This section describes the current trachoma surveillance arrangements in SA including screening for active trachoma and trichiasis, the data collection process and integration of trachoma screening with other activities.
3.8.1 Organisation of the active trachoma surveillance programIn SA, active trachoma screening is co-ordinated by the Aboriginal Health Council of South Australia (AHCSA), Eye Health and Chronic Disease Specialist Support Program (EH&CDSSP). The EH&CDSSP currently works with six ACCHSs including Nganampa, Oak Valley (Maralinga Tjarutja), Pika Wiya, Tullawon and Umoona Tjutagku to conduct active trachoma screening. Figure 3.8 shows the number of screened communities in each region and associated active trachoma prevalence in 2008.
Figure 3.8: Prevalence of active trachoma and communities where trachoma data were reported, SA, 2008
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Source: Trachoma surveillance report 2008, National Trachoma Surveillance and Reporting Unit, Centre for Eye Research Australia
3.8.2 Description of the active trachoma screening processActive trachoma screening takes place throughout the year in SA and in some instances communities are visited twice. In 2006 and 2007 many regions conducted two screening rounds in a one year period and it is not known how many children were examined once or on both occasions. In 2008, only one round of screening data was provided even though some communities were visited twice .
There is only one eye health project officer who works on the EH&CDSSP coordinating and undertaking the screening process. The project officer screens with a team of ophthalmologists and optometrists who examine children when they visit selected communities . The team screens for most eye health conditions, however active trachoma and trichiasis are not always included in the routine screen. ACCHSs and where possible Country Health South Australia resources are used to assist with screening.
Screening visits are pre-arranged with communities (via clinics and schools); however, there is often a high rate of absenteeism. Two days per year are spent in each community with only children presenting at school being screened. Children are taken to the clinic (usually next to the school) and are screened. If active trachoma is identified the child is treated immediately. If their family is present they will also be treated on the day of screening.
3.8.3 Follow-up activities post screeningIn general no follow-up screening for absent children is conducted in SA mainly due to a lack of resources. In some instances the clinic will follow-up with treatment for family members of trachoma affected children and this is dependent on the family members turning up to the clinic. This process is not formalised.
3.8.4 Trichiasis screeningTrichiasis is not routinely screened for in SA however if an ACCHS clinic doctor identifies trichiasis, the patient will be seen by the visiting ophthalmologists or referred to the closest hospital with an attending ophthalmologist. In 2008 data for trichiasis were reported for three of the six ACCHSs.
3.8.5 Data collection processData collection is undertaken on screening day by the eye health project officer on the forms provided by the NTSRU. The project officer transfers the data collected on paper forms to the NTSRU access database. This process is often not timely as the project officer spends a considerable amount of time in the field without easy access to a computer so data entry is not possible until she returns to her office in Adelaide. In some instances after a community has been screened data may be entered by the project officer into the local clinic computer system (Communicare system) so that the patient record is left at the community.
Once data have been collated by the project officer at AHCSA it is sent off to the NTSRU. The Department of Health South Australia is not involved in the data collection process. The data collection process in SA is described in Figure 3.9 top pf page
Figure 3.9: Trachoma surveillance data collection process in South Australia
3.8.6 Uses of data and dissemination processSA does not use any of the data collected through the trachoma program. Staff limitations mean that not all the data are entered into the NTSRU database and therefore the data are not representative of the current prevalence rates in SA. There are no reports provided to any of the communities that have undergone screening for trachoma. The EH&CDSSP coordinator thought this would be of great benefit if the data in the NTSRU database accurately reflected the “on the ground” situation. top of page
3.8.7 Costs associated with trachomaSA is provided with $75,000 per annum from OATSIH to coordinate the trachoma screening program. This funding is meant to assist with the cost of running the trachoma control program in SA. Most of these funds are allocated to employing the coordinator who undertakes training of health professionals to conduct screening. The ACHSA considers that these funds are insufficient to coordinate the trachoma screening program. Currently there is no funding for trachoma surveillance provided by the SA Department of Health.
3.8.8 The extent of integration with other systemsAs stated SA does not have a widespread screening program and active trachoma screening takes place while visiting ophthalmologists/optometrists check for other eye health conditions as part of the Eye Health and Chronic Disease Specialist Support Program (EH&CDSSP).
3.8.9 ConclusionThe trachoma surveillance program is very different in SA compared to the other jurisdictions. The differences include:
- there is no financial support from the Department of Health SA to undertake the program (although this is in the process of changing due to a combined proposal from ACHSA and Country Health SA to DoHA);
- there are not any public health services in remote areas, only ACCHSs, to assist in coordinating the program and/or undertaking the screening;
- active trachoma screening is integrated with the EH&CDSSP which includes screening remote communities for a range of eye conditions including trachoma and trichiasis;
- the EH&CDSSP project officer’s role involves coordinating the visits, participating in the screening activities, entering data on ACCHS databases and on the NTSRU database on return to Adelaide;
- active trachoma screening is done in ACCHS clinics on patients presenting and work is done to coordinate with the schools to bring the children to the clinic for screening;
- screening for active trachoma occurs throughout the entire year (similar to NT); and
- very little follow up activities occur unless done by local ACCHS staff .
70Tellis B, Fotis K, Dunn R, Keeffe J and Taylor H (2009). Trachoma surveillance report 2008, National Trachoma Surveillance and Reporting Unit, Centre for Eye Research Australia