The Role of Family Pathology in Noma: A Scoping Review of Household-Level Risk Factors in Sub-Saharan Africa.

Background: Noma is a neglected tropical disease that predominantly affects young children in sub-Saharan Africa, characterized by rapid orofacial tissue destruction and high mortality. While malnutrition and infections are well-recognized risk factors, less attention has been given to family-level and psychosocial determinants. Objectives: To synthesize existing evidence on the role of family pathology in Noma and identify household-level risk factors affecting disease development and outcomes. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed and MEDLINE were searched through May 2024 for Noma-specific literature and broader child health studies related to family environment. Data extraction focused on predefined family pathology themes. Narrative synthesis was performed due to the heterogeneity of study designs. Results: Thirty-five studies met the eligibility criteria, including Noma-specific case series, epidemiological reports, and child health literature. Eleven family pathology themes were identified: child developmental stage, family structure, living area, family income, family size, parental education, parental viability, marital conflict, family separation, primary caregiver, and caregiving quality. Poverty, large family size, limited caregiving quality, and psychosocial instability were interconnected, increasing the vulnerability to Noma. Conclusion: Family dysfunction and socioeconomic deprivation contribute significantly to Noma risk. Prevention strategies should integrate family-level interventions, including caregiver education, birth spacing, economic support, and community health outreach. Addressing both biomedical and familial determinants is essential for reducing disease burden.