In the end they produced a list of factors which were associated with the disease, many of which were already known or suspected. Perhaps the most intriguing such factor — a new one — was the absence of chickens from the homes of children who developed the dread disease.

Could it be that chickens exert a positive protective effect against noma, for example by influencing the bacterial flora of a child’s mouth? After all, one of the explanations of the rise in allergic conditions in western countries is excessive hygiene cleanliness that means that children are not exposed to enough infections to develop a proper immune system which then, faute de mieux, turns on quite harmless substances instead.

The authors do not consider this possibility, but rather take an absence of chickens as being a manifestation of even more extreme poverty than is normal in Niger. They attempted instead to measure the levels of vitamins in the blood of the children, both victims of the disease and controls, but they were low in both groups.

The authors conclude that a higher number of children in the household, recent diarrhoeal or other infectious disease, poor nutrition and altered bacterial flora of the mouth are associated with noma, which remains therefore a mysterious multifactorial disease, as was peptic ulceration before the discovery of the role of the Helicobacter.


image courtesy /  urbanligh / Anna Omelchenko