National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 ACKNOWLEDGEMENTS

NATIONAL TRACHOMA SURVEILLANCE AND REPORTING UNIT

TRACHOMA SURVEILLANCE REPORT 2008

AUGUST 2009

Prepared by

Ms Betty Tellis Ms Kathy Fotis Mr Ross Dunn Professor Jill Keeffe Professor Hugh Taylor

Centre for Eye Research Australia, University of Melbourne

National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 ACKNOWLEDGEMENTS

The National Trachoma Surveillance and Reporting Unit’s third Surveillance Report 2008 was compiled using data collected and/or reported by the following organisations and departments.

STATE AND TERRITORY CONTRIBUTIONS

NORTHERN TERRITORY • Australian Government Emergency Intervention (AGEI) • Aboriginal Community Controlled Health Services (ACCHS) • Centre for Disease Control, Northern Territory Department of Health and Families, Northern Territory • Healthy School Age Kids (HSAK) program: Top End • HSAK: Central Australia

SOUTH AUSTRALIA • Aboriginal Health Council of South Australia, Eye Health and Chronic Disease Specialist Support Program (EH&CDSSP) • Country Health South Australia • Ceduna/Koonibba Health Service • Nganampa Health Council • Oak Valley (Maralinga Tjarutja) Health Service • Pika Wiya Health Service • Tullawon Health Service • Umoona Tjutagku Health Service

WESTERN AUSTRALIA • Communicable Diseases Control Directorate, Department of Health, Western Australia • Population Health Units and Aboriginal Community Controlled Health Services staff in the Goldfields, Kimberley, Midwest and Pilbara regions

OTHER CONTRIBUTIONS

ANTIBIOTIC RESISTANCE

• Institute of Medical Veterinary Science (IMVS) • Northern Territory Government Pathology Service (NTGPS) • Western Diagnostics Pathology Service (WDPS)

The National Indigenous Eye Health Survey (NIEHS) data were collected by the Centre for Eye Research Australia.

The National Trachoma Surveillance Reference Group ( Table F.1, page 157) provided input into the development of the report.

i National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 CONTENTS

ACKNOWLEDGEMENTS...... I

CONTENTS...... II

LIST OF TABLES...... IV

LIST OF FIGURES ...... XII

DEFINITIONS...... XIV

ABBREVIATIONS ...... XVI

EXECUTIVE SUMMARY ...... XVIII

INTRODUCTION ...... 1

METHODS...... 3

1. DATA COLLECTION ...... 3 Antibiotic resistance ...... 4 2. SCREENING...... 5 Northern Territory...... 5 South Australia...... 5 Western Australia...... 6 3. DATA ANALYSIS AND REPORTING...... 6 RESULTS...... 9

1. NATIONAL OVERVIEW...... 9 2. NORTHERN TERRITORY ...... 15 Screening for active trachoma ...... 18 Treatment...... 23 Comparison of 2006, 2007 and 2008 active trachoma data...... 24 Trichiasis...... 25 Trachoma control activities...... 26 3. SOUTH AUSTRALIA...... 27 Screening for active trachoma ...... 30 Comparison of 2006, 2007 and 2008 active trachoma data...... 36 Trichiasis...... 37 Trachoma control activities...... 38

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4. WESTERN AUSTRALIA...... 39 Screening for active trachoma ...... 42 Treatment...... 45 Comparison of 2006, 2007 and 2008 active trachoma data...... 46 Trichiasis...... 47 Trachoma control activities...... 48 5. ANTIBIOTIC RESISTANCE...... 49 DISCUSSION ...... 53

REFERENCES ...... 57

APPENDICES ...... 59

A. NORTHERN TERRITORY COMMUNITY LEVEL DATA BY REGION...... 61 I. ALICE SPRINGS REMOTE...... 61 II. BARKLY ...... 70 III. DARWIN RURAL...... 76 IV. EAST ARNHEM...... 83 V. KATHERINE...... 88 B. SOUTH AUSTRALIA COMMUNITY LEVEL DATA BY REGION ...... 95 I. CEDUNA/KOONIBBA...... 98 II. NGANAMPA...... 101 III. OAK VALLEY (MARALINGA TJARUTJA)...... 104 IV. PIKA WIYA...... 106 V. TULLAWON ...... 109 VI. UMOONA TJUTAGKU...... 111 C. WESTERN AUSTRALIA COMMUNITY LEVEL DATA BY REGION ...... 115 I. GOLDFIELDS...... 115 II. KIMBERLEY...... 123 III. MIDWEST ...... 132 IV. PILBARA ...... 138 D. NATIONAL INDIGENOUS EYE HEALTH SURVEY RESULTS...... 147 E. DATA COLLECTION FORMS ...... 151 F. NATIONAL TRACHOMA SURVEILLANCE REFERENCE GROUP MEMBERSHIP ...... 157

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LIST OF TABLES

Table 1.1 Number of communities screened for trachoma, by trachoma risk, state and territory, 2008...... 10

Table 1.2 Community coverage, screening coverage and prevalence of active trachoma of Aboriginal children aged 1 to 9 years, by state and territory, 2006, 2007 and 2008...... 11

Table 1.3 Reported treatment for trachoma, by state and territory, 2008...... 12

Table 1.4 Timeliness of treatment for communities that treated all children, household and community contacts, by state and territory, 2008...... 12

Table 1.5 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by region, state and territory, 2006, 2007 and 2008...... 13

Table 1.7 Trichiasis screening of adults aged ≥30 years, by state and territory, 2008...... 14

Table 1.8 Implementation of trachoma control activities (SAFE strategy), by state and territory, 2008...... 14

Table 2.1 Number of communities screened for trachoma, by trachoma risk status and region, NT, 2008...... 18

Table 2.2 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by trachoma risk status and region, NT, 2006, 2007 and 2008...... 20

Table 2.3 Number of resident Aboriginal children aged 1 to 9 years, and number examined for active trachoma and facial cleanliness, by region, NT, 2008...... 21

Table 2.4 Prevalence of Aboriginal children aged 1 to 9 years with clean faces, by region, NT, 2008...... 22

Table 2.5 Active trachoma treatment strategies and timeliness of treatment of children, households and community contacts, by region, NT, 2008...... 23

Table 2.6 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by region, NT, 2006, 2007 and 2008...... 24

Table 2.7 Significant differences in the prevalence of active trachoma in Aboriginal children aged 1 to 9 years (2006–2008) in communities where ≥10 children were examined, by region, NT...... 24

Table 2.8 Trichiasis screening of Aboriginal adults aged ≥30 years, by region, NT, 2008...... 25

Table 2.9 Implementation of trachoma control activities (SAFE strategy) by region, NT, 2008...... 26

iv National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 3.1 Number of communities screened for trachoma, by trachoma risk status and ACCHS, SA, 2008...... 30

Table 3.2 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years for first (S1) and second (S2) screenings by trachoma risk status and ACCHS, SA, 2006 and 2007...... 32

Table 3.3 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by trachoma risk status and ACCHS, SA, 2008...... 33

Table 3.4 Number of resident Aboriginal children aged 1 to 9 years, and number examined for active trachoma and facial cleanliness, by ACCHS, SA, 2008...... 34

Table 3.5 Prevalence of Aboriginal children aged 1 to 9 years with clean faces, by ACCHS, SA, 2008...... 35

Table 3.6 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, from Screening 1, by ACCHS, SA, 2006, 2007 and 2008...... 36

Table 3.8 Trichiasis screening of Aboriginal adults aged ≥30 years, by ACCHS, SA, 2008...... 37

Table 3.9 Implementation of trachoma control activities (SAFE strategy), by ACCHS, SA, 2008...... 38

Table 4.1 Number of communities screened for trachoma, by trachoma risk status and region, WA, 2008...... 42

Table 4.2 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by trachoma risk status and region, WA, 2006, 2007 and 2008...... 43

Table 4.3 Number of resident Aboriginal children aged 1 to 9 years, and number examined for active trachoma and facial cleanliness, by region, WA, 2008...... 44

Table 4.4 Prevalence of Aboriginal children aged 1 to 9 years with clean faces, by region, WA, 2008...... 45

Table 4.5 Active trachoma treatment strategies and timeliness of treatment, by region, WA, 2008...... 45

Table 4.6 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by region, WA, 2006, 2007 and 2008...... 46

Table 4.7 Significant differences in the prevalence of active trachoma in Aboriginal children aged 1 to 9 years (2006–2008) in communities where ≥10 children were examined, by region, WA...... 46

Table 4.8 Trichiasis screening of Aboriginal adults aged ≥30 years, by region, WA, 2008...... 47

Table 4.9 Implementation of trachoma control activities (SAFE strategy), by region, WA, 2008...... 48 v National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 5.1 Percentage of people treated with azithromycin (total treated/total requiring treatment) in jurisdictions where trachoma is regarded as endemic, 2006, 2007 and 2008...... 49

Table 5.2 Age of Aboriginal people that S. pneumoniae isolates were collected from, by pathology service, 2008...... 50

Table 5.3 Specimen source of S. pneumoniae isolates collected from Aboriginal people, by pathology service, 2008...... 50

Table 5.4 Azithromycin resistance and susceptibility to S. pneumoniae isolates collected from Aboriginal people, by pathology service and region, 2008...... 51

TABLES IN APPENDICES

Table A.1 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Alice Springs Remote region, NT, 2006, 2007 and 2008...... 63

Table A.2 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Alice Springs Remote region, NT, 2008...... 64

Table A.3 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Alice Springs Remote region, NT, 2008...... 65

Table A.6 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Alice Springs Remote region, NT, 2008...... 67

Table A.7 Trichiasis screening of Aboriginal adults aged ≥30 years, Alice Springs Remote region, NT, 2008...... 68

Table A.8 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Alice Springs Remote region, NT, 2008...... 69

Table A.9 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Barkly region, NT, 2006, 2007 and 2008...... 71

Table A.10 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Barkly region, NT, 2008...... 72

Table A.11 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Barkly region, NT, 2008...... 72 vi National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table A.14 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Barkly region, NT, 2008...... 73

Table A.15 Trichiasis screening of Aboriginal adults aged ≥30 years, Barkly region, NT, 2008...... 74

Table A.16 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Barkly region, NT, 2008...... 75

Table A.17 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Darwin Rural region, NT, 2006, 2007 and 2008...... 77

Table A.18 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Darwin Rural region, NT, 2008...... 78

Table A.19 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Darwin Rural region, NT, 2008...... 79

Table A.22 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Darwin Rural region, NT, 2008...... 80

Table A.23 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Darwin Rural region, NT, 2008...... 82

Table A.24 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, East Arnhem region, NT, 2006, 2007 and 2008...... 84

Table A.25 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, East Arnhem region, NT, 2008...... 85

Table A.26 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, East Arnhem region, NT, 2008...... 85

Table A.29 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, East Arnhem region, NT, 2008...... 86

Table A.30 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, East Arnhem region, NT, 2008...... 87

Table A.31 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Katherine region, NT, 2006, 2007 and 2008...... 89

Table A.32 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Katherine region, NT, 2008...... 90

Table A.33 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Katherine region, NT, 2008...... 91

Table A.36 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Katherine region, NT, 2008...... 92

Table A.37 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Katherine region, NT, 2008...... 93

Table B.1 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years for Screening 1, by community, SA ACCHS, 2006, 2007 and 2008...... 95

Table B.2 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, SA ACCHS, 2008...... 96

Table B.3 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, SA ACCHS, 2008...... 97

Table B.5 Trichiasis screening of Aboriginal people, regions serviced by the Ceduna/Koonibba ACCHS, SA, 2008...... 100

Table B.6 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Nganampa ACCHS, SA, 2008...... 102

viii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table B.7 Trichiasis screening of Aboriginal people, regions serviced by the Nganampa ACCHS, SA, 2008...... 103

Table B.8 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Oak Valley ACCHS, SA, 2008...... 105

Table B.9 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Pika Wiya ACCHS, SA, 2008...... 107

Table B.10 Trichiasis screening of Aboriginal people, regions serviced by the Pika Wiya ACCHS, SA, 2008...... 108

Table B.11 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Tullawon ACCHS, SA, 2008...... 110

Table B.13 Trichiasis screening of Aboriginal people, regions serviced by the Umoona Tjutagku ACCHS, SA, 2008...... 113

Table C.1 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Goldfields region, WA, 2006, 2007 and 2008...... 116

Table C.2 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Goldfields region, WA, 2008...... 117

Table C.3 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Goldfields region, WA, 2008...... 118

Table C.6 Completeness and timeliness of active trachoma treatment, by age group, Goldfields region, WA, 2008...... 119

Table C.7 Trichiasis screening of Aboriginal people, Goldfields region, WA, 2008...... 121

Table C.8 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Goldfields region, WA, 2008...... 122

Table C.9 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Kimberley region, WA, 2006, 2007 and 2008...... 124 ix National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table C.10 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Kimberley region, WA, 2008...... 125

Table C.11 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Kimberley region, WA, 2008...... 126

Table C.14 Completeness and timeliness of active trachoma treatment, by age group, Kimberley region, WA, 2008...... 128

Table C.15 Trichiasis screening of Aboriginal people, Kimberley region, WA, 2008...... 130

Table C.16 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Kimberley region, WA, 2008...... 131

Table C.17 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Midwest region, WA, 2006, 2007 and 2008...... 133

Table C.18 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Midwest region, WA, 2008...... 134

Table C.19 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Midwest region, WA, 2008...... 134

Table C.22 Completeness and timeliness of active trachoma treatment, by age group, Midwest region, WA, 2008...... 136

Table C.23 Trichiasis screening of Aboriginal people, Midwest region, WA, 2008...... 137

Table C.24 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Midwest region, WA, 2008...... 137

Table C.25 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Pilbara region, WA, 2006, 2007 and 2008...... 139

Table C.26 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Pilbara region, WA, 2008...... 140

Table C.27 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Pilbara region, WA, 2008...... 141 x National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table C.30 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Pilbara region, WA, 2008...... 142

Table C.31 Trichiasis screening of Aboriginal people, Pilbara region, WA, 2008...... 144

Table C.32 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Pilbara region, WA, 2008...... 145

Table D.1 Summary of trachoma prevalence in children aged 5 to 9, 5 to 15 years and adults >40 years collected by the National Indigenous Eye Health Survey, 2008...... 148

Table F.1 National Trachoma Surveillance Reference Group members, 2008...... 157

xi National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

LIST OF FIGURES

Figure 1.1 Prevalence of active trachoma in Australia, by region, 2008...... 10

Figure 2.1 Prevalence of active trachoma (number of children aged 1 to 9 years examined) and the number of communities where trachoma data were reported in NT regions, 2008...... 17

Figure 2.2 Screening of communities in NT regions, 2008...... 19

Figure 3.1 Prevalence of active trachoma (number of children aged 1 to 9 years examined) and the number of communities where trachoma data were reported in regions serviced by SA ACCHS, 2008...... 29

Figure 3.2 Screening of communities in SA ACCHS, 2008...... 31

Figure 4.1 Prevalence of active trachoma (number of children aged 1 to 9 years examined) and the number of communities where trachoma data were reported in WA regions, 2008...... 41

Figure 4.2 Screening of communities in WA regions, 2008...... 42

FIGURES IN APPENDICES

Figure A.1 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in 14 communities where ≥10 children were examined, Alice Springs Remote region, NT, 2006, 2007 and 2008...... 68

Figure A.2 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in two communities where ≥10 children were examined, Barkly region, NT, 2007 and 2008...... 74

Figure A.3 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in seven communities where ≥10 children were examined, Darwin Rural region, NT, 2006, 2007 and 2008...... 81

Figure A.4 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in eight communities where ≥10 children were examined, East Arnhem region, NT, 2007 and 2008...... 87

Figure A.5 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in two communities where ≥10 children were examined, Katherine region, NT, 2007 and 2008...... 93

Figure B.1 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in six communities where ≥10 children were examined, SA ACCHS, 2006, 2007 and 2008...... 96

xii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Figure C.1 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in six communities where ≥10 children were examined, Goldfields region, WA, 2006, 2007 and 2008...... 120

Figure C.2 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in 17 communities where ≥10 children were examined, Kimberley region, WA, 2007 and 2008...... 129

Figure C.3 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in five communities where ≥10 children were examined, Midwest region, WA, 2006, 2007 and 2008...... 136

Figure C.4 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in 10 communities where ≥10 children were examined, Pilbara region, WA, 2007 and 2008...... 143

Figure D.1 Indigenous sites visited by the National Indigenous Eye Health Survey in 2008...... 147

xiii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

DEFINITIONS

Active trachoma: The presence of chronic inflammation of the conjunctiva caused by infection with Chlamydia trachomatis ; includes World Health Organization grades Trachomatous inflammation follicular (TF) and/or Trachomatous inflammation intense (TI).

Adults: Aboriginal adults aged ≥30 years unless otherwise specified.

Blinding endemic trachoma: A prevalence of active trachoma of 5% or more in children aged 1 to 9 years or a prevalence of trichiasis of 0.1% or more in the population. This is also referred to as endemic trachoma in the report and conforms with the WHO criteria.

