Trachoma in remote Indigenous Australia: a review and public health perspective

Abstract

Objectives: Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease. Methods:A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined.

Prevalence of trachomatous trichiasis in Australia: the National Eye Health Survey

“…Although trachoma is now confined to remote and very remote Indigenous communities, two of the three participants with TT in the present study were tested in major city and regional areas. This finding is similar to that of the NIEHS reported cases of TT in coastal and regional areas of Australia .…”

“…Trachoma is caused by a bacterial ( Chlamydia trachomatis ) infection of the conjunctiva and remains the leading infectious cause of blindness worldwide . The disease has two phases: the initial ‘active stage’ inflammatory response is usually seen in children, and the late stage with scarring and structural changes in the eyelids causes trichiasis, entropion, corneal scarring and vision loss . Australia is the only developed country to still have pockets of endemic active trachoma (defined as prevalence >5%) and known regional differences in the prevalence of trachoma exist, with rates being highest amongst very remote inland regions of New South Wales, the Northern Territory, South Australia and Western Australia …”

“…2 The disease has two phases: the initial 'active stage' inflammatory response is usually seen in children, and the late stage with scarring and structural changes in the eyelids causes trichiasis, entropion, corneal scarring and vision loss. 3 Australia is the only developed country to still have pockets of endemic active trachoma (defined as prevalence >5%) 4 and known regional differences in the prevalence of trachoma exist, with rates being highest amongst very remote inland regions of New South Wales, the Northern Territory, South Australia and Western Australia. 3,5 Supported by the World Health Organization (WHO), the Alliance for the Global Elimination of Blinding Trachoma by 2020 (GET 2020) promotes a four-component strategy to tackle endemic trachoma.…”

“…3 Australia is the only developed country to still have pockets of endemic active trachoma (defined as prevalence >5%) 4 and known regional differences in the prevalence of trachoma exist, with rates being highest amongst very remote inland regions of New South Wales, the Northern Territory, South Australia and Western Australia. 3,5 Supported by the World Health Organization (WHO), the Alliance for the Global Elimination of Blinding Trachoma by 2020 (GET 2020) promotes a four-component strategy to tackle endemic trachoma. 6 Known as the SAFE strategy, this model includes surgery for trichiasis, antibiotic treatment, facial cleanliness and environmental improvements.…”

Chlamydiae from Down Under: The Curious Cases of Chlamydial Infections in Australia

“…To date, trachoma still remains a public health burden and significant health threat for many remote Indigenous Aboriginal communities, despite many elimination initiatives. Trachoma occurs primarily in remote and very remote Aboriginal communities in the Northern Territory (NT), South Australia (SA) and Western Australia (WA), however cases have also been noted in other states [6,[11][12][13].…”