At present screening for trachoma takes place in trachoma endemic regions in the NT, SA and WA. Key representatives from each jurisdiction categorise communities that are considered to be ‘at risk’ and not ‘at risk’ for trachoma; these communities are then further categorised into screened and not screened. Consultations with key representatives in the jurisdictions found that history plays a key part in determining which communities are screened or not screened as does limitation of resources.
Screening for active trachoma is predominately conducted in schools, with additional children seen at clinics. The CDNA guidelines recommend that the minimum target group for active trachoma screening should be Aboriginal and Torres Strait Islander children aged 5-9 years living in communities/towns where trachoma is endemic. If health services have the resources and if there is a community agreement, children aged 1-14 years should be screened. Current practice in Australian trachoma control programs is to screen school-aged children, most of whom are aged 5–14 years.
It is generally accepted that this approach underestimates active trachoma prevalence in 1–9 year olds (the WHO recommended screening target group), as pre-school aged children carry the bulk of a community’s Chlamydia load. However, for organisational and patient/family acceptance reasons, it is more practical to screen school-aged children. Consultations with representatives of the jurisdictions revealed that although work is done with schools to provide ample notice of screening days, due to unforeseen circumstances (e.g. sorry days, deaths in the community, a football game in the next town) attendance of children at schools is not always high on the day, and resources do not allow follow up of the missing children.
WHO recommends that areas with the highest number of persons and the highest prevalence of trichiasis and suspected trichiasis should be prioritised for trachoma control. In Australia it is more appropriate to prioritise for trachoma control in the areas with the highest number of persons with active trachoma and areas with the highest prevalence of active trachoma63. WHO recommends screening every three years if active trachoma prevalence is >5% and no screening if regional trachoma prevalence <5%. Australian guidelines recommend annual screening until active trachoma prevalence is <5% for five consecutive years because of wide intra-regional variations in prevalence between communities and because Aboriginal and Torres Strait Islander communities are small, so prevalence in individual communities can vary widely from year to year. In addition, as staff turnover is high, annual screening provides a regular opportunity to maintain clinical awareness of trachoma and clinical skills in trachoma grading64.
In areas categorised as being ‘at risk’ for trachoma, the CDNA guidelines recommend that all Aboriginal adults aged 40 to 54 years should be examined every two years and those aged 55 years and over should be examined annually for trichiasis as part of an adult health check. top of page
63 Department of Health and Ageing (2006). Guidelines for the public health management of trachoma in Australia, Communicable Disease Network Australia