Chi-square test: The chi-square test is used to determine if there is a significant relationship between two or more variables. It assumes each cell has an expected frequency of five or more.

Children: Refers to Aboriginal children aged 1 to 9 years unless otherwise specified.

Communities At Risk: Thought by the jurisdictional population health staff to be at risk of having endemic trachoma.

Communities Not At Risk: Thought by the jurisdictional population health staff to not be at risk of having endemic trachoma.

Community: A group of people where there is a school. A community with two or more schools is considered as a single community.

Community-based treatment: Treatment of all children in the community aged up to 14 years and all household contacts.

Community coverage: Calculated using the number of communities that were screened as a proportion of those communities that were identified by each jurisdiction to be At Risk of trachoma. Community lists were provided by the Department of Education from each jurisdiction.

Confidence intervals: The 95% CI tells us a range of plausible values for the population mean, given the sample mean. Confidence intervals are used to indicate the reliability of an estimate.

Corneal opacity (CO): Easily visible corneal opacity over the pupil.

Endemic trachoma: A prevalence of active trachoma of 5% or more in children 1 to 9 years.

Fisher’s exact test: The Fisher's exact test is used when unable to conduct a chi-square test and one or more of your cells have an expected frequency of five or less.

Household-based treatment: Treatment of all household contacts who are clustered in several households in the community (community-wide treatment not required).

Hyper-endemic trachoma: A prevalence of active trachoma of 20% or more.

Not reported: Indicates that data were not reported for communities.

Not screened: Communities that were not screened and so could not provide data.

Prevalence of active trachoma: Includes active trachoma detected by trachoma screening programs and, in some instances, cases detected in clinics. xiv National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Prevalence of clean faces: Includes clean faces detected by trachoma screening programs and, in some instances, cases detected in clinics.

Region: Boundaries defined by: the Northern Territory Government, Department of Health and Families for NT; the Aboriginal Community Health Services for SA; and the Department of Indigenous Affairs of Western Australia for WA.

Screening coverage: Calculated using the number of children or adults who were examined for trachoma as a proportion of those who were reported by the ABS to be resident in Communities At Risk.

Town camp: An area that is leased for an indefinite duration to Indigenous housing associations for the purpose of specific Indigenous living.

Trachomatous inflammation follicular (TF): Presence of five or more follicles in the upper tarsal conjunctiva of at least 0.5 mm.

Trachomatous inflammation intense (TI): Pronounced inflammatory thickening of the tarsal conjunctiva that obscures more than half of the normal deep tarsal vessels.

Trachomatous scarring (TS): Presence of scarring in the tarsal conjunctiva.

Trachomatous trichiasis (TT): At least one eyelash rubs on the eyeball or there is evidence of the recent removal of inturned eyelashes.

xv National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

ABBREVIATIONS

ABS Australian Bureau of Statistics ACCHS Aboriginal Community Controlled Health Service(s) AGAR Australian Group on Antimicrobial Resistance AGEI Australian Government Emergency Intervention AHCSA Aboriginal Health Council of South Australia AMS Aboriginal Medical Service CDNA Communicable Diseases Network Australia CERA Centre for Eye Research Australia CI confidence interval CO corneal opacity DHF Department of Health and Families EH&CDSSP Eye Health and Chronic Disease Specialist Support Program HSAK Healthy School Age Kids program IMVS Institute of Medical Veterinary Science NA not available NACCHO National Aboriginal Community Controlled Health Organisation NR not reported NS not screened NT Northern Territory NTGPS Northern Territory Government Pathology Service NTSRU National Trachoma Surveillance and Reporting Unit OATSIH Office for Aboriginal and Torres Strait Islander Health PHLN Public Health Laboratory Network PWPS PathWest Pathology Service SA South Australia SAFE Surgery, Antibiotics, Facial Cleanliness, and Environmental improvement TF Trachomatous inflammation – follicular TI Trachomatous inflammation – intense TS Trachomatous scarring TT Trachomatous trichiasis WA Western Australia WDPS Western Diagnostics Pathology Service WHO World Health Organization

xvi

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EXECUTIVE SUMMARY

KEY FINDINGS:

• Data were received from sixteen regions from the Northern Territory, South Australia and Western Australia. • Of the 287 remote Aboriginal communities in those regions, 235 (82%) were At Risk of trachoma in 2008, and 121 (51%) were screened and reported data.

• The prevalence of active trachoma in those communities from which data were reported was 21%. o 8 regions (50%) had a prevalence of active trachoma ≥5%.

o 82 communities (68%) had a prevalence of active trachoma ≥5%. • The overall prevalence of active trachoma has not changed substantially, although variation in coverage and the examination of small numbers produces instability in estimates.

• In general the quality of reporting and coverage has shown improvement. • Treatment was reported to have been distributed in 90 of the 98 communities (92%) in which treatment for trachoma was indicated, including four communities where active trachoma was found in children aged 10 to 14 years.

o 76 communities (78%) treated in compliance with the CDNA guidelines, 14 (14%) treated children only and eight (8%) did not report data for treatment. • Trichiasis screening was carried out only in a small number of places and the overall prevalence in those screened was 4%. • Few communities fully implemented the SAFE trachoma control strategy, although resources are more widely available. • There was no measurable change in azithromycin resistance from 2007 to 2008.

BACKGROUND

In its resolve to eliminate blinding trachoma by 2020, the World Health Organization (WHO) recommends the adoption of a four component SAFE strategy: Surgery (for trichiasis), Antibiotic treatment (with azithromycin), Facial Cleanliness and Environmental improvement (SAFE). 4 Based on the SAFE strategy, the Communicable Disease Network Australia (CDNA) in 2006 developed the ‘Guidelines for the Public Health Management of Trachoma in Australia’. 2

xviii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

This is the third surveillance report compiled by the NTSRU. This report presents a national overview from data collected from screening in remote Aboriginal communities during 2008 by regions in the Northern Territory (NT), South Australia (SA) and Western Australia (WA) where trachoma was identified by states and territory as present. The report compares 2008 data with results from the screenings in 2006 and 2007, and comments on the jurisdictions’ implementation of the CDNA guidelines ‘minimum best-practice approach’. Recommendations regarding future reporting for screening and management of trachoma have been made. Community level data by region have been included in the Appendices.

METHODS

DATA COLLECTION

Key representatives from each jurisdiction categorised communities that were ‘At Risk’ or ‘Not At Risk’ for trachoma, and further categorised them into screened or not screened. Communities considered At Risk were determined using historical reports of trachoma in their regions. In most cases this did not include the large urban regions. For many communities in South Australia there was no information on prior screening for trachoma; these communities have been reported as At Risk and should have been screened. In areas categorised as being At Risk for trachoma, the CDNA guidelines recommend that regional population health units and health care services are responsible for determining the best delivery of trachoma screening and management. 2

Data collection forms (Appendix E) based on the CDNA guidelines and endorsed by the National Trachoma Surveillance Reference Group (Appendix F) were developed by the NTSRU to improve the quality and consistency of data collection of trachoma and trichiasis data in each state or territory. The forms were used to gather information regarding: • trachoma screening of Aboriginal children aged 1 to 14 • treatment with azithromycin for household and community contacts • trichiasis and trichiasis surgery in Aboriginal adults • implementation of SAFE trachoma control activities in the communities.

According to the CDNA guidelines, screening should be conducted annually in Communities At Risk until prevalence of active trachoma is <5% for five consecutive years. WHO has set the criteria for the elimination of blinding endemic trachoma in a community as being a prevalence for active trachoma of less than 5% in children aged 1 to 9 years, or a prevalence of trichiasis of less than 0.1% in the population.

All jurisdictions used the World Health Organization’s (WHO) Trachoma Grading criteria to detect and grade trachoma. 5 Where the WHO simplified grading system was used it is important to note that signs of trachoma are not mutually exclusive and should be graded independently, and people should be classified by their worse eye.

Screening was conducted annually for most of the NT by the Healthy School Aged Kids (HSAK) program in collaboration with primary health care staff from the Aboriginal Community Controlled Health Services (ACCHS). Four communities located in the Katherine West region of the NT were screened twice by the Aboriginal Medical Service over a one year period. In SA, the project coordinator of the Eye Health and Chronic Disease Specialist Support Program (EH&CDSSP) and a screening team of ophthalmologists and optometrists examined children when they visited selected communities. Some communities were visited twice in a one year period – as has been done in previous years – but only one round of screening was reported for 2008. Screening in WA was conducted annually by population health unit and primary health care staff.

xix National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

This report focuses on Aboriginal children aged 1 to 9 years, complying with CDNA guidelines, unless otherwise specified.2 In most regions children were examined for clean faces when they were examined for trachoma. Treatment strategies for affected children, household and community contacts are outlined in the CDNA guidelines 2 and the NTSRU data collection form (Appendix E, Form 2). In regions where population mobility is high, treatment is recommended to be completed in as short a timeframe as possible to minimise the likelihood of re-infection, and two weeks is a recommended time frame. Cross-regional and cross-state scheduling of trachoma screening and control activities should be considered where people are known to move frequently across borders because of strong family/cultural links.2

Bacterial resistance to azithromycin has been monitored in 2007 and 2008. The participating laboratories and health services reported azithromycin resistance (defined as both intermediate and high level resistance) for any invasive and non-invasive S. pneumoniae isolates collected from all specimen sites within the specified six month period (1 st July to 30 th December 2008).

DATA ANALYSIS AND REPORTING

A national overview and a summary of regional data for each jurisdiction are presented in the results section. Community level data are included in Appendices at the end of the report. Comparisons between jurisdictions need to be interpreted with caution because of the variation in data collection and reporting.

In 2008, a community was defined as a group of people where there is a school; larger communities where two or more schools may exist were counted as a single community instead of reporting data from each school separately. Data from previous reports that have come from two schools in the same community have been consolidated.

Community coverage was calculated using the number of communities that were screened as a proportion of those that were identified by each jurisdiction as At Risk. Communities that were reported as Not At Risk and were not screened were not included in this calculation.

Population data were reported from two sources, the Australian Bureau of Statistics (ABS) and primary health care staff. In many cases the number of children in the community varies depending on the source of the data.

The best method for calculating screening coverage of children has been to use the ABS population data for people resident in Communities At Risk as the denominator. This statistic was used to account for the people in communities where screening should have been conducted but was not.

Prevalence data of active trachoma for communities were reported using the number of children examined in the community as the denominator. Confidence intervals (95%) were calculated; however, for communities with ≤5 children examined the 95% CI were very large and have not been included in the tables and figures.

CDNA guidelines recommend providing appropriate azithromycin treatment to household and community members. In some communities the treatment strategy was not reported, although some treatment was distributed. In other communities, treatment was reported to have been distributed where active trachoma was found in children aged 10 to 14 years without being detected in children aged 1 to 9 years. Where the data indicated that treatment was only given to affected children, without providing household or community treatment, these communities were regarded as not following treatment as recommended by the CDNA guidelines.

Kimberley region (where the number of children examined from each community was not reported) nor for the Pilbara region where Trachoma follicular was graded as the presence of one or more follicles under the upper eyelid, i.e. a non-standard WHO definition, and data were reported for children aged 1 to 14 years. In 2008, comparisons of prevalence of active trachoma were not possible for four of the seven communities in the Katherine region where data were provided for children aged 0 to 15 years. Statistical comparisons must be viewed with caution due to the year-to-year variation in the coverage of children examined and to small numbers.

The screening coverage of Aboriginal adults examined for trichiasis was calculated using the ABS population of people resident in Communities At Risk as the denominator. The percentage of referrals for an ophthalmic consultation were calculated where this information was provided. The number of trichiasis surgeries was reported from regions where this information was available. Data were reported for the adults who underwent trichiasis surgery within 12 months prior to the date of reporting the screening data.

In 2008, specific fields were added into the database for the reporting of the Surgery, Antibiotics and Facial Cleanliness activities of the SAFE trachoma control strategy. The reporting of the Environmental condition of communities was kept as free text, and data were coded into categories by the NTSRU for the report.

RESULTS

NATIONAL OVERVIEW • Data were reported for 121 communities from a total of 16 regions in NT, SA and WA. Other jurisdictions were not included in this project. • The overall prevalence of active trachoma in children aged 1 to 9 years in those communities from which data were reported was 21%. o Eight regions (50%) had a prevalence of active trachoma ≥5%. o 82 communities (68%) had a prevalence of active trachoma ≥5%. • The overall prevalence of active trachoma has not changed substantially although variation in coverage and the examination of small numbers produces instability in estimates. • Since the establishment of the NTSRU more children are being examined for trachoma and clean faces; 76% were examined in 2007 compared to 89% in 2008. • Treatment was reported to have been distributed in 90 of the 98 communities (92%) in which treatment for trachoma was indicated, including four where active trachoma was found in children aged 10 to 14 years. o 76 communities (78%) were treated in compliance with the CDNA guidelines, 14 (14%) treated children only and eight (8%) did not report data for treatment. • Trichiasis screening was carried out in only a small number of places and the prevalence in those screened was 4%. • The Antibiotic (azithromycin) and Facial Cleanliness components of the SAFE trachoma control strategy were more comprehensively implemented compared to the Surgery (for trichiasis) and Environmental improvements components. o In 2007, the distribution of antibiotics was reported in 41% of communities, and this was the trachoma control activity that was most comprehensively reported.

xxi National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

o In 2008, there was a marked increase in community reporting for referrals for trichiasis surgery (57%), distribution of antibiotics (74%) and the promotion of facial cleanliness through resources (49%) and programs (70%). • Overall, blinding endemic trachoma continues to exist in many communities and more concerted efforts will be needed to eliminate it.

NORTHERN TERRITORY • Data for active trachoma were reported for six regions categorised as trachoma endemic in 2008: Alice Springs, Alice Springs Remote, Barkly, Darwin Rural, East Arnhem and Katherine. • Of the 92 communities in the endemic regions in the NT, 87 (95%) were categorised as being At Risk for trachoma and five (5%) as Not At Risk. o Included in these communities was a community (town camp) in Alice Springs, previously categorised Not At Risk. After finding a 40% prevalence of active trachoma in children, this community was then re-categorised as At Risk . • 43 of the 87 Communities At Risk in 2008 (49%) were screened and reported data. o Four communities (9%) had no active trachoma. o 35 (81%) had a prevalence of active trachoma ≥5%. • Of the remaining 44 Communities At Risk (51%), 19 (22%) were reported to have been screened – 14 during the Australian Government Emergency Intervention (AGEI) – but data were not provided, and 25 (29%) should have been screened but were not. • Of the children resident in Communities At Risk, 2462 (36%) were examined at schools, and 713 children (29%) had active trachoma (95% CI, 27%−31%). • Of the 1493 children examined for facial cleanliness, 1004 (67%) had clean faces. • Treatment was reported to have been distributed in compliance with the CDNA guidelines in 35 of the 41 communities (85%) in which treatment for trachoma was indicated, including two communities where active trachoma was found in children aged 10 to 14 years. o Overall, 3940 people were reported to have been treated with azithromycin; this included children found to have active trachoma, their household contacts and community members. • Comparisons of prevalence of active trachoma were made from 2006 to 2008. o One of the five regions (20%) showed no change in prevalence over the three years while a statistically significant increase (p<0.05) was found in four (80%). o Comparisons were not possible for four of the 43 communities (9%) because data were reported for children aged 0 to 15 years – instead of 1 to 9 years – and age breakdowns were not provided. o Of the 33 communities where comparisons could be made because ≥10 children were examined in two or more years, no change in prevalence was found in 21 communities (64%), a statistically significant increase (p<0.05) was found in two (6%) and a decrease (p<0.05) was found in 10 (30%). • Data for trichiasis screening were reported only for the Alice Springs Remote and Barkly regions. o Of the adults aged ≥30 years resident in Communities At Risk, 206 adults (2%) were examined for trichiasis, and 26 (13%) had trichiasis. • The reporting of trachoma control activities has improved since 2007 where no communities provided information about referrals for surgery, and <15% reported information for the other components of the SAFE strategy. xxii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

SOUTH AUSTRALIA • Data for active trachoma were reported for six trachoma endemic regions serviced by the ACCHS: Ceduna/Koonibba, Nganampa, Oak Valley (Maralinga Tjaratja), Pika Wiya, Tullawon and Umoona Tjutagku. o The Ceduna/Koonibba region includes communities in the Eyre school district; this incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted. o The Pika Wiya region includes communities from within the Flinders school district; this also incorporates two communities from the Northern Country school district which the EH&CDSSP coordinator advised should be included in the Pika Wiya Region. • All of the 72 communities north and west of Port Augusta in SA were categorised as being At Risk for trachoma. o 11 Communities At Risk (15%) were screened. Seven communities (64%) had no active trachoma. Three communities (27%) had a prevalence of active trachoma ≥5%. • Of the children resident in Communities At Risk, 365 (4%) were examined at schools, and six children (2%) had active trachoma (95% CI, 1%−4%). • Of the 365 children examined for facial cleanliness, 260 (71%) had clean faces. • Treatment was given to all children with active trachoma, although CDNA treatment guidelines were not followed as household or community treatment was not given irrespective of the presence of trachoma. This was similar to 2006 and 2007. • Comparisons of prevalence of active trachoma were made from 2006 to 2008. o Four of the six regions (67%) showed no change in prevalence while a statistically significant decrease (p<0.05) was found in two (33%). o There was no change in prevalence for the six communities where comparisons could be made. • Data for trichiasis screening were reported for three ACCHS: Nganampa, Pika Wiya and Umoona Tjutagku. o Of the adults aged ≥30 years resident in Communities At Risk, 298 adults (2%) were examined for trichiasis, and one (0.3%) had trichiasis. • In 2008 brief information was reported on the implementation of the SAFE trachoma control strategy unlike 2007 where no information was reported.

