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2.
Sensors (Basel) ; 21(17)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34502610

RESUMO

In order to improve the energy efficiency (EE) performance of cooperative networks, this study combines non-orthogonal multiple access (NOMA) with simultaneous wireless information and power transfer (SWIPT) technologies to construct a cooperative relay network composed of one base station (BS), multiple near users, and one far user. Based on the network characteristics, a time-division resource allocation rule is proposed, and EE formulas regarding direct-link mode and cooperative mode are derived. Considering user selection and decoding performance, to obtain the optimal EE, this study utilizes a DinkelBach iterative algorithm based on the golden section (GS-DinkelBach) to solve the EE optimization problem, which is affected by power transmitted from the BS, achievable rates under three communication links, and quality of service (QoS) constraints of users. The simulation results show that the GS-DinkelBach algorithm can obtain precise EE gains with low computational complexity. Compared with the traditional NOMA-SWIPT direct-link network model and the relay network model, the optimal EE of the established network model could be increased by 0.54 dB and 1.66 dB, respectively.


Assuntos
Redes de Comunicação de Computadores , Noma , Algoritmos , Conservação de Recursos Energéticos , Humanos , Tecnologia sem Fio
3.
Trials ; 22(1): 595, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488845

RESUMO

BACKGROUND: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. METHODS: A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. DISCUSSION: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04466007 . Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Noma , Tecido Adiposo , Animais , Ensaios Clínicos Fase II como Assunto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Método Duplo-Cego , Humanos , Isquemia/diagnóstico , Isquemia/terapia , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
4.
Br Dent J ; 231(4): 225-231, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34446893

RESUMO

'Necrotising periodontal diseases' is an umbrella term for necrotising gingivitis, necrotising periodontitis, necrotising stomatitis and noma. These rapidly destructive conditions are characterised by pain, interdental ulceration and gingival necrosis which, if left untreated, can result in osteonecrosis. Research indicates that patients with a history of alcohol misuse are at an increased risk of malnutrition, which negatively affects the immune response and predisposition to necrotising periodontal diseases. This article will discuss that osteonecrosis of the alveolar bone does not exclusively occur in association with antiresorptive medications, but can occur as a severe form of necrotising gingivitis. In this article, we will describe two cases to highlight the occurrence, presentation and management of necrotising periodontal diseases secondary to alcohol misuse.


Assuntos
Alcoolismo , Gengivite Ulcerativa Necrosante , Gengivite , Noma , Osteonecrose , Doenças Periodontais , Alcoolismo/complicações , Gengivite Ulcerativa Necrosante/etiologia , Gengivite Ulcerativa Necrosante/terapia , Humanos , Osteonecrose/induzido quimicamente , Osteonecrose/terapia
5.
BMJ Open ; 11(8): e046303, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353795

RESUMO

INTRODUCTION: Noma is a significant yet neglected disease which affects some of the least developed countries in the world. The long-term benefit and safety of Noma surgical reconstructive missions have recently been under scrutiny due to a perceived lack of measurable outcomes and appropriate follow-up. This study analyses and reports on classifications, outcome measurement tools and follow-up for reconstructive surgery after Noma disease. METHODS: This systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The three medical databases Medline, EMBASE and Web of Sciences were searched, articles published between 1 January 1983 and 15 April 2020 were included. All primary evidence on reconstructive surgery following Noma disease, reporting data on outcome after surgery, follow-up time and complications were included. Extracted data were aggregated to generate overall and population corrected mean outcomes and complication rates. RESULTS: Out of 1393 identified records, 31 studies including 1110 Noma patients were analysed. NOITULP and Montandon/WHO were the most commonly used classification systems. Mouth opening (MO) and complication rates were the two most often reported outcomes. Overall mean complication rate was 44%, reported by 24 studies. Postoperative MO was reported by eight publications, of which, five reported long-term outcomes (>12 months). Mean MO improved by 20 mm when compared with mean population weighted preoperative MO (7 mm). At long-term follow-up, MO decreased to 20 mm. CONCLUSIONS: Studies reporting on neglected diseases in developing countries often lack methodological rigour. Surgeons should be mindful during patient examination by using a classification system that allows to compare preoperative versus postoperative state of disease. Short-term mission surgery is a vital part of healthcare delivery to underdeveloped and poor regions. Future missions should aim at sustainable partnerships with local healthcare providers to ensure postoperative care and long-term patient-oriented follow-up. A shift towards a diagonal treatment delivery approach, whereby local surgeons and healthcare staff are educated and empowered, should be actively promoted. PROSPERO REGISTRATION NUMBER: CRD42020181931.


