 856-21-242168, E-mail: paul{at}tropmedres.ac, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, and London School of Hygiene and Tropical Medicine, London, UK.

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