WESTERN AUSTRALIA • Data for active trachoma were reported for four trachoma endemic regions: Goldfields, Kimberley, Midwest and Pilbara. • Of the 123 communities in the endemic regions in WA, 76 (62%) were categorised as being At Risk for trachoma, and 47 (38%) Not At Risk. o None of the 47 Communities Not At Risk were screened. o 67 of the 76 Communities At Risk (88%) were screened and reported data. 16 communities (24%) had no active trachoma. 44 communities (66%) had a prevalence of active trachoma ≥5%. xxiii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

o Of the remaining nine Communities At Risk (12%), two (22%) were screened but data were not provided, and seven (78%) should have been screened but were not. • Of the children resident in Communities At Risk, 1823 children (44%) were examined at schools, and 278 children (15%) had active trachoma (95% CI, 13%−17%). • Of the 1833 children examined for facial cleanliness, 1433 (78%) had clean faces. • Treatment was reported to have been distributed in compliance with the CDNA guidelines in 41 of the 52 communities (79%) in which treatment for trachoma was indicated, including one community where active trachoma was found in children aged 10 to 14 years. o Overall, 2917 people (97%) were reported to have been treated with azithromycin; this included children found to have active trachoma, their household contacts and community members. • Comparisons of prevalence of active trachoma were made from 2006 to 2008. o One of the four regions (25%) showed no change in prevalence, a statistically significant increase (p<0.05) was found in one (25%) and a decrease (p<0.05) was found in two (50%). o Of the 38 communities where comparisons could be made, no change was found in 26 communities (68%), a statistically significant increase (p<0.05) was found in four (11%) and a decrease (p<0.05) was found in eight (21%). • Data for trichiasis screening were reported for all four regions. o Of the adults aged ≥30 years resident in Communities At Risk, 903 adults(13%) were examined for trichiasis, and 25 (3%) had trichiasis. • The Antibiotic and Facial Cleanliness components of the SAFE trachoma control strategy were more comprehensively implemented compared to the Surgery and Environmental improvements components. o In 2008 there was a marked increase in community reporting for referrals for trichiasis surgery and the implementation of programs to promote facial cleanliness.

DISCUSSION

Surveillance data presented to the NTSRU clearly indicates that endemic trachoma still exists in Australia. It is important to delineate which communities have trachoma and which do not before confident estimates can be made regarding the full extent of trachoma in Australia.

In 2008, 235 of the 287 communities (82%) in NT, SA and WA were categorised as being At Risk for trachoma in 16 regions of Australia; this included a town camp in Alice Springs that was previously regarded as Not At Risk. A similar percentage of communities were screened and reported in 2008 (51%) compared to 2006 (57%) and 2007 (52%). However, WA showed a significant increase (p<0.05) in community coverage, 64% in 2006 and 88% in 2008, and NT showed a significant decrease (p<0.05) in community coverage, 78% in 2006 and 49% in 2008. The community coverage in SA has been consistently lower than the other jurisdictions because a coordinated screening program does not exist in this state; there was no significant difference between the community coverage in 2006 (24%) and 2008 (15%).

The decrease in community coverage in the NT was in part due to the exclusion of communities examined during the AGEI. Data collected by the AGEI have been presented with caution in government reports due to limited training of staff collecting the data. For this reason they have not been presented in this report. The HSAK program which provided data for other NT communities did not re-visit communities screened by the AGEI. xxiv National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

In the last three years (2006 to 2008) there has been much discussion regarding the best way to report screening coverage of children. We believe the best assessment of the denominator is given by the ABS population data for children resident in Communities At Risk for trachoma. There were increases and decreases in the regional screening coverage, although the overall coverage for each jurisdiction was similar across the three years. Less than half of the children residing in Communities At Risk are being examined, emphasising that there are still many gaps in the screening.

Across all the jurisdictions the average prevalence of active trachoma from which the data were reported was 21% (p<0.05) compared to the 14% reported for 2007. There are no consistent changes in regional prevalence even though statistically significant increases and decreases (p<0.05) between 2006 and 2008 were found in some regions. Caution must be exercised due to variable coverage and small numbers. The majority of communities, 53 of the 77 (69%) where comparisons could be made, showed no change.

Screening all children and providing appropriate azithromycin treatment to household and community members is a necessary component of trachoma control. The surveillance data indicates that household and community treatment has improved from 2006 to 2008 following the CDNA guidelines and the operation of the NTSRU. A change in azithromycin resistance has not been detected over this time. In 2008 treatment was reported to have been distributed according to the CDNA guidelines in 35 communities (85%) in the NT and 41 (79%) in WA; most of the regions within these jurisdictions treated >80% of the people who required treatment. However, SA has consistently examined few children at the schools and continues to treat children found to have active trachoma without providing household or community treatment as recommended by the CDNA guidelines.

Poor facial hygiene is an important risk factor for trachoma and the promotion of facial cleanliness is a key component of the SAFE strategy. Reporting of facial cleanliness data have improved between 2006 and 2008 with many communities also reporting the promotion of facial cleanliness through the use of programs and resources . Such programs are important in order to integrate behavioural change regarding hygiene and break the cycle of re-infection.

The reporting of trichiasis data has improved somewhat. In 2008 almost every region reported at least some data on trichiasis screening, although in many regions this was still fragmentary. The inclusion of trichiasis screening into existing programs – such as the Adult Health Check and influenza vaccination programs – has made it possible to monitor the later stages of trachoma. This should lead to appropriate referrals for surgery when trichiasis is identified.

Improvements have been made for the reporting of the availability of the Surgery, Antibiotics and Facial Cleanliness activities of the SAFE trachoma control strategy; however, these components still need to be strengthened. It is apparent that activities for the Environmental improvement component of the SAFE strategy have not been comprehensively reported. However, there have been reports of the installation of new swimming pools in some of the remote Aboriginal communities. While research has shown considerable health and social benefits of the pools, efforts should also be made to improve housing sanitation, nutrition, education and access to health care. 6

This report also includes data collected by the Centre for Eye Research Australia (CERA) as part of the National Indigenous Eye Health Survey (NIEHS) (Appendix D: Table D.1, page 148-149). The Survey was designed to determine the prevalence and main causes of vision impairment, the utilisation of eye care services, barriers to eye health care and, the impact of vision impairment on indigenous children aged 5 to 15 years and adults aged ≥40 years. In total, 3 0 randomly selected sites around Australia and a pilot site were visited as part of the NIEHS (Figure D.1, page 147). The NIEHS results have data for sites from states not included in the NTSRU.

A cross-regional ‘health blitz’ focusing on outreach screening and treatment of multiple conditions has been discussed by some jurisdictions to assist with the collection of data from communities that share borders. This also aims to deal with the cycle of re-infection caused by population mobility.

Future activities should also consider the responsibilities of members of the screening teams. For example, an efficient team might include at least two people responsible for the examination of trachoma, a nurse to administer treatment, and a health worker to assist in engaging with the community. It is important for all health workers and organisations involved in the monitoring of trachoma to be accountable and to take responsibility for their roles. Good relationships should be maintained with key representatives in the schools and communities to aid the collection and reporting of data and to make the elimination of trachoma a priority.

Future control activities would benefit from incorporating simple health messages – such as ‘keep your face clean’ – as part of existing programs aimed at children and families. It would also be valuable to have health promotion messages repeated during the year period by key members in the schools or communities to reinforce the importance of hygiene.

In summary, although there are still gaps and limitations in the reporting of data, considerable improvements have been made over the last three years. Recommendations for the future include reviewing assumptions that Aboriginal children in urban communities are Not At Risk, screening all Communities At Risk, examining at least all children 5 to 9 years in these communities whether they are attending school or not, and strengthening the implementation of trachoma control activities in these communities. Additional effort is required to ensure that azithromycin is appropriately and comprehensively distributed, facial cleanliness is actively promoted and that adults with trichiasis are detected and operated on. An increase in community and screening coverage will enable more stable and reliable estimates of the prevalence and distribution of trachoma, and strengthening the implementation of all four components of the WHO SAFE strategy will lead to the elimination of blinding endemic trachoma.

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xxvii National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 INTRODUCTION

Trachoma is the most common cause of infectious blindness worldwide. 1 It is caused by specific strains of the bacteria Chlamydia trachomatis that causes scarring of the eyelid, inturned eyelashes (trichiasis) and blindness if left untreated. 2 Trachoma occurs predominantly in developing countries where living conditions are crowded and hygiene is poor. 3 Australia is the only developed country where trachoma still exists. 2 The reports published in 2007 and 2008 showed findings consistent with other data that trachoma remains endemic (as defined by the WHO) in remote Aboriginal communities in the NT, SA and WA. 7,8

In its resolve to eliminate blinding trachoma by 2020, the World Health Organization (WHO) recommends the adoption of a four component strategy: Surgery (for trichiasis), Antibiotic treatment (with azithromycin), Facial Cleanliness and Environmental improvement (SAFE). 4 Based on the SAFE strategy, the Communicable Disease Network Australia (CDNA) in 2006 developed the ‘Guidelines for the Public Health Management of Trachoma in Australia’. 2

In 2006 the Australian Government awarded a tender to the Centre for Eye Research Australia (CERA) to establish the National Trachoma Surveillance and Reporting Unit (NTSRU) with the responsibility of providing high quality national information on trachoma prevalence based on data received from state and territory jurisdictions. Government funding was also allocated to the jurisdictions for the training of health workers in the implementation of consistent trachoma screening and control measures. 9

The CDNA guidelines recommend that each state and territory take responsibility for trachoma management through their regional population health units. Key representatives from each jurisdiction determine Communities At Risk based on historical reports of trachoma in remote Aboriginal communities. CDNA guidelines further recommend that the regional population health units report trachoma data to a national trachoma database to allow consistency in data collection and reporting, so meaningful comparisons can be made between regions and states of Australia. 2

Although Chlamydia remains sensitive to azithromycin, some studies have shown antibiotic resistance developing in other bacteria following community-based azithromycin treatment. 10,11 For these reasons CDNA recommended that some monitoring of azithromycin resistance in other bacteria be conducted. The organism usually monitored for this purpose is Streptococcus pneumoniae . Resistance to azithromycin can be predicted by testing resistance to erythromycin and this is the recommended method. 12 The bacterial resistance has been assessed and data have been collected for 2007 and 2008. These data have been compared with national data collected by the Australian Group on Antimicrobial Resistance (AGAR) in 2005.13

This is the third surveillance report compiled by the NTSRU. The previous two Trachoma Surveillance Reports are available as public documents on the Department of Health and Ageing website at: www.health.gov.au .14,15 A summary of each report has also been published in the Communicable Diseases Intelligence journal which can also be accessed online at the Department website. 7,16

This report presents a national overview from data collected from screening in remote Aboriginal communities during 2008 by regions in the Northern Territory (NT), South Australia (SA) and Western Australia (WA) where trachoma was identified by states and territory as present. The report compares 2008 data with results from the screenings in 2006 and 2007, and comments on the jurisdictions’ implementation of the CDNA guidelines ‘minimum best-practice approach’. Recommendations regarding future reporting for screening and management of trachoma have been made. Community level data by region have been included in the Appendices.

2 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

METHODS

Summary • Trachoma screening was conducted in trachoma endemic regions in the NT, SA and WA. • Key representatives from each jurisdiction categorised communities as ‘At Risk’ or ‘Not At Risk’ for trachoma. • Data collection forms based on the CDNA guidelines ‘minimum best-practice’ approach for trachoma management in Australia, and endorsed by the National Trachoma Surveillance Reference Group, were used to gather information regarding: o trachoma screening o treatment strategies o trichiasis o SAFE strategy control measures. • The WHO Trachoma Grading criteria were used to detect and grade trachoma. • Screening for active trachoma was conducted predominately in schools, with additional children seen at clinics. • This report focuses on data for Aboriginal children aged 1 to 9 years, unless otherwise specified.

• Community coverage was calculated using the number of communities that were screened as a proportion of Communities At Risk for trachoma. • Screening coverage was calculated using the number of people examined for trachoma as a proportion of those who were reported by the ABS to be resident in Communities At Risk. • Antibiotic resistance data were collected from three pathology services servicing Aboriginal communities in trachoma endemic regions over two years (2007–2008).

1. DATA COLLECTION

Data collection forms (Appendix E) based on the CDNA guidelines, and endorsed by the National Trachoma Surveillance Reference Group (Appendix F), were developed by the NTSRU to improve the quality and consistency of data collection of trachoma and trichiasis in each state or territory. The forms were used to gather information regarding: • trachoma screening of Aboriginal children aged 1 to 14 • treatment with azithromycin for household and community contacts • trichiasis and trichiasis surgery in Aboriginal adults • implementation of SAFE trachoma control activities in the communities.

3 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

This report focuses on the data for Aboriginal children aged 1 to 9 years to comply with CDNA guidelines, unless otherwise specified.2 Data for children aged 1 to 14 were reported for some communities. In most regions children were examined for clean faces when they were examined for trachoma.

Treatment strategies for affected children, household and community contacts are outlined in the CDNA guidelines 2 and the NTSRU data collection form (Appendix E, Form 2). In hyper-endemic communities, community-based treatment should be considered. In regions where population mobility is high, treatment is recommended to be completed in as short a timeframe as possible to minimise the likelihood of re-infection and two weeks is a recommended time frame. Cross-regional and cross-state scheduling of trachoma screening and control activities should be considered where people are known to move frequently across borders because of strong family/cultural links.2

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 (part of the Medical Benefits Schedule item for Aboriginal people). 2 The CDNA guidelines also state that it is the responsibility of the regional population health units, primary health care services and specialist eye health services to decide on the best way to identify patients with trichiasis and to ensure that they have access to surgical referral and treatment. 2 In 2007 and 2008 screening data for trichiasis were reported for the <30, 30 to 49 and 50 years and over age categories as specified on the data collection form endorsed by the National Trachoma Surveillance Reference Group. For 2009 the data collection form will be changed to report data for people aged <40, 40 to 54 and 55 years which have been specifically targeted by the CDNA guidelines for screening.

ANTIBIOTIC RESISTANCE

The NTSRU has monitored antibiotic resistance in Aboriginal communities for two years (2007 and 2008).

DATA SOURCES

Three pathology services have provided erythromycin resistance data for isolates of S. pneumoniae specimens collected from Aboriginal people in trachoma endemic regions: • Institute of Medical Veterinary Science (IMVS) (SA) • Northern Territory Government Pathology Service (NTGPS) • Western Diagnostics Pathology Service (WDPS) (NT).

Information on Aboriginality was only reported from the NTGPS; specimens were collected from outpatients or those in the emergency room of the Alice Springs hospital. This information is not routinely collected by the other two pathology services. For this reason IMVS and WDPS have provided data for specimens from those regions or health services that predominately serve Aboriginal people.

4 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

SAMPLING FRAMEWORK

The participating laboratories and health services reported azithromycin resistance (defined as both intermediate and high level resistance) for any invasive and non-invasive S. pneumoniae isolates collected from all specimen sites within the specified six month period (1 st July to 30 th December 2008).

Data on patients’ age, gender, region of residence, and specimen source were reported by each pathology service when available. Isolates were de-identified for personal and community information so regional data only have been reported.

DATA ANALYSIS

Each participating laboratory performed antimicrobial susceptibility tests according to their routine standardised methodology (CDS, CLSI, agar dilution or MIC testing methods are identified in other sources) 17,18 ; this is consistent with the methodology used by AGAR.13

2. SCREENING

NORTHERN TERRITORY

Screening for trachoma was conducted annually for most of the NT between February and November 2008; four communities located in the Katherine West region were screened twice by the Aboriginal Medical Service over a one year period. The Healthy School Age Kids (HSAK) program conducted most of the screening in the Top End and in Central Australia in collaboration with primary health care staff from the Aboriginal Community Controlled Health Services (ACCHS). In 2008 the HSAK program was fully implemented in Central Australia. For the previous two years there had been less training and resources in this region. Screening was conducted in an Alice Springs town camp for the first time by the trachoma coordinator in conjunction with the Australian Government Emergency Intervention (AGEI) at the Central Australian Aboriginal Congress. Previously Alice Springs town camps had not been screened because they were not regarded as At Risk for trachoma, and because the HSAK program is responsible for screening in remote areas.