Assuntos
Noma , Procedimentos Cirúrgicos Reconstrutivos , Seguimentos , Humanos , Período Pós-Operatório
6.
Sensors (Basel) ; 21(14)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34300522

RESUMO

The increasing proliferation of Internet-of-things (IoT) networks in a given space requires exploring various communication solutions (e.g., cooperative relaying, non-orthogonal multiple access, spectrum sharing) jointly to increase the performance of coexisting IoT systems. However, the design complexity of such a system increases, especially under the constraints of performance targets. In this respect, this paper studies multiple-access enabled relaying by a lower-priority secondary system, which cooperatively relays the incoming information to the primary users and simultaneously transmits its own data. We consider that the direct link between the primary transmitter-receiver pair uses orthogonal multiple access in the first phase. In the second phase, a secondary transmitter adopts a relaying strategy to support the direct link while it uses non-orthogonal multiple access (NOMA) to serve the secondary receiver. As a relaying scheme, we propose a piece-wise and forward (PF) relay protocol, which, depending on the absolute value of the received primary signal, acts similar to decode-and-forward (DF) and amplify-and-forward (AF) schemes in high and low signal-to-noise ratio (SNR), respectively. By doing so, PF achieves the best of these two relaying protocols using the adaptive threshold according to the transmitter-relay channel condition. Under PF-NOMA, first, we find the achievable rate region for primary and secondary receivers, and then we formulate an optimization problem to derive the optimal PF-NOMA time and power fraction that maximize the secondary rate subject to reliability constraints on both the primary and the secondary links. Our simulation results and analysis show that the PF-NOMA outperforms DF-NOMA and AF-NOMA-based relaying techniques in terms of achievable rate regions and rate-guaranteed relay locations.


Assuntos
Algoritmos , Noma , Redes de Comunicação de Computadores , Simulação por Computador , Humanos , Reprodutibilidade dos Testes
7.
Sensors (Basel) ; 21(12)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207104

RESUMO

This paper studies the cell-edge user's performance of a secure multiple-input single-output non-orthogonal multiple-access (MISO-NOMA) system under the Rayleigh fading channel in the presence of an eavesdropper. We suppose a worst-case scenario that an eavesdropper has ideal user detection ability. In particular, we suggest an optimization-based beamforming scheme with MISO-NOMA to improve the security and outage probability of a cell-edge user while maintaining the quality of service of the near-user and degrading the performance of the eavesdropper. To this end, power allocation coefficients are adjusted with the help of target data rates of both the users by utilizing a simultaneous wireless information and power transfer with time switching/power splitting protocol, where the near-user is used to forward the information to cell-edge user. The analytical results demonstrate that our beamformer analysis can achieve reduced outage probability of cell-edge user in the presence of the eavesdropper. Moreover, the provided simulation results validate our theoretical analysis and show that our approach improves the overall performance of a two-user cooperative MISO-NOMA system.


Assuntos
Noma , Simulação por Computador , Humanos , Probabilidade
8.
Trop Med Int Health ; 26(9): 1088-1097, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34080264

RESUMO

The Nigerian Ministry of Health has been offering care for noma patients for many years at the Noma Children's Hospital (NCH) in Sokoto, northwest Nigeria, and Médecins Sans Frontières has supported these initiatives since 2014. The comprehensive model of care consists of four main components: acute care, care for noma sequelae, integrated hospital-based services and community-based services. The model of care is based on the limited evidence available for prevention and treatment of noma and follows WHO's protocols for acute patients and best practice guidelines for the surgical treatment of noma survivors. The model is updated continually as new evidence becomes available, including evidence generated through the operational research studies performed at NCH. By describing the model of care, we wish to share the lessons learned with other actors working in the noma and neglected tropical disease sphere in the hope of guiding programme development.


