The Swiss foundation "Winds of Hope" is making its first donation to WHO to help African children facing the threat of the deadly Noma disease. A contribution of US$100,000 will support prevention and sustain primary health care in the battle against Noma. A battle WHO has been engaged in since 1994, when a global campaign was launched to eliminate this disfiguring and lethal disease.

"Winds of Hope" was created last year by Betrand Piccard and Brian Jones when they returned from their round-the-world trip by balloon. Each year, on the anniversary date of their landing - 21 March - a donation will be made with the objective to fight against neglected causes, especially those striking children.

"Even health professionals think Noma has disappeared, and that it is a plague of the past. However, as long as there are people living in distress and misery, without access to clean water and sanitation, the disfigured faces of Noma children will bear witness to an intolerable injustice", says Mrs Marie-Hélène Leclercq, Officer responsible for the WHO action programme against Noma.

Noma, also known as cancrum oris, is a gangrenous condition which starts in the mouth as a benign oral lesion and rapidly destroys both soft and hard tissues of the mouth and face. Most Noma sufferers are children under six years of age. The expert consensus emerging from an extensive review of the scientific literature is that the case-fatality rate could be extremely high. The survivors are disfigured for life. Most of them will never again eat, speak and breathe normally. The victims are often rejected by their community as they are the living proof of an evil curse not only on their family, but on the whole village as well.

The magnitude of Noma is not well documented. It is estimated by different sources that there may thousands of African children under the age of six who contract Noma every year. Epidemiological estimates are currently being investigated under a joint research project involving WHO, the National Institutes of Health of the United States, and the University of Maryland at Baltimore. Obstacles are numerous : the disease strikes people living in the most remote areas, often with no access to health care services. There is no systematic case registration; mortality is extremely high - occurring within two to three weeks after the initial clinical signs of the disease; its victims are hidden. At present, Noma is reaching endemic proportions in Africa, especially among some populations of the Sahel region – the poorest area of the continent.

"Today, Noma is preventable", says Mrs Leclercq. "If the disease is detected and recognised at an early stage, simple and low-cost care can be provided, and it is possible to stop the evolution of the gangrene, and to avoid disfigurement," she adds. It requires topical antiseptics, provision of antibiotics and nutritional rehabilitation.

The WHO action strategy officially adopted in 1992 is based on: prevention and early detection; immediate care; public information and education; epidemiological and etiological research, and referral for treatment of sequelae.

In the last six years, the WHO action plan against Noma has been developed through an international network of institutions, associations, universities, media and individuals. Experience and knowledge have been gained; methods and approaches have been validated to implement activities at country level, to build up awareness and catalyse energies at national and international levels.

If populations are informed and village chiefs alerted, if primary health care workers and traditional healers are trained, if non-governmental staff are mobilised, hundreds of children will be saved, and hundreds of adults will lead normal lives. Social mobilisation, training of personnel, early detection and care will be the focus of activities conducted with the donation of "Winds of Hope". Our initial programme will be launched in Niger. It will be coordinated by the office of the WHO Representative and it will involve partners working in neighbouring countries such as Burkina-Faso and Mali.

Action against Noma breaks down the barriers, such as those between members of different medical disciplines – plastic surgeons, dentists, dermatologists, nurses and traditional healers – who all have a role to play and are increasingly working together. It brings together established institutions and social groups. It creates a link between clinical care and public health. It bridges the gap between scientific knowledge and traditional beliefs, between north and south, and between the fortunate and the unfortunate. It gives a practical meaning to collective action, compassion and solidarity.