In 2007, the Australian Government Emergency Intervention (AGEI) conducted Child Health Checks throughout the NT. The AGEI clinical advisory panel decided that trachoma screening was only to be conducted by members of the intervention teams who had appropriate skills and training to do so. However, during Phase 2 of the AGEI in 2008, some children in the NT were examined for trachoma during the Child Health Check by clinicians with varying experience with trachoma. The grading reported during this screening was not regarded by NT authorities as reliable or consistent and has not been included in this report. The AGEI conducted screening in 14 of the 19 communities where data were collected but not reported in 2008. Those communities that were visited by the AGEI were not revisited by the HSAK program which provided data for other NT communities, and this contributed to the smaller number of communities reporting trachoma data for 2008.

Ophthalmologists examined adults for trichiasis when they conducted specialist outreach visits in the trachoma endemic regions.

SOUTH AUSTRALIA

Screening for trachoma was conducted between April and December 2008 in regions serviced by six ACCHS. A coordinated screening program was not implemented as the Eye Health and Chronic Disease Support Program (EH&CDSSP) is only funded to visit selected communities serviced by some ACCHS. The project coordinator of the EH&CDSSP assisted a screening team of ophthalmologists and optometrists in recording information on active trachoma in the time available that the team had to

5 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 visit these communities. Some communities were visited twice over a one year period, although only one round of data was reported. Some Aboriginal children who were identified for screening were seen in schools while others were brought to the clinics by family members, Aboriginal health workers and other clinic staff. Data from the Pika Wiya region were collected by the mainstream Health Service and forwarded to the EH&CDSSP coordinator to be included in this report.

The screening team of eye specialists and the EH&CDSSP coordinator also visited ACCHS clinics twice in a one year period to examine adults for trichiasis. Everyone who attended the clinic on the day and wanted to participate was examined by the ophthalmologist except at the Pika Wiya ACCHS where an optometrist conducted the examinations.

WESTERN AUSTRALIA

Screening for trachoma was conducted between August and September 2008. Population Health Units collected data in partnership with primary health care staff from state government ACCHS . In most regions letters were sent to parents in order to gain permission for the screening of their children.

Adults were examined for trichiasis as part of an annual influenza vaccination program.

3. DATA ANALYSIS AND REPORTING

A national overview and a summary of regional data for each jurisdiction are presented in the results section. Community level data are included in Appendices at the end of the document. Comparisons between jurisdictions need to be interpreted with caution because in some areas incomplete data were reported.

In 2008, a community was defined as a group of people where there is a school; larger communities with two or more schools were counted as a single community instead of reporting data from each school separately. Data from previous reports that have come from two schools in the same community have been consolidated. The denominator of communities within each region or area serviced by an ACCHS was provided by school lists from each state and territory Department of Education. 19-21

Special education schools, schools of the air and senior schools with children from Year 8 onwards were excluded from the WA and NT lists. Urban schools were also excluded from the NT with the exception of the town camps that were screened in Alice Springs.

For SA, information on the number of schools was reported by the Department of Education under the school districts but these do not correspond with the zoning of the ACCHS regions. In 2008, the number of communities screened within the regions serviced by the ACCHS was reported. For this reason, the number of communities in regions serviced by the Nganampa, Oak Valley (Maralinga Tjarutja) and Tullawon ACCHS were separated according to the ACCHS that serviced these regions. The EH&CDSSP coordinator advised that two communities in the Northern Country school district (Umoona Tjutagku ACCHS) should be included in the Flinders school district (Pika Wiya ACCHS); one community from the Flinders school district was reassigned to the Nganampa ACCHS region. Communities from the Eyre school district (located south-east of the Ceduna/Koonibba Health Service) were counted in the Ceduna/Koonibba region; this incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted. Communities from the Flinders school district were counted in the Pika Wiya region. For this reason the Australian Bureau of Statistics Census data for the Aboriginal population in the Ceduna/Koonibba and Pika Wiya regions appear larger than what would be expected for some of these regions as serviced by the ACCHS.

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Population data were reported from two sources, the Australian Bureau of Statistics (ABS) and primary health care staff, to investigate the number of Aboriginal children At Risk and the screening coverage. In most cases the number of children in the community varied depending on the source used. The ABS population projections are difficult due to the quality of data regarding births, deaths and migration. 22 The 2006 ABS Census data of the number of Aboriginal people resident in a region and in Communities At Risk were used to calculate 2008 high and low population growth projections. Both growth projections are presented in the results section for each jurisdiction. The low projection estimates are used in the report to provide a conservative estimate to calculate the coverage of children and adults examined in these jurisdictions. 23 The high series growth rate projection was not calculated for the regional data as there was little difference between the numbers at this level of reporting. Reporting of the estimated resident population by Indigenous status was explored; however, this information could not be broken down into the 1 to 4, 5 to 9 and 10 to 14 year age categories reported in the tables. Similarly, the ABS school enrolment data were not reported because age categories were not provided and data were available only for ‘pre-school’, ‘primary’ and ‘secondary children’.

Primary health care staff reported the number of children in the communities where screening was conducted; these data came from enrolment lists from the schools or population data for the communities. In most regions, the number of children examined did not reflect the number of children estimated to be in the community.

The preferred method of screening coverage is to use the ABS population data for Communities At Risk as the denominator. This statistic was used to account for the children in communities where screening should have been conducted but was not.

CDNA guidelines recommend providing appropriate azithromycin treatment to household and community members. In some communities the treatment strategy was not reported, although some treatment was distributed. In other communities, treatment was reported to have been distributed where active trachoma was found in children aged 10 to 14 years without being detected in children 1 to 9 years. Where the data indicated that treatment was only given to affected children, without providing household or community treatment, these communities were regarded as not following treatment as recommended by the CDNA guidelines.

Where data were reported for communities that had been screened and reported in 2006 or 2007 the same code was used so that comparisons could be made across the three years. Community codes for SA have been changed so the communities reflect the ACCHS they come from; the previous codes used for SA in the 2006 and 2007 reports have been included in Table B.1 (page 95).

Chi-square tests were used to compare significant differences in prevalence of active trachoma for communities that examined 10 or more children in two or more years. Where numbers were less than five in any cell, a Fisher’s exact test was used. Analysis could not be done with 2006 data for the Kimberley region (where the number of children examined from each community was not reported) nor for the Pilbara region where Trachoma follicular was graded as the presence of one or more follicles under the upper eyelid, i.e. a non-standard WHO definition, and data were reported for children aged 1 to 14 years. In 2008, comparisons of prevalence of active trachoma were not possible for four of the seven communities in the Katherine region where data were provided for children aged 0 to 15 years.

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Statistical comparisons must be viewed with caution due to the year-to-year variation in the coverage of children examined and to small numbers.

In 2008, fields were added into the database for the reporting of the Surgery, Antibiotics and Facial Cleanliness activities of the SAFE trachoma control strategy. Where there were inconsistencies in the reporting of timeliness of antibiotic treatment between the trachoma control activities and the treatment data, the treatment data were reported. The reporting of the Environmental condition of communities was kept as free text, and data were coded into categories by the NTSRU for the report.

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RESULTS

1. NATIONAL OVERVIEW

• Data were reported for 121 communities from a total of 16 regions in NT, SA and WA (Table 1.1). Other jurisdictions were not included in this project (Figure 1.1). • The overall prevalence of active trachoma has not changed substantially although variation in coverage and the examination of small numbers produces instability in estimates (Table 1.2). • The overall prevalence of active trachoma in children aged 1 to 9 years in those communities from which data were reported was 21% (p<0.05) compared to the 14% in 2007 (Table 1.2). o 82 communities (68%) had a prevalence of active trachoma of 5% or more, and this occurred in eight of the16 regions (50%). • Since the establishment of the NTSRU more children are being examined for trachoma and clean faces; 76% were examined in 2007 compared to 89% in 2008. • Treatment was reported to have been distributed in 90 of the 98 communities (92%) where treatment was indicated, including four communities where active trachoma was found in children aged 10 to 14 years (Table 1.3). o 76 communities (78%) were treated in compliance with the CDNA guidelines, 14 (14%) treated children only and eight (8%) did not report data for treatment. o In 50 communities (51%) all children found to have active trachoma, their household contacts and community members were treated (Table 1.4). • Comparisons of prevalence of active trachoma were possible from 2006 to 2008. o Seven of the 16 regions (44%) showed no change in prevalence, a statistically significant increase (p<0.05) was found in five regions (31%) and a decrease (p<0.05) was found in four (25%) (Table 1.5). o Of the 77 communities where comparisons could be made, no change was found in 53 communities (69%), a statistically significant increase (p<0.05) was found in 14 (18%) and a decrease (p<0.05) was found in 10 (13%) (Table 1.6). • Trichiasis screening was carried out only in a small number of communities and the overall prevalence in those screened was 4% (Table 1.7). • The Antibiotic (azithromycin) and Facial Cleanliness components of the SAFE trachoma control strategy were more comprehensively implemented compared to the Surgery (for trichiasis) and Environmental improvements components (Table 1.8). • Overall, blinding endemic trachoma continues to exist in many communities and more concerted efforts are needed to eliminate it.

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Figure 1.1 Prevalence of active trachoma in Australia, by region, 2008. * No active trachoma was found; however, only nine children were examined in this area

SCREENING FOR ACTIVE TRACHOMA

Table 1.1 Number of communities screened for trachoma, by trachoma risk, state and territory, 2008. Communities Number (%) of communities Total Northern South Western Territory Australia Australia Not At Risk Screened 0 0 0 0 Not screened 5 (100%) 0 47 (100%) 52 (100%) Total Not At Risk 5 0 47 52 At Risk Screened with no trachoma found 4 (5%) 7 (10%) 16 (21%) 27 (11%) Screened with trachoma found 39 (45%) 4 (6%) 51 (67%) 94 (40%) Reported screened but no data received 19 (22%) 0 2 (3%) 21 (9%) Not screened 25 (29%) 61 (85%) 7 (9%) 93 (40%) Total At Risk 87 72 76 235

Total communities 92 72 123 287 Source: Data were collected by the HSAK program in NT, the EH&CDSSP in South Australia and Population Health Units in WA

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Table 1.2 Community coverage, screening coverage and prevalence of active trachoma of Aboriginal children aged 1 to 9 years, by state and territory, 2006, 2007 and 2008. State/territory and region Number of Community coverage Screening coverage Prevalence of active trachoma Communities Number of communities screened Number of children examined Children 1 to 9 years At Risk (2008) (% of Communities At Risk) (% of children in Communities At Risk) (% prevalence) 2006 2007 2008 2006 2007 2008 2006 2007 2008 Northern Territory Alice Springs 1 -- -- 1 (100%) -- -- 45 (22%) -- -- 18 (40%) Alice Springs Remote 30 25 (83%) 19 (63%) 18 (60%) 530 (35%) 231 (15%) 459 (29%) 94 (18%) 46 (20%) 157 (34%)* Barkly † 8 6 (67%) 6 (67%) 2 (25%) 105 (20%) 68 (13%) 87 (26%) 22 (21%) 18 (26%) 58 (67%)* Darwin Rural 16 15 (94%) 12 (75%) 11 (69%) 522 (27%) 377 (19%) 907 (45%) 84 (16%) 25 (7%) 183 (20%)* East Arnhem 12 12 (100%) 12 (100%) 4 (33%) 879 (78%) 465 (41%) 232 (20%) 22 (3%) 23 (5%) 10 (4%) Katherine † 20 11 (52%) 11 (52%) 7 (35%) 218 (12%) 562 (31%) 732 (50%) 65 (30%) 104 (19%) 287 (39%)* Total NT 87 69 (78%) 60 (67%) 43 (49%) 2254 (33%) 1703 (24%) 2462 (36%) 287 (13%) 216 (13%) 713 (29%)*

South Australia Ceduna/Koonibba 21 1 (5%) 1 (5%) 1 (5%) 18 (1%) 16 (1%) 121 (6%) 1 (6%) 1 (6%) 0 (0%) Nganampa 10 8 (80%) 4 (40%) 6 (60%) 27 (8%) 76 (23%) 167 (50%) 5 (19%) 10 (13%) 4 (2%)*

Oak Valley ‡ 2 2 (100%) 2 (100%) 2 (100%) 28 (108%) 34 (131%) 25 (93%) 7 (25%) 7 (21%) 2 (8%) Pika Wiya 33 5 (15%) -- 1 (3%) 51 (1%) -- 37 (1%) 6 (12%) -- 0 (0%)* Umoona Tjutagku 6 1 (17%) 1 (17%) 1 (17%) 6 (7%) 2 (2%) 15 (17%) 1 (17%) 0 (0%) 0 (0%) Total SA 72 17 (24%) 8 (11%) 11 (15%) 130 (1%) 128 (1%) 365 (4%) 20 (15%) 18 (14%) 6 (2%)*

Western Australia Goldfields 20 6 (30%) 10 (50%) 13 (65%) 231 (24%) 227 (23%) 238 (23%) 43 (19%) 8 (4%) 18 (8%)* Kimberley † 34 28 (82%) 25 (83%) 32 (94%) 1048 (51%) 1006 (58%) 1169 (55%) 192 (18%) 164 (16%) 175 (15%) Midwest 6 6 (100%) 5 (83%) 6 (100%) 167 (90%) 127 (68%) 122 (64%) 32 (19%) 28 (22%) 12 (10%)* Pilbara § 16 9 (56%) 14 (88%) 16 (100%) 273 (36%) 306 (40%) 294 (37%) 146 (53%) 50 (16%) 73 (25%)* Total WA 76 49 (64%) 54 (75%) 67 (88%) 1719 (43%) 1666 (45%) 1823 (44%) 413 (24%) 250 (15%) 278 (15%)*

Australia 235 135 (57%) 122 (52%) 121 (51%) 4103 (21%) 3497 (18%) 4650 (23%) 720 (18%) 484 (14%) 997 (21%)* -- Data not reported * p<0.05 = statistical significant change found between 2006 and 2008 using chi-square test † Barkly had nine Communities At Risk of trachoma in 2006 and 2007; Katherine had 21 Communities At Risk in 2006 and 2007; and Kimberley had 30 Communities At Risk in 2007 ‡ Communities in regions serviced by the Oak Valley ACCHS were reported with communities from the Tullawon ACCHS § Change in grading from 2007 Source: Data were collected by the HSAK program in NT, the EH&CDSSP in South Australia and Population Health Units in WA

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TREATMENT

Table 1.3 Reported treatment for trachoma, by state and territory, 2008. Communities Northern South Western Total Territory Australia Australia

Treated in compliance with CDNA guidelines* Community-based 9 26% 0 20 49% 29 38% Household-based 19 54% 0 21 51% 40 53% Strategy not reported † 7 20% 0 0 7 9% Total treated 35 0 41 76 Not treated in compliance with CDNA guidelines Children only 0 5 100% 9 82% 14 64% No treatment reported 6 100% 0 2 18% 8 36% Total not following CDNA 6 5 11 22 Total communities 41 5 52 98 Note: The Communicable Diseases Network Australia (CDNA) guidelines recommend that treatment of children and household or community contacts >6 months be completed in as short a timeframe as possible where population mobility is high * Includes two communities in the NT, one in SA and one in WA where active trachoma was found in children aged 10 to 14 years without being detected in children aged 1 to 9 years † Communities carried out treatment but the strategy was not reported Source: Data were collected by the HSAK program in NT, the EH&CDSSP in SA and Population Health Units in WA

Table 1.4 Timeliness of treatment for communities that treated all children, household and community contacts, by state and territory, 2008. State/territory Number (%) of communities With active Treated within 2 Treated trachoma* weeks of screening (%) (%) (%) Northern Territory 41/43 (95%) 14/41 (34%) 14/41 (34%) South Australia † 5/11 (45%) 0/5 (0%) 0/5 (0%) Western Australia 52/67 (78%) 27/52 (52%) 36/52 (69%) Australia 98/121 (81%) 41/98 (42%) 50/98 (51%) Note: Communities were included in the total if all people requiring treatment received treatment * Includes two communities in the NT, one in SA and one in WA where active trachoma was found in children aged 10 to 14 years without being detected in children aged 1 to 9 years † Although all children found to have active trachoma at the screening were treated, household and community contacts were not treated irrespective of the presence of trachoma Source: Data were collected by the HSAK program in NT, the EH&CDSSP in SA and Population Health Units in WA

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COMPARISONS OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