Assuntos
Assistência Integral à Saúde , Noma/terapia , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Masculino , Nigéria/epidemiologia , Noma/prevenção & controle
10.
Facial Plast Surg ; 37(4): 439-445, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33517575

RESUMO

Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.


Assuntos
Fasciite Necrosante , Noma , Face , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Cabeça , Humanos , Pescoço
11.
J Stomatol Oral Maxillofac Surg ; 122(2): 182-184, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32659408

RESUMO

Noma research protocol was conducted in the Auschwitz Birkernau camp by the infamous (Schutzstaffel) SS doctor Josef Mengele who was known as "the Angel of Death" in close collaboration with researchers at the Kaiser-Wilhelm Institute in Berlin Crimes. Mengele who held the post of camp doctor in the "Gypsy camp" saw an opportunity to set up a research program on gypsy children called "Nomaprojekt". The purpose of this program was to study the causes of noma and to find treatment methods. The experimental treatment protocol consisted of administering a combination of sulfanilamido-ethyl thiodiazole and nicotinic acid. Heads and selected body parts of children suffering from noma were prepared in formaldehyde jars and sent to researchers at the prestigious Kaiser-Wilhelm Institute for Anthropology, Human Heredity and Eugenics in Berlin-Dahlem, but also to the SS Medical Academy in Graz to carry out further examinations. The experimental protocol for the treatment of noma among Gypsy children is one of the most horrific crimes that Dr. Josef Mengele committed in the Auschwitz camp.


Assuntos
Noma , Academias e Institutos , Criança , Campos de Concentração , História do Século XX , Humanos , Polônia
12.
PLoS Negl Trop Dis ; 14(8): e0008435, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32817617

RESUMO

Noma is an orofacial gangrene affecting primarily children living in extreme poverty in remote parts of subtropical and tropical countries. Mortality and disability are high, and survivors often have physical and functional deformities resulting in stigma and isolation. Many healthcare professionals and primary healthcare workers where noma risk factors exist have no knowledge about noma and its implications. Public health measures to improve nutrition, immunizations, sanitation, and access to healthcare and measures to eliminate extreme poverty can lead to the eradication of noma. Research allocation has been insufficient to study the epidemiology, treatment, and prevention of noma. In a recent editorial by Hotez and colleagues in PLOS Neglected Tropical Diseases (NTDs), "What constitutes an NTD?" Noma is not included. The exclusion of noma from NTDs constitutes this preventable childhood disease as a neglected neglected disease. The purpose of this article is the inclusion of noma with the PLOS NTDs. Increased awareness and attention to noma can lead to the eradication of this disease affecting the world's most vulnerable.


Assuntos
Transtornos da Nutrição Infantil/complicações , Doenças Negligenciadas , Noma , Criança , Humanos , Pobreza , Fatores de Risco
13.
Trans R Soc Trop Med Hyg ; 114(11): 812-819, 2020 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-32785671

RESUMO

BACKGROUND: Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. METHODS: A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. RESULTS: Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0-20 mm at follow-up. All patients reported that the surgery had improved their quality of life. CONCLUSIONS: Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.


Assuntos
Noma , Criança , Hospitais , Humanos , Masculino , Nigéria , Noma/cirurgia , Qualidade de Vida , Estudos Retrospectivos
14.
Am J Trop Med Hyg ; 103(4): 1697-1699, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783790

RESUMO

Noma is a progressive infectious disease manifested by a necrotic ulcer of the mouth and face. It usually occurs in poor, malnourished children, with about 30,000-140,000 cases each year and a low survival rate. The exact cause of noma remains unclear, but bacterial infection has been postulated to be a major cause of this disease. Antibiotics and improved nutrition could help inhibit the progression of noma, but most patients still require oral surgery because of the bacterial infection-induced tissue damage. In this study, we report an unusual case of a noma patient whose facial lesion developed a malignancy. The necrotic tissue and infectious area were surgically resected, and a forearm flap was used to repair the patient's facial defect. This case aimed at increasing people's awareness of tropical diseases such as noma.


