Protocol for a systematic review of the evidence-based knowledge on the distribution, associated risk factors, the prevention and treatment modalities for noma

Abstract

Introduction: Noma (cancrum oris) is a devastating opportunistic infection resulting in severe tissue destruction that affects mouth and oro-facial structures. There are substantial gaps in our current knowledge and understanding of its aetiology, pathogenesis, prevention and treatment efficacy, as well as its distribution and burden. Although observed worldwide, the disease impacts the most vulnerable and marginalised populations, and is most reported in young children from sub-Saharan Africa. Noma often presents alongside conditions of extreme poverty, malnutrition and poor environmental sanitation. This protocol paper outlines the methodology for a systematic review planned to exhaustively synthesize the findings of the available noma literature. The project aims to generate an account of the present state of knowledge about the various aspects of noma to aid in framing effective strategies and interventions to curb this disease which disproportionately afflicts the poorest in society. Methods and analysis: The following databases have been searched by a medical librarian from database inception to 7 December 2022: OVID (MEDLINE/ Embase/ CAB abstracts/ Global Health), Scopus, Web of Science, African Index Medicus, African Journals Online: Health, French language search: Pascal, ClinicalTrials.gov, and WHO ICTRP. All primary research studies reporting on patients of any age diagnosed with noma will be eligible for inclusion in the review, including clinical trials, cohort studies, case-control, cross-sectional, other observational studies, case studies and case series. Data will be extracted from included studies to analyse the current evidence-based knowledge on the distribution, risk factors, microbiology, prevention and treatment modalities, and outcomes of noma. Ethics and dissemination: Results of this systematic review will be published in a peer-reviewed journal upon completion. PROSPERO Registration: CRD42019124839 (08/03/2019)