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Most Noma patients are under the age of 6 and are most often between 3- and 4-years-old. Noma is the result of a combination of factors. It strikes malnourished children and frequently occurs following an infectious disease, generally measles, but also malaria, scarlet fever or chicken pox. The lack of an adequate diet lowers the immune system’s defenses in children and these illnesses only aggravate the situation.  Reasearch in oral diseases associated with HIV-infection have revealed that certain HIV-positive patients have micro-organisms in the mouth that are similar to those found in children suffering from Noma. Further research is being conducted to determine if there could be a possible link. Noma patients generally have vitamin, protein and iron deficiencies and oral hygiene is nearly inexistant. Although mouth ulcers are a precursor to Noma, it still remains to be understood why they develop into Noma in only a minority of cases.