Assuntos
Antibacterianos/uso terapêutico , Neoplasias Bucais/diagnóstico , Noma/diagnóstico , Idoso , Feminino , Antebraço , Humanos , Boca/patologia , Neoplasias Bucais/etiologia , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Necrose , Neoplasias , Noma/complicações , Noma/patologia , Noma/cirurgia
16.
Am J Trop Med Hyg ; 103(2): 613-618, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32372746

RESUMO

Noma affects the most marginalized communities in the world, beginning as oral ulceration and rapidly progressing to orofacial gangrene. With a mortality rate estimated to be as high as 90% and with very few able to access treatment in its active phase, very little is understood about the disease. This retrospective review of patients treated by Facing Africa for deformity and functional impairment secondary to noma between May 2015 and 2019 highlights some of the difficulties encountered by those afflicted. Eighty new patients with historical noma defects were identified and were seen over the course of nine surgical missions, with notes providing valuable geographical, socioeconomic, and psychosocial information. The mean self-reported age of onset was 5 years and 8 months, with a median time of 18 years from onset to accessing treatment. Before intervention, 65% covered their face in public, 59% reported difficulty eating, 81% were unhappy with their appearance, and 71% experienced bullying. We aimed at emphasizing the significant burden, both psychologically and physically of noma, demonstrating the disparity between recent decades of progress in the well-being of Ethiopians in general and the access to health care and mental health support for some of those most in need.


Assuntos
Comunicação , Água Potável , Ingestão de Alimentos , Acesso aos Serviços de Saúde , Noma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Idade de Início , Insatisfação Corporal/psicologia , Bullying/psicologia , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Missões Médicas , Noma/fisiopatologia , Noma/psicologia , Pobreza , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Abastecimento de Água , Adulto Jovem
17.
BMJ Glob Health ; 5(4): e002141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32377404

RESUMO

Background: Noma, a rapidly progressing infection of the oral cavity, mainly affects children. The true burden is unknown. This study reports estimated noma prevalence in children in northwest Nigeria. Methods: Oral screening was performed on all ≤15 year olds, with caretaker consent, in selected households during this cross-sectional survey. Noma stages were classified using WHO criteria and caretakers answered survey questions. The prevalence of noma was estimated stratified by age group (0-5 and 6-15 years). Factors associated with noma were estimated using logistic regression. Results: A total of 177 clusters, 3499 households and 7122 children were included. In this sample, 4239 (59.8%) were 0-5 years and 3692 (52.1%) were female. Simple gingivitis was identified in 3.1% (n=181; 95% CI 2.6 to 3.8), acute necrotising gingivitis in 0.1% (n=10; CI 0.1 to 0.3) and oedema in 0.05% (n=3; CI 0.02 to 0.2). No cases of late-stage noma were detected. Multivariable analysis in the group aged 0-5 years showed having a well as the drinking water source (adjusted odds ratio (aOR) 2.1; CI 1.2 to 3.6) and being aged 3-5 years (aOR 3.9; CI 2.1 to 7.8) was associated with being a noma case. In 6-15 year olds, being male (aOR 1.5; CI 1.0 to 2.2) was associated with being a noma case and preparing pap once or more per week (aOR 0.4; CI 0.2 to 0.8) was associated with not having noma. We estimated that 129120 (CI 105294 to 1 52 947) individuals <15 years of age would have any stage of noma at the time of the survey within the two states. Most of these cases (93%; n=120 082) would be children with simple gingivitis. Conclusions: Our study identified a high prevalence of children at risk of developing advanced noma. This disease is important but neglected and therefore merits inclusion in the WHO neglected tropical diseases list.


