Each jurisdiction undertook screening and treatment for trachoma according to its respective protocols, and in the context of the 2014 CDNA National guidelines for the public health management of trachoma in Australia that recommend specific treatment strategies depending on the prevalence of trachoma detected through screening. reference 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 or removed from the at-risk category. 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. Data collection forms for data collection at the community level were developed by the National Trachoma Surveillance and Control Reference Group, based on the CDNA guidelines (Appendix 2). 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 othercommunity 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.
While data may be collected for Aboriginal children aged 0-14 years, the focus age group in all regions is the 5-9-year age group as required by jurisdictional Project Agreements.
In 2013 and 2014, the NT followed the screening and treatment schedule recommended in the 2014 CDNA National guidelines for the public health management of trachoma in Australia. Trachoma screening and management in the NT was undertaken through collaboration between the Department of Health (Centre for Disease Control [CDC] and Health Development) and Aboriginal Community Controlled Health Services (ACCHS). Trachoma screening was incorporated into the Healthy School-Age Kids program annual check and conducted by either local primary health-care services or community-controlled services, with support from the CDC trachoma team. The NT uses school enrolment lists, electronic health records and local knowledge to best determine the 5-9-year-old children present in the community at the time of screening. Following screening, treatment was generally undertaken by primary health-care services with support from the CDC trachoma team, particularly where community-wide treatments were required.
In 2014, screening for trichiasis was undertaken primarily by clinic staff during adult health checks,or by optometrists or ophthalmologists from the Regional Eye Health Service based in Alice Springs.
In South Australia, Country Health SA works collaboratively with Aboriginal Community Controlled Organisations, community health services and the Aboriginal Health Council of South Australia (AHCSA) to ensure that trachoma screening and treatment is undertaken in all at-risk communities. An interagency State Trachoma Reference Group provides guidance to the project. Country Health SA enters into contracts with services for the provision of both trachoma and trichiasis screening and treatment services. In 2014 Anangu Pitjantjatjara Yankunytjatjara (APY) Lands aggregated all nine previously distinct communities into one single community for the purpose of trachoma surveillance because of the small populations of each community and kinship links resulting in frequent mobility between these communities. This definition alters trends presented in reports from 2013 and 2014. Additional trichiasis 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. This program provides regular visits to SA remote Aboriginal communities by optometrists and ophthalmologists. Trichiasis screening was undertaken opportunistically for adults by the contracted trachoma screening service providers, the EH&CDSSP team and also routinely as part of the Adult Annual Health Checks. In 2014 there was extra focus on the promotion of the clean faces health message in the at-risk communities. With the support from the University of Melbourne Indigenous Eye Health Unit the Imparja television characters Yamba and Milpa undertook a successful Health Promotion road show visiting five schools on the APY Lands emphasising the importance of clean faces. The Country Health SA Trachoma Control team engaged in ongoing conversations with stakeholders with regard to the delivery of healthy housing. It is believed that overcrowding and adequate maintenance of hardware in housing remain a concern in some communities.
Trachoma screening and management in WA is the responsibility of the WA Country Health Service (WACHS) Population Health Units in the Kimberley, Goldfields, Pilbara and Midwest health regions. An interagency State Trachoma Reference Group has been established to provide program oversight. The WA State Trachoma Reference Group has established a set of principles which guide the program and provide consistent practice across the four endemic regions.
In collaboration with the local primary health-care providers, the Population Health Units screened communities in each region within a 2-week period, in August and September. People identified with active trachoma were treated at the time of screening. In 2014 each region determined the screening denominator based on the school register, which was updated by removing names of children known to be out of the community at the time of the screen and by adding names of children who were present in the community at the time of the screen.
In WA, trichiasis screening was undertaken in conjunction with adult influenza vaccinations. Screening of the target population also occurs with the Visiting Optometrist Scheme (VOS) in the Kimberley region. The Goldfields region also undertook additional trichiasis screening during the trachoma screening period. In addition, screening occurs as part of the adult health checks provided through the Medicare Benefits Scheme. The total volume of screening is not able to be determined at this time as the level of data is not available through the MBS information system.
In 2011 and 2014, WA Health aggregated several previously distinct communities into one single community for the purpose of trachoma surveillance because of the small populations of each community and kinship links resulting in frequent mobility between these communities. This definition alters trends presented in reports from 2010-2014.
New South Wales
In 2014, NSW Health expanded the trachoma screening project to include a further nine potentially at-risk communities in north western and far western NSW. Repeat screening was also undertaken in the affected community that was identified in 2013. Screening was conducted by the Bathurst Population Health Unit with support from NSW Ministry of Health. No trichiasis screening was undertaken in NSW.
In 2012, Queensland Health was funded to undertake a baseline screening of remote communities to establish whether trachoma was a public health concern in Queensland. Findings from this exercise were reported in the 2012 Annual report. In one community in the Torres Strait, follicles were observed in eight children. PCR swabs were taken from the eight children and household contacts. Results from the PCR test were all negative for C. trachomatis. Azithromycin was administered to the eight children and household contacts before the results of the PCR test were available. Planning for future screening in this community and a limited number of neighbouring communities in the Torres Strait is underway.
For 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 as possibly having trachoma. Individual screening coverage is the proportion of children in the target age group in a region that was actually screened.
In 2014, population data for trachoma screening coverage were provided by each jurisdiction. The population for communities in years 2007 to 2011 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% and 2.1% in the NT, WA and SA, respectively). Population estimates based on ABS census data 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 0-4, 5-9 and 10-14 years. Comparisons over time were limited to the 5-9-year age group, which is the target age group for the trachoma screening programs in all regions. Data from 2006 were excluded from assessment of time trends as collection methods in this first year differed from those subsequently adopted.
Projected data for trachoma prevalence
In 2014 all jurisdictions undertook trachoma control activities according to the revised 2014 CDNA National guidelines for the public health management of trachoma in Australia. reference 1 Under these guidelines not all at-risk communities were required to undertake screening for trachoma in 2014. For reporting purposes, the NTSRU has carried the most recent prevalence data forward in those communities that did not screen in the 2014 calendar year as a direct program decision, providing what is believed to be a conservative upper-bound on average levels of trachoma. This principle applies to all tables and figures relating to trachoma prevalence data. This method of projecting data was approved by the Trachoma Surveillance and Control Reference Group on 26 November 2013.Top of page