New bacterial species linked to noma reveals systemic gaps in neglected tropical disease research and care

Indigenous African medical systems historically treated noma-like conditions with plant-based remedies, such as extracts from *Khaya senegalensis* (African mahogany) or *Sarcocephalus latifolius* (African peach), which show antimicrobial properties in modern studies. Colonial suppression of these practices severed continuity with pre-existing knowledge, leaving a void that modern biomedicine is only now attempting to fill. The current 'discovery' narrative risks repeating this pattern by centering Western science over traditional wisdom.

Noma shares parallels with yaws, a disfiguring disease targeted by colonial-era public health campaigns that prioritised control over equity, often using coercive methods. The disease's re-emergence in post-colonial Africa reflects the collapse of these systems and the persistence of structural poverty. Historical records from 19th-century European physicians describe noma as a 'neglected scourge,' mirroring today's framing, yet solutions then focused on sanitation and nutrition—approaches still sidelined today.

In Ayurvedic medicine, oral ulcers with tissue destruction are treated with *Triphala* and *Neem*, which have documented antimicrobial effects, suggesting cross-cultural patterns in addressing similar conditions. Traditional healers in Nigeria's Hausa communities use *Ficus sycomorus* latex to treat oral lesions, a practice documented in 19th-century colonial reports but ignored in modern research. These systems frame disease as a disruption of bodily harmony, offering a holistic lens absent in Western biomedical reductionism.

The newly identified bacteria, provisionally named *Prevotella nomaensis*, belongs to a genus linked to oral and gut dysbiosis, but its role in noma's pathogenesis remains unclear without longitudinal studies. Modern metagenomic sequencing confirms the bacterium's presence in noma lesions, but research has not yet explored its interaction with malnutrition or immune suppression. The discovery underscores the need for interdisciplinary approaches combining microbiology with social epidemiology.

In many West African cultures, noma is framed as a 'curse' or spiritual affliction, with rituals involving drumming, offerings, and communal support to 'cleanse' the patient. Artistic traditions, such as the *Gelede* masks of the Yoruba, depict disfigured faces as symbols of societal imbalance, reflecting a spiritual understanding of disease. These perspectives highlight the role of collective trauma and healing, often dismissed as 'superstition' in Western narratives.

Modeling noma's resurgence requires integrating climate change projections (e.g., droughts increasing malnutrition) with healthcare access data to predict hotspots. Scenario planning should prioritise community-led surveillance systems over top-down interventions, as seen in successful HIV programs in sub-Saharan Africa. Future research must include decolonised clinical trials that centre local knowledge and ethical frameworks.

Affected communities in Niger and Nigeria report that noma is stigmatised as a 'disease of the poor,' with families hiding afflicted children due to shame and lack of care. Women and children bear the brunt of noma due to gendered malnutrition and limited healthcare access, yet their experiences are rarely included in research. Survivors like Fatima Ibrahim from Kano, Nigeria, describe noma as a 'silent killer' that erases identity, calling for survivor-led advocacy.