Assuntos
Noma , Criança , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Nigéria/epidemiologia , Prevalência
18.
J Craniofac Surg ; 31(2): 488-491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996539

RESUMO

Trismus is a frequent complication of healed Noma infection and is caused by soft tissue and muscle contraction. Free-flap surgery is recommended to replace the missing oral mucosa and soft tissue. However, significant complications can occur if this surgery is performed in places like Africa, where conditions are usually less than optimal. In 2007, the authors started to treat patients with trismus in Niamey, Niger by distracting the soft tissue and muscle constriction between the jaws with a bone distractor continuously for 1 month with the aim of achieving a mouth opening of 3 cm. The distraction was limited to 1 mm/d. performed under local anesthesia with some sedation. Minor complications such as infection in the pin holes were easily managed. In 2009, 2 patients with trismus after Noma with a follow-up of 2 years were reported. Till date, the authors have successfully performed trismus release in more than 69 patients in Niamey and Guinea Bissau. The present study analyses the results of distraction therapy in 40 patients with follow-ups until 60 months. At the end of distraction, the mean interincisal distance was 2.7 ±â€Š0.5 cm. Mouth opening 6 months after distraction had not reverted. However, 3 to 5 years after treatment, some signs of relapse were detected, with an average mouth opening of 1.5 ±â€Š1.9 cm. Physiotherapy was unfortunately not feasible. The presented results strongly support the efficacy of distraction therapy to correct trismus in Noma patients.


Assuntos
Noma/complicações , Trismo/terapia , Criança , Humanos , Mucosa Bucal , Modalidades de Fisioterapia , Trismo/etiologia
19.
PLoS Negl Trop Dis ; 14(1): e0007972, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31971944

RESUMO

BACKGROUND: Noma is an orofacial gangrene that rapidly disintegrates the tissues of the face. Little is known about noma, as most patients live in underserved and inaccessible regions. We aimed to assess the descriptive language used and beliefs around noma, at the Noma Children's Hospital in Sokoto, Nigeria. Findings will be used to inform prevention programs. METHODS: Five focus group discussions (FGD) were held with caretakers of patients with noma who were admitted to the hospital at the time of interview, and 12 in-depth interviews (IDI) were held with staff at the hospital. Topic guides used for interviews were adapted to encourage the natural flow of conversation. Emergent codes, patterns and themes were deciphered from the data derived from IDI's and FGDs. RESULTS: Our study uncovered two main themes: names, descriptions and explanations for the disease, and risks and consequences of noma. Naming of the disease differed between caretakers and heath care workers. The general names used for noma illustrate the beliefs and social system used to explain the disease. Beliefs were varied; participant responses demonstrate a wide range of understanding of the disease and its causes. Difficulty in accessing care for patients with noma was evident and the findings suggest a variety of actions taking place before reaching a health center or health worker. Patient caretakers mentioned that barriers to care included a lack of knowledge regarding this medical condition, as well as a lack of trust in seeking medical care. Participants in our study spoke of the mental health strain the disease placed on them, particularly due to the stigma that is associated with noma. CONCLUSIONS: Caretaker and practitioner perspectives enhance our understanding of the disease in this context and can be used to improve treatment and prevention programs, and to better understand barriers to accessing health care. Differences in disease naming illustrate the difference in beliefs about the disease. This has an impact on health seeking behaviours, which for noma cases has important ramifications on outcomes, due to the rapid progression of the disease.


Assuntos
Cultura , Idioma , Noma/epidemiologia , Feminino , Grupos Focais , Pessoal de Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Nigéria/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde
20.
Int Health ; 12(1): 28-35, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504549

RESUMO

BACKGROUND: Noma, a neglected disease mostly affecting children, with a 90% mortality rate if untreated, is an orofacial gangrene that disintegrates the tissues of the face in <1 wk. Noma can become inactive with early stage antibiotic treatment. Traditional healers, known as mai maganin gargajiya in Hausa, play an important role in the health system and provide care to noma patients. METHODS: We conducted 12 in-depth interviews with caretakers who were looking after noma patients admitted at the Noma Children's Hospital and 15 traditional healers in their home villages in Sokoto state, northwest Nigeria. We explored perceptions of noma, relationship dynamics, healthcare practices and intervention opportunities. Interviews were audiorecorded, transcribed and translated. Manual coding and thematic analysis were utilised. RESULTS: Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers. CONCLUSIONS: Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. This collaboration could save lives and reduce the severity of noma complications.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Medicina Tradicional Africana , Noma/terapia , Adulto , Criança , Pré-Escolar , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nigéria , Pesquisa Qualitativa , Encaminhamento e Consulta , Adulto Jovem
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