Noma Survivors and Long-Term Surgical Rehabilitation: A National Prospective Study of Functional Outcomes, Psychological Wellbeing, and Social Reintegration Across Northern Nigeria

Noma (cancrum oris) causes severe orofacial disfigurement in surviving children, necessitating prolonged and staged surgical rehabilitation. Long-term functional outcomes, psychological sequelae, and social reintegration among noma survivors in Nigeria are virtually undocumented in peer-reviewed literature, despite Nigeria accounting for a disproportionate share of the global noma burden. This prospective national cohort study follows noma survivors who underwent surgical rehabilitation at Sokoto Noma Hospital and two regional reconstructive centers in Kano and Maiduguri over a five-year follow-up period. One hundred and eight survivors aged 8 to 35 years were enrolled and assessed annually. Functional outcome domains include maximum mouth opening, masticatory efficiency, speech intelligibility, and facial symmetry. Psychological wellbeing was assessed using the adapted Strengths and Difficulties Questionnaire (SDQ) for children and the PHQ-9 for adults. Social reintegration was measured using a composite index of school enrollment, employment, marital status, and self-reported community participation. Results at five-year follow-up demonstrate sustained functional gains in maximum mouth opening (mean 28.4mm) and speech intelligibility (62% rated good to excellent by speech therapist assessment). However, 43% of adult survivors screened positive for moderate to severe depressive symptoms, and social reintegration was significantly lower in female survivors and those with residual visible scarring. Geographic remoteness from follow-up centers was the primary driver of loss to follow-up at 37%. The study establishes the first longitudinal evidence base for noma surgical rehabilitation outcomes in Nigeria and advocates for a national noma survivor support program with integrated mental health and social welfare components. Keywords: noma, surgical rehabilitation, functional outcomes, psychosocial wellbeing, northern Nigeria.