Each jurisdiction undertook screening and treatment for trachoma according to its respective protocols, and in the context of the national 2006 CDNA Guidelines for the public health management of trachoma in Australia, which recommend specific treatment strategies depending on the prevalence of trachoma detected through screening.1
In 2006, when the National Trachoma Management Program was initiated, each jurisdiction identified at‑risk communities from historical prevalence data and other knowledge. Over time, additional communities have been reclassified as being at‑risk. Screening for trachoma focuses on the at‑risk communities, but a small number of other communities designated as not‑at‑risk have also been screened, generally if there is anecdotal information suggesting the presence of active trachoma.
The WHO trachoma grading criteria (Appendix 1) were used to diagnose and classify individual cases of trachoma in all jurisdictions except Qld. Data collection forms (Appendix 2) for data collection at the community level were developed by the National Trachoma Surveillance and Control Reference Group, based on the CDNA Guidelines. Completed forms were forwarded from the jurisdictional coordinators to the NTSRU for checking and analysis. Information provided to the NTSRU at the community level for each calendar year included:
- Number of Aboriginal children aged 1‑14 years screened for clean faces and the number with clean faces, by age group;
- Number of Aboriginal children aged 1‑14 years screened for trachoma and the number with trachoma, by age group;
- Number of episodes of treatment for active trachoma, household contacts and other community members, by age group;
- Number of Aboriginal adults screened for trichiasis, number with trichiasis, and the number who had surgery for trichiasis;
- Community level implementation of WHO SAFE strategies.
Northern TerritoryTrachoma screening and management in the NT was undertaken through collaboration between the Department of Health (Centre for Disease Control and Health Development) and Aboriginal Community Controlled Health Services (ACCHS). Trachoma screening was incorporated into the Healthy School‑Age Kids (HSAK) program14 annual check and conducted by either local primary health‑care services or community‑controlled services, with support from the Centre for Disease Control (CDC) Trachoma Team. Following screening, treatment was generally undertaken by primary health‑care services with support from the CDC Trachoma Team when requested.
In 2012, community screening for trichiasis was undertaken primarily by clinic staff, ACCHS, or by optometrists or ophthalmologists from the Regional Eye Health Service based in Alice Springs. In two large communities in the NT, mass trichiasis screening of all Indigenous adults aged over 40 years was conducted with assistance from CDC Trachoma Team staff.
South AustraliaIn 2012, Country Health South Australia was responsible for managing the SA trachoma screening and treatment program. Country Health South Australia contracted with local health service providers, Aboriginal community‑controlled health services, the Aboriginal Health Council of South Australia and Nganampa Health Service to ensure coverage of screening services in all at‑risk rural and remote areas. Additional screening activities were undertaken by the Eye Health and Chronic Disease Specialist Support Program (EH&CDSSP), coordinated by the Aboriginal Health Council of South Australia and supported by the Medical Specialist Outreach Assistance Program (MSOAP). This program provides regular visits to SA remote Aboriginal communities by optometrists and ophthalmologists. Trichiasis screening was undertaken opportunistically for adults by both the EH&CDSSP team and the trachoma screening service providers, and is also undertaken routinely as part of the Adult Annual Health Checks. Country Health South Australia has changed regional structure in years 2011 and 2012 and therefore data from these reports cannot be directly compared with previous reports.
Western AustraliaTrachoma screening and management in WA is the responsibility of Population Health Units (PHUs) in the Kimberley, Goldfields, Pilbara and Midwest health regions. In collaboration with the local primary health‑care providers, the PHUs screened communities in each region within a 2‑week period, usually at the end of August or early September. People identified with active trachoma were treated at the time of screening.
Trichiasis screening was undertaken in conjunction with adult influenza vaccinations. Screening of the target population also occurs with the Visiting Optometrist Scheme (VOS) program in the Kimberley region.
In 2011, the government of WA changed the definition of community, specifically amalgamating several previously distinct communities into one single community. This definition alters trends presented in reports from 2010 – 2012.
QueenslandIn 2012 Qld undertook a one‑off screening exercise in six remote communities in three regions that were considered to be potentially at risk. This screening was undertaken by the Queensland Health’s Deadly Ears Program and supported by an ophthalmologist. Queensland screened according to CDNA Guidelines for areas of low prevalence or endemicity, which recommend using the WHO grading system to identify possible trachoma cases.
No trichiasis screening was required to be undertaken.
Data analysisFor the purpose of this report, a community is defined as ‘a specific location where people reside and where there is at least one school.’ Community coverage is defined as the number of at‑risk communities screened for trachoma as a proportion of those that were identified to possibly have trachoma. Individual screening coverage is the proportion of children in the target age group in a region that was actually screened.
In 2012, population data for trachoma screening coverage were provided by each jurisdiction. For communities where population data were not provided, coverage estimates were based on the 2011 Australian census projected forward.15 The population for communities in previous years was derived from projected data from the 2006 Australian census using Australian Bureau of Statistics (ABS) standard estimates of population increase (1.6%, 1.8%, 2.1% and 2.6% in the NT, WA, SA and Qld respectively). Population estimates for trichiasis screening coverage were based on the projected 2011 Australian census data. Population estimates based on the 2011 census do not account for population movements within communities, regions and jurisdictions. Prevalence of active trachoma was calculated using the number of children screened as the denominator.
Trachoma data were analysed in the age groups 1‑4, 5‑9 and 10‑14 years. Comparisons over time were limited to the 5‑9‑year age group, for which screening coverage has been consistently high. Data from 2006 were excluded from assessment of time trends as collection methods in this first year differed from those subsequently adopted.