Table 1.5 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by region, state and territory, 2006, 2007 and 2008. State/territory and Prevalence of active trachoma Chi-square region 2006 2007 2008 test used to calculate % (95% CI) n % (95%CI) n % (95%CI) n significance Northern Territory Alice Springs -- -- 40% (27, 55) 45 Alice Springs Remote 18% (15, 21) 530 20% (15, 26) 231 34% (30, 39) 459 ↑ p<0.05 Barkly 21% (14, 30) 105 26% (17, 38) 68 67% (56, 76) 87 ↑ p<0.05 Darwin Rural 16% (13, 19) 522 7% (5, 10) 377 20% (18, 23) 907 ↑ p<0.05 East Arnhem 3% (2, 4) 879 5% (3, 7) 465 4% (2, 8) 232 p = 0.20 Katherine 30% (24, 36) 218 19% (16, 22) 562 39% (36, 43) 732 ↑ p<0.05 Total NT 13% (11, 14) 2254 13% (11, 14) 1703 29% (27, 31) 2462 ↑ p<0.05 South Australia Ceduna/Koonibba 6% (1, 26) 18 6% (1, 28) 16 0% (0, 3) 121 p = 0.05 Nganampa 19% (8,37) 27 13% (7,23) 76 2% (1, 6) 167 ↓ p<0.05 Oak Valley * 22% (9, 45) 18 13% (3, 36) 16 p = 1.00 Pika Wiya 12% (5,23) 51 NS 0% (0, 9) 37 ↓ p<0.05 Tullawon 25% (13,43) 28* 19% (7, 43) 16 0% (0, 30) 9 Umoona Tjutagku 17% (3, 56) 6 0% 2 0% (0, 20) 15 Total SA 15% (10,23) 130 14% (9,21) 128 2% (1, 4) 365 ↓ p<0.05 Western Australia Goldfields 19% (15, 25) 231 4% (2, 7) 227 8% (5, 12) 238 ↓ p<0.05 Kimberley 18% (16, 20) 1048 16% (14, 18) 1006 15% (13, 17) 1169 p = 0.51 Midwest 19% (14, 26) 167 22% (16, 30) 127 10% (6, 16) 122 ↓ p<0.05 Pilbara † 53% (47, 59) 273 16% (12, 21) 306 25% (21, 30) 294 ↑ p<0.05 Total WA 24% (22, 26) 1719 15% (13, 17) 1666 15% (13, 17) 1823 ↓ p<0.05

Australia 18% (17, 19) 4103 14% (13, 15) 3497 21% (20, 23) 4650 ↑ p<0.05 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table n = Number of children examined -- Data not reported p<0.05 = statistical significant change found between 2006 and 2008 using a chi-square test; comparisons could not be made for regions where <10 children were examined * Communities in the Oak Valley and Tullawon ACCHS were reported together in 2006, therefore these data could not be compared with 2007 and 2008 † Analysis could not be done with 2006 data because a different grading system was used in the Pilbara in 2006 Source: Data were collected by Healthy School Age Kids program in NT, the EH&CDSSP coordinator and the screening team in SA, and Population Health Units in WA

Table 1.6 Changes in the prevalence of active trachoma in Aboriginal children aged 1 to 9 years in communities where ≥10 children were examined, by state and territory for 2006, 2007 and 2008. State/territory Prevalence of active trachoma 2006–2008 Total Significant No change Significant decrease* increase* Northern Territory 2 (6%) 21 (64%) 10 (30%) 33 South Australia 0 6 (100%) 0 6 Western Australia 8 (21%) 26 (68%) 4 (11%) 38 Australia 10 (13%) 53 (69%) 14 (18%) 77 * Fisher’s test used to evaluate change; significant at p<0.05 Source: Data were collected by Healthy School Age Kids program in NT, the EH&CDSSP coordinator and the screening team in SA, and Population Health Units in WA

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TRICHIASIS

Table 1.7 Trichiasis screening of adults aged ≥30 years, by state and territory, 2008. Northern South Western Total Territory Australia Australia ABS projection Adults resident: in region * 16,307 16,281 10,183 42,771 in Communities At Risk * 11,249 16,281 7073 34,603 Trichiasis Communities from which data were 14/87 8/72 40/76 62/235 reported/Communities At Risk Adults examined 206 298 903 1407 With trichiasis (%) 26 (13%) 1 (0.3%) 25 (3%) 52 (4%) Trichiasis surgery within 12 months prior to the date 46 1 2 49 of reporting * Projected 2008 population data based on low series population grow rate in the NT, SA and WA Source: Data were collected by the HSAK program in NT, the EH&CDSSP in SA and Population Health Units in WA

TRACHOMA CONTROL ACTIVITIES

Table 1.8 Implementation of trachoma control activities (SAFE strategy), by state and territory, 2008. SAFE trachoma control activities Number (%) of communities from which Total trachoma control activities were reported Northern South Western Territory Australia Australia n % n % n % n % Surgery referral process for trichiasis 39 (91%) 4 (36%) 26 (39%) 69 (57%) Antibiotics distributed 35 (81%) 5 (45%) 50 (75%) 90 (74%) Facial cleanliness resources used 27 (63%) 1 (9%) 31 (46%) 59 (49%) Facial cleanliness programs implemented 32 (74%) 0 53 (79%) 85 (70%) Good environmental conditions 2 (5%) 0 9 (13%) 11 (9%) Total number of communities from which trachoma screening data were reported 43 11 67 121 Source: Data were collected by the HSAK program in NT, the EH&CDSSP in SA and Population Health Units in WA

14 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 2. NORTHERN TERRITORY

SUMMARY:

• Screening was conducted in the six regions that were categorised as being At Risk for trachoma in 2008.

• Of the 92 Aboriginal communities in the six regions, 87 communities (95%) were categorised as being At Risk for trachoma in 2008 and, of these, 43 (49%) were screened and reported data.

o Included in these communities was a community (town camp) in Alice Springs, previously categorised Not At Risk. After finding a 40% prevalence of active trachoma in children, this community was then re-categorised as At Risk. • The overall prevalence of active trachoma in the Northern Territory was 29%. o Five regions had a prevalence of active trachoma ≥5%.

o 35 communities (81%) had a prevalence of active trachoma ≥5%. • Of the 1493 children examined for facial cleanliness, 1004 (67%) had clean faces.

• Treatment was reported to have been distributed in compliance with the CDNA

guidelines in 35 of the 41 communities (85%) in which treatment for trachoma was indicated, including two communities where active trachoma was found in children aged 10 to 14 years.

• Trichiasis screening was carried out only in a few communities but the overall prevalence of trichiasis in those screened was 13%. • The Surgery and Antibiotic components of the SAFE trachoma control strategy were more comprehensively implemented compared to the Facial Cleanliness and Environmental improvements components.

This section presents a summary of trachoma data from the Northern Territory by region with community level data provided in Appendix A.

Trachoma data were provided for five trachoma endemic regions in the NT: Alice Springs Remote, Barkly, Darwin Rural, East Arnhem and the Katherine region (Figure 2.1). Data were also provided for town camps in the Alice Springs region which had not been screened previously because trachoma was not thought to be present.

Of the 92 communities in the six regions, 87 communities (95%) were categorised as being At Risk for trachoma and five (5%) were Not At Risk (Table 2.1). A community (town camp) in Alice Springs, previously categorised Not At Risk, was screened in 2008 and a prevalence of 40% of active trachoma in children was found; this community was then re-catergorised as At Risk. A total of 62 of the 87 Communities At Risk (71%) were screened in 2008 and data were provided for 43 (69%) (Figure 2.2 and Table 2.2). No data were received from 19 communities (31%) where screening was conducted; 14 (74%) of these communities were screened by the AGEI, and data for five (26%) were screened by the HSAK program. Data from the AGEI screening were not included because the staff conducting the screening had not received appropriate training and therefore the data were considered unreliable by NT authorities. Reports for five communities screened by HSAK could not be obtained. This led to a decrease in the number of communities that had prevalence data of active trachoma in 2008, particularly in the East Arnhem region (Table 2.2).

Overall, 35 of the 43 communities (81%) had a prevalence of active trachoma ≥5% (Table 2.2). In 2008, a greater proportion of communities were reported to have had a prevalence of active trachoma ≥5% compared to the 35 (49%) in 2006 and the 24 (40%) in 2007.

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Using the 2008 ABS low series population growth estimates, 6747 Aboriginal children aged 1 to 9 years were resident in Communities At Risk in the six regions (Table 2.3); the high series population growth estimates are also in Table 2.3. Of the children resident in Communities At Risk, 2462 (36%) were examined, and 713 were found to have active trachoma (prevalence = 29%, 95% CI, 27%−31%) (Table 2.3). Data for four of the seven communities (57%) in the Katherine region were for children aged 0 to 15 years – instead of 1 to 9 years – and age breakdowns were not provided.

Facial cleanliness data were provided for 30 of the 43 communities (70%) from which trachoma screening data were reported (Table 2.3); this was a marked increase from the 57% of communities reported in 2007. In 2008, nine communities (30%) found >80% of the children examined for facial cleanliness had clean faces (Table 2.4). Overall, 1004 children (67%) were reported to have clean faces (Table 2.3). The percentage of children with clean faces (by region) ranged from 27% to 89%.

Treatment was reported to have been distributed in 35 of the 41 communities (85%) in which treatment for trachoma was indicated (Table 2.5), including two communities where active trachoma was found in children aged 10 to 14 years without being detected in children aged 1 to 9 years. Overall, 35 communities treated according to the CDNA guidelines, community-based treatment was given in nine communities (26%), household-based treatment in 19 (54%) and the treatment strategy was not reported for seven (20%). No treatment data were reported for the remaining six communities where treatment for trachoma was indicated. Overall, 3940 of the people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members. Of the total number of people treated, 871 were treated in four communities in the Katherine region, the number of people requiring treatment was not provided (Table 2.5).

A comparison of prevalence of active trachoma from 2006 to 2008 found a statistically significant increase (p<0.05) in all regions except East Arnhem (Table 2.6). Comparisons were not possible for four of the 43 communities (9%) because data were reported for children aged 0 to 15 years. Comparisons were made for 33 communities where ≥10 children were examined in two or more years (Table 2.7). No change in prevalence was found in 21 communities (64%), a statistically significant increase (p<0.05) was found in 10 (30%) and a decrease (p<0.05) was found in two (6%). In 2007, comparisons could only be made for 20 communities: no change in prevalence was found in 10 (50%), a statistically significant increase (p<0.05) was found in six (30%) and a decrease (p<0.05) was found in four (20%).

In 2008 screening for trichiasis was conducted by ophthalmologists during specialist outreach visits; however, data were only provided for the Alice Springs Remote and Barkly regions. Data were provided for 14 of the 87 Communities At Risk in 2008 (16%). Of the 11,592 Aboriginal adults aged ≥30 years in Communities At Risk, 206 (2%) were examined for trichiasis and 26 (13%) were found to have trichiasis (Table 2.8). Forty-six adults were reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting. In 2007, screening for trichiasis was only reported for the Katherine region where no trichiasis was found.

In 2008 the SAFE trachoma control strategy was partially implemented in the 43 communities where screening was conducted and reported. Most communities, 39 (91%), had a referral process for trichiasis surgery and 32 (74%) had programs to promote facial cleanliness (Table 2.9). Overall, antibiotics for active trachoma were reported to have been distributed in 35 communities (74%). The majority of communities, 39 (91%), had no information reported about their environmental condition or improvements being made. Although little information has been reported about environmental improvements, a swimming program in the NT (Swimming NT) receives government funding to develop swimming and water safety skills in remote Aboriginal communities. There are 20 swimming pools in the 92 communities (23%) in the NT. Research has found that swimming pools in remote Aboriginal communities have important health and social benefits. 24

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Figure 2.1 Prevalence of active trachoma (number of children aged 1 to 9 years examined) and the number of communities where trachoma data were reported in NT regions, 2008. Source: Data were collected by the Healthy School Age Kids program

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SCREENING FOR ACTIVE TRACHOMA

Table 2.1 Number of communities screened for trachoma, by trachoma risk status and region, NT, 2008. Communities Number (%) of communities Total Alice Alice Barkly Darwin East Katherine Springs Springs Rural Arnhem Remote Not At Risk Screened 0 0 0 0 0 0 0 Not screened 0 0 1 (100%) 1 (100%) 1 (100%) 2 (100%) 5 (100%) Total Not At Risk 0 0 1 1 1 2 5 At Risk Screened with no trachoma found 0 3 (10%) 0 0 0 1 (5%) 4 (5%) Screened with trachoma found 1 (100%) 15 (50%) 2 (25%) 11 (69%) 4 (33%) 6 (30%) 39 (45%) Reported screened but no data received 0 6 (20%) 4 (50%) 2 (13%) 7 (58%) 0 19 (22%) Should have been screened but were not 0 6 (20%) 2 (25%) 3 (19%) 1 (8%) 13 (65%) 25 (29%) Total At Risk 1 30 8 16 12 20 87 Total communities 1 30 9 17 13 22 92 Source: Data were collected by the Healthy School Age Kids program

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100% Not At Risk - Not screened 90% 80% At Risk - Data not reported 70% At Risk - Screened 60% 50% 40% 30% 20%

Percentage of communities communities Percentageof 10% 0%

30) 22) = = n (n (n=17) (n=13) ( m te ne rings (n=1) arkly (n=9) he ri p B n S the Remo Ar a K gs Alice East rin Darwin Rural p ce S li A Region (n=number of communities)

Figure 2.2 Screening of communities in NT regions, 2008. Source: Data were collected by the Healthy School Age Kids program

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Table 2.2 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by trachoma risk status and region, NT, 2006, 2007 and 2008. Community status Number (%) of communities Total Alice Alice Barkly Darwin East Katherine Springs Springs Rural Arnhem Remote 2006 Data Not At Risk and not screened 1 0 0 0 0 0 1 in 2006 Not screened in 2006 0 0 0 0 0 0 0 Status not reported in 2006* 0 5 3 2 1 11 22 Screened and reported in 0 27 6 16 12 11 72 2006 Prevalence 0% 0 11 (41%) 3 (50%) 7 (44%) 4 (33%) 5 (45%) 30 (42%) 1 to <5% 0 2 (7%) 1 (17%) 0 4 (33%) 0 7 (10%) 5 to <10% 0 1 (4%) 0 2 (13%) 4 (33%) 0 7 (10%) 10 to <20% 0 4 (15%) 0 1 (6%) 0 1 (9%) 6 (8%) 20 to <50% 0 7 (26%) 1 (17%) 3 (19%) 0 1 (9%) 12 (17%) ≥ 50% 0 2 (7%) 1 (17%) 3 (19%) 0 4 (36%) 10 (14%) Total 1 32 9 18 13 22 95 2007 Data Not At Risk and not screened 1 0 0 0 1 1 3 in 2007 Screened but not reported in 0 3 0 1 0 0 4 2007 Not screened in 2007 0 8 3 4 0 10 25 Screened and reported in 0 19 6 12 12 11 60 2007 Prevalence 0% 0 10 (53%) 4 (67%) 5 (42%) 7 (58%) 3 (27%) 29 (48%) 1 to <5% 0 1 (5%) 0 2 (17%) 3 (25%) 1 (9%) 7 (12%) 5 to <10% 0 1 (5%) 0 2 (17%) 0 1 (9%) 4 (7%) 10 to <20% 0 1 (5%) 0 2 (17%) 2 (17%) 3 (27%) 8 (13%) 20 to <50% 0 5 (26%) 2 (33%) 1 (8%) 0 3 (27%) 11 (18%) ≥ 50% 0 1 (5%) 0 0 0 0 1 (2%) Total 1 30 † 9 17 ‡ 13 22 92 2008 Data Not At Risk and not screened 0 0 1 1 1 2 5 in 2008 Screened but not reported in 0 6 4 2 7 0 19 2008 Not screened in 2008 0 6 2 3 1 13 25 Screened and reported in 1 18 2 11 4 7 43 2008 Prevalence 0% 0 3 (17%) 0 0 0 1 (14%) 4 (9%) 1 to <5% 0 1 (6%) 0 1 (9%) 2 (50%) 0 4 (9%) 5 to <10% 0 1 (6%) 0 1 (9%) 2 (50%) 0 4 (9%) 10 to <20% 0 3 (17%) 0 3 (27%) 0 0 6 (14%) 20 to <50% 1 100%) 4 (22%) 0 6 (55%) 0 5 (71%) 16 (37%) ≥ 50% 0 6 (33%) 2 (100%) 0 0 1 (14%) 9 (21%) Total 1 30 † 9 17 ‡ 13 22 92 * In 2006 no data were available for these communities and no additional information was available † In 2007 and 2008, data from two communities were combined with another community from the same location ‡ In 2007 and 2008, data from one community was combined with another community from the same location Source: Data were collected by the Healthy School Age Kids program

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Table 2.3 Number of resident Aboriginal children aged 1 to 9 years, and number examined for active trachoma and facial cleanliness, by region, NT, 2008. Alice Springs Alice Springs Barkly Darwin Rural East Arnhem Katherine Total Remote Population data Children resident: in region* 954 (956) 1817 (1821) 661 (662) 2146 (2150) 1916 (1920) 1991 (1995) 9485 (9504) in Communities At Risk * 201 (201) 1577 (1580) 341 (342) 2013 (2017) 1155 (1157) 1460 (1463) 6747 (6760) in Communities At Risk from which data 112 1254 167 2602 724 1367 ‡ 6226 were reported †

