Article Text
Abstract
Background Previous studies have suggested that acute necrotising gingivitis precedes noma disease and that noma clusters in some villages in certain regions of low- and middle-income countries. We sought to assess the prevalence of gingivitis with bleeding in young children from villages with or without a history of noma and to analyse epidemiological differences related to sociodemographic characteristics, nutritional status and oral hygiene practices.
Methods We conducted a cross-sectional study in 440 children aged between 2 and 6 years from four villages in the Zinder region of southeast Niger in Africa. In two villages, cases of noma have repeatedly been detected; in the other two, noma has never been identified. We randomly selected 110 participants from each village.
Results The prevalence of acute necrotising gingivitis was significantly higher in the noma villages compared with the non-noma villages (6.8% vs 0.9%; p=0.001). We found differences between the four villages regarding socioeconomic factors, stunting, undernourishment and oral hygiene practices. The type of oral hygiene procedures influenced the amount of dental plaque and gingival inflammation. Children using sand, coal or other abrasive products instead of a toothbrush had a significantly increased likelihood to be diagnosed with acute necrotising gingivitis (p=0.041).
Conclusions Our data suggest that efforts to prevent noma should focus on populations with a high prevalence of acute necrotising gingivitis and include nutritional support and attempts to introduce safe and efficient oral hygiene practices to improve gingival health.
- acute necrotizing gingivitis
- noma
- epidemiology
- Niger
- risk factors
- cross-sectional study
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Footnotes
Contributors DB-M, AG-A, DP and AM had responsibility for the overall study design, management, conduct, analysis and writing of the paper. MAM and NC carried out the clinical part of the study. DB-M, AG-A, DP and AM were involved in the data analysis, interpretation, synthesis and writing. All authors reviewed and approved the final version.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethics committee of the Ministry of Health in Niger and the institutional ethics committee of the University of Geneva Hospitals, Geneva, Switzerland.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional unpublished data are available.