Guidelines for the public health management of trachoma in Australia
Contribution to Book
Trachoma continues to be endemic in Aboriginal and Torres Strait Islander populations in some parts of the NT, SA and WA. Trachoma has been endemic in the past in NSW and Qld, but there are no recent data regarding its existence or prevalence in these States. Major improvements in environmental conditions in Aboriginal and Torres Strait Islander communities in Australia are a core requirement for trachoma eradication.
In line with its Vision 2020 initiative, the World Health Organization (WHO) has adopted a resolution to eliminate blinding trachoma by 2020. Guidelines for the Public Health Management of Trachoma in Australia provides recommendations to ensure consistent trachoma screening, control measures and data collection in Australia.
Data collected by the Australian Government Department of Health and Ageing from state and territory public health units were used in the development of these guidelines. Current WHO and Australian guidelines, international literature, the opinions of experts and feedback from consultations were also used to inform the guidelines. The guidelines were prepared by a consultant (Dr Donna Mak), guided by a CDNA Trachoma Steering Committee.
The guidelines establish a minimum best-practice approach for the public health management of trachoma. The guidelines do not prevent individual jurisdictions, health services or communities from implementing control strategies over and above what is recommended here (eg screening and/or treating 6-monthly instead of annually, or offering azithromycin to adults in addition to children in high prevalence communities). However, it is important to remember the principle ‘Primum non nocere’ (First, do no harm) when implementing any health intervention.
The guidelines recommend that trachoma control should be the responsibility of state and territory government-run regional population health units. Regional population health units should provide to primary health care services, optometry and ophthalmology services and community representatives information about the natural history and transmission of trachoma, local prevalence data regarding active trachoma and trichiasis, and details of proposed interventions; this will allow informed decisions to be made about the implementation of trachoma control measures.
In addition, the guidelines recommend that regional population health units collect trachoma data in accordance with the minimal national trachoma dataset (see Table 4 and Appendixes 1 and 2) and report these data to a national trachoma database. It is essential to standardise trachoma data collection systems so that data are comparable between regions and states, and so that Australia can contribute meaningful data to global trachoma reports. A central agency will analyse the data each year and collated reports will be distributed to regional population health units and other relevant stakeholders.
The guidelines acknowledge that appropriate engagement with the local community, both Aboriginal and Torres Strait Islander people and non-Indigenous people, is a prerequisite to implementing the WHO ‘SAFE’ (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) strategy and therefore an essential part of effective trachoma control. The principles and processes for engaging with communities recommended by WHO have been successfully adapted by health staff in Australia and will not be reproduced here.
Establishing and maintaining a health workforce with knowledge, skills and experience in trachoma control is another prerequisite of effective trachoma control and should also be the responsibility of regional population health units. There are several challenges to achieving this, including the high staff turnover in rural and remote health care settings and the disappearance of trachoma from many parts of Australia, including the capital cities and regional centres where health professionals are trained.
ISBN: 0 642 82865 2
Mak, D. B. (2006). Guidelines for the public health management of trachoma in Australia, Canberra, ACT: Australian Government Department of Health and Ageing.