Active trachoma Communities from which data were 1/1 18/30 2/8 11/16 4/12 7/20 ‡ 43/87 reported/Communities At Risk Children resident in Communities At Risk (% 201 (21%) 1577 (87%) 341 (52%) 2013 (94%) 1155 (60%) 1460 (73%) 6747 (71%) of children resident in region) Children examined (% of those currently 45 (22%) 459 (29%) 87 (26%) 907 (45%) 232 (20%) 732 (50%) 2462 (36%) resident in Communities At Risk) Active trachoma (%) 18 (40%) 157 (34%) 58 (67%) 183 (20%) 10 (4%) 287 (39%) 713 (29%)

Facial cleanliness Communities from which data were 1/1 18/30 2/8 5/16 2/12 2/20 30/87 reported/Communities At Risk Children examined 45 468 87 627 133 133 1493 Clean faces (%) 12 (27%) 222 (47%) 42 (48%) 497 (79%) 112 (84%) 119 (89%) 1004 (67%)

* Projected 2008 population data based on the ABS 1.4% low series (1.6% high series) population growth rate in the NT † Number of children in Communities At Risk, from which data were reported, were provided by the Healthy School Age Kids program ‡ In four of the seven communities age breakdowns were not provided for children who were examined; data for children aged 0–15 years were reported Source: Data regarding active trachoma and clean faces were collected by the Healthy School Age Kids program

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Table 2.4 Prevalence of Aboriginal children aged 1 to 9 years with clean faces, by region, NT, 2008. Community prevalence of clean faces Number (%) of communities with children with clean faces Total Alice Alice Barkly Darwin East Katherine Springs Springs Rural Arnhem Remote Not At Risk and not screened in 2008 0 0 1 1 1 2 5 Screened but not reported in 2008 0 6 4 8* 7 5 † 30 Not screened in 2008 0 6 2 3 3 13 27 Screened and reported in 2008 1 18 2 5 2 2 30 Prevalence 0 to 10% 0 3 (17%) 0 0 0 0 3 (10%) 11 to 20% 0 2 (11%) 0 0 0 0 2 (7%) 21 to 40% 1 (100%) 2 (11%) 1 (50%) 0 0 0 4 (13%) 41 to 60% 0 7 (39%) 0 0 1 (50%) 0 8 (27%) 61 to 80% 0 2 (11%) 1 (50%) 1 (20%) 0 0 4 (13%) 81 to 90% 0 1 (6%) 0 1 (20%) 0 1 (50%) 3 (10%) 91 to 100% 0 1 (6%) 0 3 (60%) 1 (50%) 1 (50%) 6 (20%) Total 1 30 9 17 13 22 92 * For six of the eight communities the children who were examined for active trachoma were also reported to have been examined for clean faces; however, the number of children with clean faces was not provided † For one of the five communities the children who were examined for active trachoma were also reported to have been examined for clean faces; however, the number of children with clean faces was not provided Source: Data were collected by the Healthy School Age Kids program

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TREATMENT

Table 2.5 Active trachoma treatment strategies and timeliness of treatment of children, households and community contacts, by region, NT, 2008. Alice Alice Springs Barkly Darwin East Katherine Total Springs Remote Rural Arnhem Treatment strategy Community-based 0 4 (22%) 2 (100%) 2 (18%) 0 1 (14%) 9 (21%) Household-based 1 (100%) 9 (50%)* 0 6 (55%) 2 (50%) 1 (14%)* 19 (44%) Strategy not reported 0 1 (6%) 0 1 (9%) 1 (25%) 4 (57%) 7 (16%) Children only 0 0 0 0 0 0 0 No treatment reported 0 2 (11%) 0 2 (18%) 1 (25%) 1 (14%) 6 (14%) No treatment required 0 2 (11%) 0 0 0 0 2 (5%) Total communities 1 18 2 11 4 7 43 Total number of people to be treated 315 2243 519 1035 119 629 4860 † Treated within 2 weeks (%) 263 (83%) 526 (23%) 424 (82%) 361 (35%) 39 (33%) 42 (7%) 1655 (34%) Total treated (%) 263 (83%) 1608 (72%) 424 (82%) 622 (60%) 110 (92%) 913 † 3940 † * Includes a community where active trachoma was found in children aged 10 to 14 without being detected in children aged 1 to 9 years † ‘Total treated’ includes 871 people who were treated in four communities in the Katherine region, the number of people requiring treatment was not provided therefore not included (n=4860) Source: Data were collected by the Healthy School Age Kids program

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

Table 2.6 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by region, NT, 2006, 2007 and 2008. Region Prevalence of active trachoma Chi-square 2006 2007 2008 test used to Communities = 72 Communities = 60 Communities = 43 calculate significance % (95% CI) n % (95%CI) n % (95%CI) n Alice Springs -- -- 40% (27, 55) 45 Alice Springs Remote 18% (15, 21) 530 20% (15, 26) 231 34% (30, 39) 459 ↑ p<0.05 Barkly 21% (14, 30) 105 26% (17, 38) 68 67% (56, 76) 87 ↑ p<0.05 Darwin Rural 16% (13, 19) 522 7% (5, 10) 377 20% (18, 23) 907 ↑ p<0.05 East Arnhem 3% (2, 4) 879 5% (3, 7) 465 4% (2, 8) 232 p=0.20 Katherine 30% (24, 36) 218 19% (16, 22) 562 39% (36, 43) 732 ↑ p<0.05 Total 13% (11, 14) 2254 13% (11, 14) 1703 29% (27, 31) 2462 ↑ p<0.05 n = Number of children examined -- Data not reported Source: Data were collected by Healthy School Age Kids program

Table 2.7 Significant differences in the prevalence of active trachoma in Aboriginal children aged 1 to 9 years (2006–2008) in communities where ≥10 children were examined, by region, NT. Region Significant differences in the prevalence of active Total trachoma 2006–2008 Significant No change Significant decrease* increase* Alice Springs Remote 0 10 (71%) 4 (29%) 14 Barkly 0 1 (50%) 1 (50%) 2 Darwin Rural 1 (14%) 3 (43%) 3 (43%) 7 East Arnhem 0 7 (88%) 1 (13%) 8 Katherine 1 (50%) 0 1 (50%) 2 Total 2 (6%) 21 (64%) 10 (30%) 33 * Fisher’s test used to evaluate change; significant at p<0.05 Source: Data were collected by the Healthy School Age Kids program

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TRICHIASIS

Table 2.8 Trichiasis screening of Aboriginal adults aged ≥30 years, by region, NT, 2008. Alice Alice Barkly Darwin East Katherine Total Springs Springs Rural Arnhem Remote ABS projection Adults resident: in region * 1838 3521 1301 3297 3309 3041 16,307 (1842) (3528) (1304) (3304) (3316) (3047) (16,341) in Communities At 514 3010 542 3173 2315 2038 11,592 Risk* (515) (3016) (543) (3179) (2320) (2042) (11,615) Trichiasis Communities from 0/1 12/30 2/8 0/16 0/12 0/20 14/87 which data were reported/Communities At Risk Adults examined (% of -- 183 (6%) 23 (4%) ------206 (2%) the resident adults in Communities At Risk – ABS low series) Trichiasis (%) -- 23 (13%) 3 (13%) ------26 (13%) Offered an ophthalmic -- 183 23 ------206 consultation within 6 months of screening † Trichiasis surgery -- 36 3 7 -- -- 46 within 12 months prior to the date of reporting

-- Data not reported * Projected 2008 population data based on the ABS 1.4% low series (1.6% high series) population growth rate in NT † Adults were seen by an ophthalmologist during specialist outreach visits Source: Data regarding trichiasis were collected by eye health professionals as part of specialist outreach visits

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TRACHOMA CONTROL ACTIVITIES

Table 2.9 Implementation of trachoma control activities (SAFE strategy) by region, NT, 2008. SAFE trachoma control Number (%) of communities Total activities Alice Alice Barkly Darwin East Katherine Springs Springs Rural Arnhem Remote

Surgery for trichiasis Referral process 1 (100%) 18 (100%) 2 (100%) 11 (100%) 4 (100%) 3 (43%) 39 (91%) available No referral process 0 0 0 0 0 0 0 Referral process 0 0 0 0 0 0 0 unknown Not reported 0 0 0 0 0 4 (57%) 4 (9%) Subtotal 1 (100%) 18 (100%) 2 (100%) 11 (100%) 4 (100%) 7 (100%) 43 (100%) Antibiotics Treated within 2 weeks 0 7 (39%) 0 5 (45%) 2 (50%) 1 (14%) 15 (35%) of the screening Treated but not within 2 1 (100%) 7 (39%) 2 (100%) 4 (36%) 1 (25%) 5 (71%) 20 (47%) weeks of the screening No treatment 0 2 (11%) 0 0 0 0 2 (5%) Treatment unknown 0 0 0 0 0 0 0 Not reported 0 2 (11%) 0 2 (18%) 1 (25%) 1 (14%) 6 (14%) Subtotal 1 (100%) 18 (100%) 2 (100%) 11 (100%) 4 (100%) 7 (100%) 43 (100%) Facial cleanliness resources Available and used 0 15 (83%) 2 (100%) 7 (64%) 2 (50%) 1 (14%) 27 (63%) Available but not used 0 0 0 2 (18%) 0 1 (14%) 3 (7%) Not available 1 (100%) 0 0 0 0 0 1 (2%) Not known 0 2 (11%) 0 1 (9%) 0 1 (14%) 4 (9%) Not reported 0 1 (6%) 0 1 (9%) 2 (50%) 4 (57%) 8 (19%) Subtotal 1 (100%) 18 (100%) 2 (100%) 11 (100%) 4 (100%) 7 (100%) 43 (100%) Facial cleanliness programs Available 0 16 (89%) 2 (100%) 9 (82%) 2 (50%) 3 (43%) 32 (74%) Not available 1 (100%) 0 0 0 0 0 1 (2%) Not known 0 2 (11%) 0 2 (18%) 2 (50%) 0 6 (14%) Not reported 0 0 0 0 0 4 (57%) 4 (9%) Subtotal 1 (100%) 18 (100%) 2 (100%) 11 (100%) 4 (100%) 7 (100%) 43 (100%) Environmental conditions Generally good 0 1 (6%) 0 1 (9%) 0 0 2 (5%) conditions Variable conditions but 0 0 1 (50%) 0 0 0 1 (2%) improvements are being made Very poor conditions 0 1 (6%) 0 0 0 0 1 (2%) Not known 0 0 0 0 0 0 0 Not reported 1 (100%) 16 (89%) 1 (50%) 10 (91%) 4 (100%) 7 (100%) 39 (91%) Subtotal 1 (100%) 18 (100%) 2 (100%) 11 (100%) 4 (100%) 7 (100%) 43 (100%) Total number of communities from which trachoma screening data were reported 1 18 2 11 4 7 43 Source: Data were collected by the Healthy School Age Kids program

26 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 3. SOUTH AUSTRALIA

SUMMARY:

• Results from South Australia should be interpreted with caution because few

communities were visited and 365/9218 children (4%) were examined.

• Six regions serviced by Aboriginal Community Controlled Health Services examined children during school visits.

• Of the 72 Aboriginal communities in these regions, all were categorised as being At

Risk for trachoma as no screening had been done to confirm otherwise.

o 11 communities (15%) were visited.

• The overall prevalence of active trachoma in South Australia was 2%.

o One region (17%) had a prevalence of active trachoma ≥5%.

o Three communities (27%) had a prevalence of active trachoma ≥5%.

• Of the 365 children examined for facial cleanliness, 260 (71%) had clean faces.

• Treatment was reported to have been distributed in all five of the communities in

which treatment for trachoma was indicated, including one community where active trachoma was found in a child aged 10 to 14 years. o Treatment was given to all children with active trachoma. CDNA treatment guidelines were not followed as household or community treatment was not given irrespective of the presence of trachoma. This was similar to 2006 and 2007. • Trichiasis screening was carried out only in a few communities and the overall prevalence of trichiasis in those screened was 0.3%. • In 2008 brief information was reported on the implementation of the SAFE trachoma control strategy unlike 2007 where no information was reported.

This section presents a summary of trachoma data from South Australia by ACCHS with community level data provided in Appendix B.

Data from South Australia present a number of difficulties as these data were not collected as part of a trachoma screening program. Data were reported for a relatively small number of children and there was variation with the combination or pooling of community data in 2006. 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 data for one round of screening were provided even though some communities were visited twice.

Trachoma data were provided for trachoma endemic regions serviced by six Aboriginal Community Controlled Health Services (ACCHS) and funded by the Eye Health and Chronic Diseases Specialist Support Program (EH&CDSSP) (Figure 3.1): • Ceduna/Koonibba • Nganampa • Oak Valley (Maralinga Tjarutja) • Pika Wiya • Tullawon and • Umoona Tjutagku

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The total number of communities in the Ceduna/Koonibba region included those from the Eyre school district; this incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted. Communities in the Pika Wiya region included those from the Flinders school district, and two communities from the Northern country school district (Port Augusta and Whyalla) which were reassigned by the EH&CDSSP coordinator.

All 72 communities in the six ACCHS were categorised as being At Risk for trachoma (Table 3.1), and 11 of these communities (15%) were screened and reported data in 2008. (Figure 3.2 and Table 3.3).

Overall, three of the 11 communities (27%) had a prevalence of active trachoma ≥5% (Table 3.3). Although more communities had ≥5% prevalence in 2006 (76%) and 2007 (50%), few children were examined in all years which makes comparisons difficult (Table 3.2).

Using the 2008 ABS low series population growth estimates, 9218 Aboriginal children aged 1 to 9 years were resident in Communities At Risk in regions serviced by the six ACCHS (Table 3.4); the high series population growth estimates are also in Table 3.4. Of the children resident in Communities At Risk, 365 children (4%) were examined, and six were found to have active trachoma (prevalence = 2%, 95% CI, 1%−4%) (Table 3.6).

Facial cleanliness data were provided for all 11 communities that examined children for trachoma. In four communities (36%), >80% of the children examined for facial cleanliness had clean faces (Table 3.5). Overall, 260 children (71%) had clean faces (Table 3.4). The percentage of children with clean faces (by ACCHS) ranged from 0% to 100%.

Treatment was reported to have been distributed in all five of the communities in which treatment for trachoma was indicated; including one community where active trachoma was found in children aged 10 to 14 years without being detected in children aged 1 to 9 years. Treatment was given to all seven children who were examined and found to have active trachoma. CDNA treatment guidelines were not followed as household or community treatment was not given irrespective of the presence of trachoma. For this reason there are no tables for treatment data in SA.

A comparison of prevalence of active trachoma from 2006 to 2008 found no change in prevalence for four ACCHS regions (67%) and a statistically significant decrease (p<0.05) in two (33%) (Table 3.6). Comparisons were made for six communities where ≥10 children were examined in two years; however no change in prevalence was found (Table 3.7 and Appendix Figure 2.1). An analysis could not be done with 2006 data for four communities as data were combined. In 2007, comparisons were made for three communities, two of which were combined and no change in prevalence was found.

In 2008, screening for trichiasis was reported for communities in regions serviced by three of the ACCHS (Table 3.8). Of the 16,281 Aboriginal adults aged ≥30 years in Communities At Risk, 298 (2%) were examined for trichiasis, and one case of trichiasis was found (0.3%). One adult was reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting.

In 2008 brief information was reported on the implementation of SAFE trachoma control activities in the 11 communities that were visited (Table 3.9), although this was an improvement from no data that were reported in 2007. In 2008, four communities (36%) had a referral process for trichiasis surgery. Five communities (45%) had antibiotics for active trachoma distributed within two weeks of the screening to children only. Only one community (9%) reported using resources to promote facial cleanliness, while no communities reported the use of programs to promote clean faces. There was also no information reported about environmental conditions or improvements being made in the communities.

