Noma (cancrum oris) is an orofacial gangrene, an opportunistic infection, affecting primarily chronically malnourished young children, living in extreme poverty and often without access to medical care [1]. Many medical professionals and front-line healthcare workers have no knowledge about noma and would not recognize the early stages when treatment reduces mortality or be able to refer a noma survivor [2,3]. Although noma is the quintessential neglected tropical disease (NTD), noma is not included in lists of NTDs and remains a neglected-neglected tropical disease. In the recent PLOS NTD editorial, “What constitutes a neglected tropical disease?,” noma is not included [4]. The purpose of this article is to support the inclusion of noma with Neglected Tropical Diseases, especially by PLOS NTDs. The integration of noma with NTDs could improve awareness about noma and target investments in research regarding its etiology, diagnosis, and treatment leading to prevention, early detection, and eradication of this preventable childhood disease that affects the world’s most vulnerable children.

The World Health Organization (WHO) has four criteria for inclusion in their list of NTDs. First, the disease is a cause of stigma, morbidity and mortality of impoverished people. Second, the disease primarily occurs in tropical or subtropical regions. Third, control and eradication are feasible with known public health strategies. Fourth, there has been insufficient research support to determine best treatment and control options. Noma meets all of the above criteria.

First, noma is primarily found in remote regions, affecting young children living in extreme poverty. Noma is called the “Face of Poverty” [5] because the disease severely damages the faces of children living in extreme poverty and uniquely illustrates the severity of children’s lives whose parents lack sufficient resources to adequately feed their children. Untreated mortality is high (80% to 90%), and survivors are often severely affected with facial deformities that cause difficulty with eating, speaking, and appearance, leading to stigmatization and isolation [1,5]. Survivors of noma are often discriminated against and unable to attend school, socialize, marry, or find employment [6].

Noma survivors often present after decades of suffering seeking surgical rehabilitation, having been denied access to education, vocation, marriage, and social acceptance. Surgical treatment of survivors is difficult, requires experienced surgical teams, and, usually, is not available to survivors of noma.

Second, noma is primarily reported from poor developing countries in Africa and Asia, but noma can occur wherever the risk factors exist. Risk factors for noma include extreme poverty, malnutrition, lack of exclusive breastfeeding, lack of access to medical care and immunizations, maternal undernutrition and grand multiparity, preceding febrile illness (especially measles or malaria), poor oral health, and reduced diversity of oral bacterial flora [1,7].

Third, public health interventions (such as promotion of exclusive breastfeeding), adequate complementary foods, sufficient vitamins, immunizations, sanitation, and access to healthcare result in the prevention, detection, and early treatment of noma and disease sequelae. The risk factors for noma are common to the current NTDs, which often exist where noma is found. Vertical programs to target noma alone may be ineffective, so including noma where it belongs with the diseases of poverty can break the cycle of neglect.

Fourth, research regarding the epidemiology, diagnosis, treatment, and prevention of noma has been insufficient to guide control and eradication. The funding and implementation of public health interventions could lead to the disappearance of noma [8]