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Figure 3.1 Prevalence of active trachoma (number of children aged 1 to 9 years examined) and the number of communities where trachoma data were reported in regions serviced by SA ACCHS, 2008. Source: Data were collected by the EH&CDSSP coordinator and the screening team The total number of communities in the Ceduna/Koonibba region includes communities in the Eyre school district (located south east of the Ceduna/Koonibba Health Service) and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted The total number of communities in the Pika Wiya region includes communities in the Flinders school district and two from the Northern Country school district which were reassigned by the EH&CDSSP coordinator

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SCREENING FOR ACTIVE TRACHOMA

Table 3.1 Number of communities screened for trachoma, by trachoma risk status and ACCHS, SA, 2008. Communities Number (%) of communities Total Ceduna/ Nganampa Oak Valley Pika Tullawon Umoona

Koonibba* Wiya † Tjutagku Not At Risk Screened 0 0 0 0 0 0 0 Not screened 0 0 0 0 0 0 0 Total Not At Risk 0 0 0 0 0 0 0 At Risk Screened with no trachoma found 1 (5%) 3 (30%) 0 1 (3%) 1 (100%) 1 (17%) 7 (10%) Screened with trachoma found 0 3 (30%) 1 (100%) 0 0 0 4 (6%) Reported screened but no data received 0 0 0 0 0 0 0 Should have been screened but were not 20 (95%) 4 (40%) 0 32 (97%) 0 5 (83%) 61 (85%) Total At Risk 21 10 1 33 1 6 72 Total communities 21 10 1 33 1 6 72

* Includes communities in the Eyre school district in SA and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted † Includes communities in the Flinders school district in SA and two from the Northern Country school district which were reassigned by the EH&CDSSP coordinator Source: Data were collected by the EH&CDSSP coordinator and the screening team

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100% 90% Not At Risk - Data not reported 80% 70% At Risk - Screened 60% 50% 40% 30% 20% Percentage of communities communities Percentageof 10% 0%

) ) 0) 33) =1 =1 = n=6) ( (n (n n (n u ey (n=1) ya all wo mpa V oonibba (n=21 ak Tulla /K O Pika Wi a Ngana dun moona Tjutagk U Ce Region (n=number of communities)

Figure 3.2 Screening of communities in SA ACCHS, 2008. Source: Data were collected by the EH&CDSSP coordinator and the screening team

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Ceduna/ Koonibba Nganampa Oak Valley * Pika Wiya Tullawon Umoona Tjutagku Total S1 S2 S1 S2 S1 S2 S1 S2 S1 S2 S1 S2 S1 S2 2006 Data Not At Risk and not 0 0 0 0 0 0 0 0 0 0 0 0 screened in 2006 Not screened in 2006 0 0 0 0 0 1 0 0 0 0 0 1 Status not reported in 20 21 2 2 28 28 0 0 5 5 55 56 † 2006 Screened and reported 1 0 3 3 2 1 1 1 1 1 8 6 in 2006 Prevalence 0% 0 0 0 1 (33%) 0 0 0 0 0 1 (100%) 0 2 (33%) 1 to <5% 0 0 0 0 0 0 0 0 0 0 0 0 5 to <10% 1 (100%) 0 0 0 1 (50%) 1 (100%) 0 0 0 0 2 (25%) 1 (17%) 10 to <20% 0 0 2 (67%) 1 (33%) 0 0 0 1 (100%) 1 (100%) 0 3 (38%) 2 (33%) 20 to <50% 0 0 1 (33%) 1 (33%) 1 (50%) 0 1 (100%) 0 0 0 3 (38%) 1 (17%) ≥ 50% 0 0 0 0 0 0 0 0 0 0 0 0 ‡ ‡ § § Total 21 21 5 5 30 30 1* 1* 6 6 63 62 2007 Data Not At Risk and not 0 0 0 0 0 0 0 0 0 0 0 0 0 0 screened in 2007 Not screened in 2007 20 21 6 6 0 1 33 33 0 0 5 5 64 66 Screened and reported 1 0 4 4 1 0 0 0 1 1 1 1 8 6 in 2007 Prevalence 0% 0 0 1 (25%) 1 (25%) 0 0 0 0 0 0 1 (100%) 1 (100%) 2 (25%) 2 (33%) 1 to <5% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 to <10% 1 (100%) 0 1 (25%) 0 0 0 0 0 0 0 0 0 2 (25%) 0 10 to <20% 0 0 1 (25%) 1 (25%) 0 0 0 0 1 (100%) 1 (100%) 0 0 2 (25%) 2 (33%) 20 to <50% 0 0 1 (25%) 1 (25%) 1 (100%) 0 0 0 0 0 0 0 2 (25%) 1 (17%) ≥ 50% 0 0 0 1 (25%) 0 0 0 0 0 0 0 0 0 1 (17%) Total 21 21 10 10 1 1 33 33 1 1 6 6 72 72 * In 2006 data from the community serviced by the Oak Valley ACCHS were reported with the community serviced by the Tullawon ACCHS † In 2006 no data were available for these communities and no additional information was available ‡ In 2006, data for eight communities were reported as two groups of three communities and one pair § In 2006, data for four communities were reported as one community Source: Data were collected by the EH&CDSSP coordinator and the screening team

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Table 3.3 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by trachoma risk status and ACCHS, SA, 2008.

Community status Number (%) of communities Total Ceduna/ Nganampa Oak Valley Pika Wiya Tullawon Umoona Koonibba Tjutagku 2008 Data Not At Risk and not screened in 0 0 0 0 0 0 0 2008 Screened but not reported in 2008 0 0 0 0 0 0 0 Not screened in 2008 20 4 0 32 0 5 61

Screened and reported in 2008 1 6 1 1 1 1 11 Prevalence 0% 1 (100%) 3 (50%) 0 1 (100%) 1 (100%) 1 (100%) 7 (64%) 1 to <5% 0 1 (17%) 0 0 0 0 1 (9%) 5 to <10% 0 2 (33%) 0 0 0 0 2 (18%) 10 to <20% 0 0 1 (100%) 0 0 0 1 (9%) 20 to <50% 0 0 0 0 0 0 0 ≥ 50% 0 0 0 0 0 0 0 Total 21 10 1 33 1 6 72 Source: Data were collected by the EH&CDSSP coordinator and the screening team

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Table 3.4 Number of resident Aboriginal children aged 1 to 9 years, and number examined for active trachoma and facial cleanliness, by ACCHS, SA, 2008.

Ceduna/ Nganampa Oak Valley Pika Wiya † Tullawon Umoona Total Koonibba * Tjutagku Population data Children resident: in ACCHS region‡ 2083 (2104) 334 (337) 9 (9) 6687 (6754) 18 (18) 87 (88) 9218 (9310) in Communities At Risk‡ 2083 (2104) 334 (337) 9 (9) 6687 (6754) 18 (18) 87 (88) 9218 (9310) in Communities At Risk from which data 121 221 41 194 34 -- 611 were reported § Active trachoma Communities from which data were 1/21 6/10 1/1 1/33 1/1 1/6 11/72 reported/Communities At Risk Children resident in Communities At Risk (% 2083 (100%) 334 (100%) 9 (100%) 6687 (100%) 18 (100%) 87 (100%) 9218 (100%) of children resident in region) Children examined (% of those currently 121 (6%) 167 (50%) 16 (178%) 37 (1%) 9 (50%) 15 (17%) 365 (4%) resident in Communities At Risk) Active trachoma (%) 0 (0%) 4 (2%) 2 (13%) 0 (0%) 0 (0%) 0 (0%) 6 (2%) Facial cleanliness Communities from which data were 1/21 6/10 1/1 1/33 1/1 1/6 11/72 reported/Communities At Risk Children examined 121 167 16 37 9 15 365 Clean faces (%) 121 (100%) 78 (47%) 0 (0%) 37 (100%) 9 (100%) 15 (100%) 260 (71%) Note: All communities in SA were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same -- Data not reported * Includes Aboriginal children from communities in the Eyre school district and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted † Includes Aboriginal children from communities in the Flinders school district and two from the Northern Country school district which were reassigned by the EH&CDSSP coordinator ‡ Projected 2008 population data based on the ABS 1.9% low series (2.9% high series) population growth rate in SA § Number of children in Communities At Risk from which data were reported were provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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Table 3.5 Prevalence of Aboriginal children aged 1 to 9 years with clean faces, by ACCHS, SA, 2008. Community prevalence of clean Number (%) of communities with children with clean faces Total faces Ceduna/ Nganampa Oak Valley Pika Wiya Tullawon Umoona Koonibba Tjutagku Not At Risk and not screened in 2008 0 0 0 0 0 0 0 Screened but not reported in 2008 0 0 0 0 0 0 0 Not screened in 2008 20 4 0 32 0 5 61 Screened and reported in 2008 1 6 1 1 1 1 11 Prevalence 0 to 10% 0 0 1 (100%) 0 0 0 1 (9%) 11 to 20% 0 0 0 0 0 0 0 21 to 40% 0 3 (50%) 0 0 0 0 3 (27%) 41 to 60% 0 2 (33%) 0 0 0 0 2 (18%) 61 to 80% 0 1 (17%) 0 0 0 0 1 (9%) 81 to 90% 0 0 0 0 0 0 0 91 to 100% 1 (100%) 0 0 1 (100%) 1 (100%) 1 (100%) 4 (36%) Total 21 10 1 33 1 6 72 Source: Data were collected by the EH&CDSSP coordinator and the screening team

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

Table 3.6 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, from Screening 1, by ACCHS, SA, 2006, 2007 and 2008. Aboriginal Prevalence of active trachoma Chi-square Community 2006 2007 2008 test used to Controlled Health Communities = 17 Communities = 8 Communities = 11 calculate Service significance % (95% CI) n % (95%CI) n % (95%CI) n Ceduna/Koonibba 6% (1, 26) 18 6% (1, 28) 16 0% (0, 3) 121 p = 0.05 Nganampa 19% (8,37) 27 13% (7,23) 76 2% (1, 6) 167 ↓ p<0.05 Oak Valley * 22% (9, 45) 18 13% (3, 36) 16 P = 1.00 Pika Wiya 12% (5,23) 51 NS 0% (0, 9) 37 ↓ p<0.05 Tullawon 25% (13,43) 28 19% (7, 43) 16 0% (0, 30) 9 Umoona Tjutagku 17% (3, 56) 6 0% 2 0% (0, 20) 15 Total 15% (10,23) 130 14% (9,21) 128 2% (1, 4) 365 ↓ p<0.05 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NS = Not screened * Reported with the community screened by the Tullawon ACCHS in 2006 Source: Data were collected by the EH&CDSSP coordinator and the screening team

Table 3.7 Significant differences in the prevalence of active trachoma in Aboriginal children aged 1 to 9 years (2006–2008) in communities where ≥10 children were examined, by SA ACCHS, SA. Aboriginal Community Significant differences in the prevalence of active Total Controlled Health trachoma 2006–2008 Service Significant No change Significant decrease* increase* Ceduna/Koonibba 0 1 (100%) 0 1 Nganampa 0 3 (100%) 0 3 Oak Valley 0 1 (100%) 0 1 Pika Wiya 0 1 (100%) 0 1 Tullawon 0 0 0 0 Umoona Tjutagku 0 0 0 0 Total 0 6 (100%) 0 6 * Fisher’s test used to evaluate change; significant at p<0.05 Source: Data were collected by the EH&CDSSP coordinator and the screening team

36 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

TRICHIASIS

Table 3.8 Trichiasis screening of Aboriginal adults aged ≥30 years, by ACCHS, SA, 2008.

Ceduna/ Nganampa Oak Pika Tullawon Umoona Total Koonibba * Valley Wiya † Tjutagku ABS projection Adults resident: in ACCHS region ‡ 3568 673 34 11772 28 206 16281 (3604) (680) (34) (11890) (28) (208) (16444)

in Communities At 3568 673 34 11772 28 206 16281 Risk ‡ (3604) (680) (34) (11890) (28) (208) (16444)

Trichiasis Communities from 0/21 6/10 0/1 1/33 0/1 1/6 8/72 which data were reported/Communities At Risk Adults examined (% of -- 221 (33%) -- 26 (0.2%) -- 51 (25%) 298 (2%) the resident adults in Communities At Risk – ABS low series) Trichiasis (%) -- 1 (0.5%) -- 0 (0%) -- 0 (0%) 1 (0.3%) Offered an ophthalmic -- 221 -- -- 51 272 consultation within 6 months of screening § Trichiasis surgery -- 1 -- -- 1 within 12 months prior to the date of reporting Note: All communities in SA were considered At Risk, therefore the number of adults resident in the region and in Communities At Risk is the same -- Data not reported * Includes Aboriginal adults from communities in the Eyre school district and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted † Includes Aboriginal adults from communities in the Flinders school district and two from the Northern Country school district which were reassigned by the EH&CDSSP coordinator ‡ Projected 2008 population data based on the ABS 1.9% low series (2.9% high series) population growth rate in SA § Adults were seen by the ophthalmologist in the screening team when they were examined in the clinics from all ACCHS except Pika Wiya where an optometrist examined the adults Source: Data were collected by the EH&CDSSP coordinator and the screening team

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TRACHOMA CONTROL ACTIVITIES

Table 3.9 Implementation of trachoma control activities (SAFE strategy), by ACCHS, SA, 2008. SAFE strategy trachoma Number (%) of communities Total control activities Ceduna Nganampa Oak Valley Pika Wiya Tullawon Umoona Tjutagku

Surgery for trichiasis Referral process available 0 1 (17%) 1 (100%) 0 1 (100%) 1 (100%) 4 (36%) No referral process 0 0 0 0 0 0 0 Referral process unknown 0 0 0 0 0 0 0 Not reported 1 (100%) 5 (83%) 0 1 (100%) 0 0 7 (64%) Subtotal 1 (100%) 6 (100%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 11 (100%) Antibiotics Treated within 2 weeks of 0 3 (50%) 1 (100%) 0 1 (100%) 0 5 (45%) the screening Treated but not within 2 0 0 0 0 0 0 0 weeks of the screening No treatment 1 (100%) 3 (50%) 0 1 (100%) 0 1 (100%) 6 (55%) Treatment unknown 0 0 0 0 0 0 0 Not reported 0 0 0 0 0 0 0 Subtotal 1 (100%) 6 (100%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 11 (100%) Facial cleanliness resources Available and used 0 0 0 0 0 1 (100%) 1 (9%) Available but not used 0 0 0 0 0 0 0 Not available 0 0 0 0 0 0 0 Not known 0 1 (17%) 1 (100%) 0 1 (100%) 0 3 (27%) Not reported 1 (100%) 5 (83%) 0 1 (100%) 0 0 7 (64%) Subtotal 1 (100%) 6 (100%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 11 (100%) Facial cleanliness programs Available 0 0 0 0 0 0 0 Not available 0 0 0 0 0 0 0 Not known 0 1 (17%) 1 (100%) 0 1 (100%) 1 (100%) 4 (36%) Not reported 1 (100%) 5 (83%) 0 1 (100%) 0 0 7 (64%) Subtotal 1 (100%) 6 (100%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 11 (100%) Environmental conditions Generally good conditions 0 0 0 0 0 0 0 Variable conditions but 0 0 0 0 0 0 0 improvements are being made Very poor conditions 0 0 0 0 0 0 0 Not known 0 0 0 0 0 0 0 Not reported 1 (100%) 6 (100%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 11 (100%) Subtotal 1 (100%) 6 (100%) 1 (100%) 1 (100%) 1 (100%) 1 (100%) 11 (100%) Total number of communities from which trachoma screening data were reported 1 6 1 1 1 1 11 Source: Data were collected by the EH&CDSSP coordinator and the screening team

38 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 4. WESTERN AUSTRALIA

SUMMARY:

• Screening was conducted in the four regions that were categorised as being At Risk

for trachoma.

• Of the 123 Aboriginal communities in the four regions, 76 communities (62%) were categorised At Risk and, of these, 67 (88%) were screened and reported data.

• The overall prevalence of active trachoma in Western Australia was 15%.

o All four regions had a prevalence of active trachoma ≥5%.

o 44 communities (66%) had a prevalence of active trachoma ≥5%.

• Of the 1833 children examined for facial cleanliness, 1433 (78%) had clean faces.

• Treatment was reported to have been distributed in 50 of the 52 communities (96%)

in which treatment for trachoma was indicated, including one community where

active trachoma was found in children aged 10 to 14 years.

o 41 communities (79%) were treated in compliance with the CDNA guidelines, nine (17%) treated children only and two (4%) did not report data for treatment.

• Trichiasis screening was carried out only in a few communities and the overall

prevalence of trichiasis in those screened was 3%.

• The Antibiotic and Facial Cleanliness components of the SAFE trachoma control strategy were more comprehensively implemented compared to the Surgery and Environmental improvements components.

This section presents a summary of trachoma data from Western Australia by region with community level data provided in Appendix C.

Trachoma data were provided for four trachoma endemic regions in WA: Goldfields, Kimberley, Midwest and the Pilbara (Figure 4.1).

Of the 123 communities in the four regions, 76 communities (62%) were categorised as being At Risk for trachoma (Table 4.1), of which 69 (91%) were screened in 2008, and data were reported from 67 (97%) (Figure 4.2 and Table 4.2).

Overall, 44 of the 67 communities (66%) had a prevalence of active trachoma ≥5% (Table 4.2). A greater proportion of communities, 45 (85%), were reported to have had a prevalence of active trachoma ≥5% in 2006 compared to 35 (64%) in 2007 and 44 (66%) in 2008. However, a different trachoma grading system was used in the Pilbara in 2006.

Using the 2008 ABS low series population growth estimates, 4112 Aboriginal children aged 1 to 9 years were resident in Communities At Risk in the four regions (Table 4.3); the high series population growth estimates are also in Table 4.3. Of the children resident in Communities At Risk, 1823 (44%) were examined, and 278 were found to have active trachoma (prevalence = 15%, 95% CI, 13%−17%) (Table 4.3).

Facial cleanliness data were provided for all 67 communities that examined children for trachoma (Table 4.3). In 41 communities (61%), >80% of the children examined for facial cleanliness had clean faces (Table 4.4). Overall, 1433 children (78%) were reported to have clean faces (Table 4.3). The percentage of children with clean faces (by region) ranged from 72% to 82%.

39 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Treatment was reported to have been distributed in 50 of the 52 communities (96%) in which treatment for trachoma was indicated (Table 4.5); including one community where active trachoma was found in children aged 10 to 14 years without being detected in children aged 1 to 9 years. Overall, 41 communities (79%) were treated according to the CDNA guidelines, community-based treatment was given in 20 communities (47%) and household-based treatment was given in 21 (51%). In nine of the 11 communities (82%) that did not treat according to the guidelines, antibiotics were given to affected children only, and treatment data were not reported for the remaining two (18%). Overall, 2917 (97%) of the people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members.

A comparison of prevalence of active trachoma from 2006 to 2008 found no change in the Kimberley region and a statistically significant increase (p<0.05) in prevalence between 2007 and 2008 was found for the Pilbara region. Decreases (p<0.05) were found for the Goldfields and Midwest regions (Table 4.6). Comparisons were made for the 38 communities where ≥10 children were examined in two or more years (Table 4.7). No change was found in 26 communities (68%), a statistically significant increase (p<0.05) was found in four (11%) and a decrease (p<0.05) was found in eight communities (21%). In 2007, comparisons could only be made for 10 communities, as analysis could not be done with 2006 data for the Kimberley region (where the number of children examined from each community was not reported) nor for the Pilbara region (where the grading criteria were changed). No change in prevalence was found in five communities (50%), a statistically significant increase (p<0.05) was found in one (10%) and a decrease (p<0.05) was found in four (40%).

In 2008 screening for trichiasis was conducted in all four regions during an annual influenza vaccination program in 40 of the 76 Communities At Risk (53%) (Table 4.8). Of the 7073 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 903 (13%) were examined for trichiasis, and 25 (3%) were found to have trichiasis. Two adults were reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting. In 2007 screening for trichiasis was only conducted and reported for the Goldfields region, and 17 adults (6%) had trichiasis.

In 2008 the SAFE trachoma control strategy was partially implemented in the 67 communities where screening was conducted and data were reported . Twenty-six communities (39%) had a referral process for trichiasis surgery, and antibiotics for active trachoma were reported to have been distributed in 50 (74%) (Table 4.9). The implementation of facial cleanliness programs were reported for 53 communities (79%) compared to the use of facial cleanliness resources in 31 communities (46%). Good environmental conditions were reported for nine communities (13%) and in 37 (55%) measures had been taken to improve environmental conditions. In addition to the improvements already mentioned, there are swimming pools in three of the 123 communities (2%) in WA. Surveys investigating the health and social benefits of the pools in two communities found reductions in ear and skin infections. Truancy also decreased following ‘no school no pool’ programs implemented at the schools. 24

40 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Figure 4.1 Prevalence of active trachoma (number of children aged 1 to 9 years examined) and the number of communities where trachoma data were reported in WA regions, 2008. Source: Data were collected by Population Health Units and staff from ACCHS in WA

41 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

SCREENING FOR ACTIVE TRACHOMA

Table 4.1 Number of communities screened for trachoma, by trachoma risk status and region, WA, 2008. Communities Number (%) of communities Total Goldfields Kimberley Midwest Pilbara Not At Risk Screened 0 0 0 0 0 Not screened 9 (100%) 1 (100%) 30 (100%) 7 (100%) 47 (100%) Total Not At Risk 9 1 30 7 47 At Risk Screened with no trachoma found 7 (35%) 6 (18%) 1 (17%) 0 14 (18%) Screened with trachoma found 6 (30%) 26 (76%) 5 (83%) 16 (100%) 53 (70%) Reported screened but no data received 1 (5%) 1 (3%) 0 0 2 (3%) Should have been screened but were not 6 (35%) 1 (3%) 0 0 7 (9%) Total At Risk 20 34 6 16 76

Total communities 29 35 36 23 123 Source: Data were collected by the Population Health Units and staff from ACCHS in WA

100%

90% Not At Risk - Not screened 80% At Risk - Data not reported At Risk - Screened 70%

60%

50%

40%

30%

Percentage of communities of Percentage 20%

10%

) 5 =36) =23) n n (n=3 y a ( e r ilba berl P m Midwest ( Goldfields (n=29) Ki Region (n=number of communities)

Figure 4.2 Screening of communities in WA regions, 2008 . Source: Data were collected by the Population Health Units and staff from ACCHS in WA

42 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 4.2 Number of communities screened for trachoma, and prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by trachoma risk status and region, WA, 2006, 2007 and 2008. Community status Number (%) of communities Total Goldfields Kimberley Midwest Pilbara 2006 Data Not At Risk and not screened in 0 0 0 0 0 2006 Not screened in 2006 0 0 0 0 0 Status not reported in 2006* 23 8 30 14 75 Screened and reported in 2006 6 31 6 10 53 Prevalence 0% 2 (33%) 1 (3%) 1 (17%) 1 (10%) 5 (9%) 1 to <5% 0 3 (10%) 0 0 3 (6%) 5 to <10% 1 (17%) 5 (16%) 1 (17%) 1 (10%) 8 (15%) 10 to <20% 0 5 (16%) 1 (17%) 0 6 (11%) 20 to <50% 3 (50%) 12 (39%) 2 (33%) 2 (10%) 19 (36%) ≥ 50% 0 5 (16%) 1 (17%) 6 (60%) 12 (23%) Total 29 39 36 24 128 2007 Data Not At Risk and not screened in 8 6 30 7 51 2007 Screened but not reported in 2007 0 3 0 0 3 Not screened in 2007 11 2 1 2 16 Screened and reported in 2007 7 28 5 15 55 Prevalence 0% 4 (57%) 9 (32%) 0 7 (47%) 20 (36%) 1 to <5% 0 0 0 0 0 5 to <10% 1 (14%) 4 (14%) 0 0 5 (9%) 10 to <20% 2 (29%) 5 (18%) 3 (60%) 2 (13%) 12 (22%) 20 to <50% 0 10 (36%) 2 (40%) 4 (27%) 16 (29%) ≥ 50% 0 0 0 2 (13%) 2 (4%) Total 26† 39 36 24 125 2008 Data Not At Risk and not screened in 9 1 30 7 47 2008 Screened but not reported in 2008 1 1 0 0 2 Not screened in 2008 6 1 0 0 7 Screened and reported in 2008 13 32 6 16 67 Prevalence 0% 7 (54%) 6 (19%) 1 (17%) 2 (13%) 16 (24%) 1 to <5% 2 (15%) 4 (13%) 1 (17%) 0 7 (10%) 5 to <10% 1 (8%) 5 (16%) 0 2 (13%) 8 (12%) 10 to <20% 0 4 (13%) 1 (17%) 2 (13%) 7 (10%) 20 to <50% 3 (23%) 9 (28%) 3 (50%) 6 (38%) 21 (31%) ≥ 50% 0 4 (13%) 0 4 (25%) 8 (12%) Total 29 35 ‡ 36 23 § 123 * In 2006 no data were available for these communities and no additional information was available † Six communities were counted as three pairs ‡ In 2008, data from four communities were combined with other communities from the same location § In 2008, data from one community were combined with another community in the same location Source: Data were collected by the Population Health Units and staff from ACCHS in WA

43 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 4.3 Number of resident Aboriginal children aged 1 to 9 years, and number examined for active trachoma and facial cleanliness, by region, WA, 2008. Goldfields Kimberley Midwest Pilbara Total Population data Children resident: in region* 1184 (1199) 2875 (2912) 1239 (1255) 1199 (1215) 6497 (6581) in Communities At Risk * 1017 (1030) 2116 (2144) 192 (194) 787 (797) 4112 (4165) in Communities At Risk from 240 1909 251 351 2751 which data were reported † Active trachoma Communities from which data 13/20 32/34 6/6 16/16 67/76 were reported/Communities At Risk Children resident in 1017 (86%) 2116 (74%) 192 (15%) 787 (66%) 4112 (63%) Communities At Risk (% of children resident in region) Children examined (% of those 238 (23%) 1169 (55%) 122 (64%) 294 (37%) 1823 (44%) currently resident in Communities At Risk) Active trachoma (%) 18 (8%) 175 (15%) 12 (10%) 73 (25%) 278 (15%) Facial cleanliness Communities from which data 13/20 32/34 6/6 16/16 67/76 were reported/Communities At Risk Children examined 235 1182 122 294 1833 Clean faces (%) 169 (72%) 952 (81%) 100 (82%) 212 (72%) 1433 (78%)

* Projected 2008 population data based on the ABS 1.8% low series (3.1% high series) population growth rate in WA † Number of children in Communities At Risk from which data were reported were provided by the Population Health Units from each region Source: Data regarding active trachoma and clean faces were collected by the Population Health Units and staff from ACCHS in WA

44 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 4.4 Prevalence of Aboriginal children aged 1 to 9 years with clean faces, by region, WA, 2008. Community prevalence Number (%) of communities with children Total with clean faces Goldfields Kimberley Midwest Pilbara Not At Risk and not screened in 9 1 30 7 47 2008 Screened but not reported in 2008 1 1 0 0 2 Not screened in 2008 6 1 0 0 7 Screened and reported in 2008 13 32 6 16 67 Prevalence 0 to 10% 0 1 (3%) 1 (17%) 0 2 (3%) 11 to 20% 0 1 (3%) 0 0 1 (1%) 21 to 40% 1 (8%) 1 (3%) 0 2 (13%) 4 (6%) 41 to 60% 2 (15%) 1 (3%) 0 3 (19%) 6 (9%) 61 to 80% 5 (38%) 4 (13%) 1 (17%) 3 (19%) 13 (19%) 81 to 90% 3 (23%) 9 (28%) 0 2 (13%) 14 (21%) 91 to 100% 2 (15%) 15 (47%) 4 (67%) 6 (38%) 27 (40%) Total 29 35 36 23 123 Source: Data were collected by the Population Health Units and staff from ACCHS in WA

TREATMENT

Table 4.5 Active trachoma treatment strategies and timeliness of treatment, by region, WA, 2008. Goldfields Kimberley Midwest Pilbara Total Treatment strategy Community-based 1 (8%) 17 (53%) 0 2 (13%) 20 (30%) Household-based 2 (15%) 9 (28%) 6 (100%)* 4 (25%) 21 (31%)* Strategy not reported 0 0 0 0 0 Children only 2 (15%) 0 0 7 (44%) 9 (13%) No treatment reported 1 (8%) 0 0 1 (6%) 2 (3%) No treatment required 7 (54%) 6 (19%) 0 2 (13%) 15 (22%) Total communities 13 32 6 16 67 Total number of people to be 80 2440 75 † 418 3013 treated Treated within 2 weeks (%) 88 (110%) 2297 (94%) 43 (57%) 334 (80%) 2762 (92%) Total treated (%) 95 (119%) 2333 (96%) 69 (92%) 420 (100%) 2917 (97%) * Includes a community where active trachoma was found in 2/12 children aged 10 to 14 years without being detected in children aged 1 to 9 years † An additional two households were treated within two weeks of the screening; however, the number of people was not provided and therefore could not be included in these data Source: Data were collected by the Population Health Units and staff from ACCHS in WA

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

Table 4.6 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by region, WA, 2006, 2007 and 2008. Region Prevalence of active trachoma Chi-square test 2006 2007 2008 used to calculate Communities = 53 Communities = 55 Communities = 67 significance

% (95% CI) n % (95%CI) n % (95%CI) n Goldfields 19% (15, 25) 231 4% (2, 7) 227 8% (5, 12) 238 ↓ p<0.05 Kimberley 18% (16, 20) 1048 16% (14, 18) 1006 15% (13, 17) 1169 p = 0.51 Midwest 19% (14, 26) 167 22% (16, 30) 127 10% (6, 16) 122 ↓ p<0.05 Pilbara* 53% (47, 59) 273 16% (12, 21) 306 25% (21, 30) 294 ↑ p<0.05 Total 24% (22, 26) 1719 15% (13, 17) 1666 15% (13, 17) 1823 ↑ p<0.05 n = Number of children examined * Analysis could not be done with 2006 data because a different grading system was used in the Pilbara in 2006 Source: Data were collected by Population Health Units and staff from ACCHS in WA

Table 4.7 Significant differences in the prevalence of active trachoma in Aboriginal children aged 1 to 9 years (2006–2008) in communities where ≥10 children were examined, by region, WA. Region Significant differences in the prevalence of active Total trachoma 2006–2008 Significant No change Significant decrease* increase* Goldfields 2 (33%) 4 (67%) 0 6 Kimberley † 3 (18%) 11 (65%) 3 (18%) 17 Midwest 2 (40%) 2 (40%) 1 (20%) 5 Pilbara ‡ 1 (10%) 9 (90%) 0 10 Total 8 (21%) 26 (68%) 4 (11%) 38 * Fisher’s test used to evaluate change; significant at p<0.05 † Data for 2007 and 2008 only as the number of children examined was not reported in 2006 ‡ Data for 2007 and 2008 only as different grading criteria were used in 2006 Source: Data were collected by Population Health Units and staff from ACCHS in WA

46 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

TRICHIASIS

Table 4.8 Trichiasis screening of Aboriginal adults aged ≥30 years, by region, WA, 2008. Goldfields Kimberley Midwest Pilbara Total ABS projection Adults resident: in region * 2063 (2090) 3551 (3597) 2185 (2213) 2384 (2415) 10,183 (10,315) in Communities At Risk* 1761 (1765) 3321 (3328) 406 (407) 1585 (1588) 7073 (7088) Trichiasis Communities from which 11/20 15/34 5/6 9/16 40/76 data were reported/Communities At Risk Adults examined (% of the 67 (4%) 442 (13%) 210 (52%) 184 (12%) 903 (13%) resident adults in Communities At Risk– ABS low series) Trichiasis (%) 3 (4%) 21 (5%) 1 (0.5%) 0 (0%) 25 (3%) Offered an ophthalmic -- 21 (100%) -- 21 (84%) consultation within 6 months of screening (% with trichiasis) Trichiasis surgery within 12 -- 2 -- 2 months prior to the date of reporting -- Data not reported * Projected 2008 population data based on the ABS 1.8% low series (3.1% high series) population growth rate in WA Source: Data regarding trichiasis were collected by the Population Health Units and staff from ACCHS in WA

47 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

TRACHOMA CONTROL ACTIVITIES

Table 4.9 Implementation of trachoma control activities (SAFE strategy), by region, WA, 2008. SAFE trachoma control activities Number (%) of communities Total Goldfields Kimberley Midwest Pilbara Surgery for trichiasis Referral process available 7 (54%) 19 (59%) 0 0 26 (39%) No referral process 3 (23%) 0 0 0 3 (4%) Referral process unknown 0 12 (38%) 0 1 (6%) 13 (19%) Not reported 3 (23%) 1 (3%) 6 (100%) 15 (94%) 25 (37%) Subtotal 13 (100%) 32 (100%) 6 (100%) 16 (100%) 67 (100%) Antibiotics Treated within 2 weeks of the 4 (31%) 15 (47%) 0 8 (50%) 27 (40%) screening Treated but not within 2 weeks 1 (8%) 11 (34%) 6 (100%) 5 (31%) 23 (34%) of the screening No treatment 7 (54%) 6 (19%) 0 3 (19%) 16 (24%) Treatment unknown 1 (8%) 0 0 0 1 (1%) Subtotal 13 (100%) 32 (100%) 6 (100%) 16 (100%) 67 (100%) Facial cleanliness resources Available and used 0 18 (56%) 1 (17%) 12 (75%) 31 (46%) Available but not used 0 10 (31%) 3 (50%) 0 13 (19%) Not available 0 1 (3%) 0 1 (6%) 2 (3%) Not known 0 2 (6%) 1 (17%) 3 (19%) 6 (9%) Not reported 13 (100%) 1 (3%) 1 (17%) 0 15 (22%) Subtotal 13 (100%) 32 (100%) 6 (100%) 16 (100%) 67 (100%) Facial cleanliness programs Available 9 (69%) 28 (88%) 1 (17%) 15 (94%) 53 (79%) Not available 3 (23%) 3 (9%) 4 (67%) 0 10 (15%) Not known 1 (7%) 1 (3%) 1 (17%) 1 (6%) 4 (6%) Subtotal 13 (100%) 32 (100%) 6 (100%) 16 (100%) 67 (100%) Environmental conditions Generally good conditions 3 (23%) 0 1 (17%) 5 (31%) 9 (13%) Variable conditions but 7 (54%) 19 (59%) 3 (50%) 8 (50%) 37 (55%) improvements are being made Very poor conditions 3 (23%) 3 (9%) 2 (34%) 1 (6%) 9 (13%) Not known 0 10 (31%) 0 1 (6%) 11 (16%) Not reported 0 0 0 1 (6%) 1 (2%) Subtotal 13 (100%) 32 (100%) 6 (100%) 16 (100%) 67 (100%) Total number of communities from which trachoma screening data were reported 13 32 6 16 67 Source: Data were collected by the Population Health Units and staff from ACCHS in WA

48 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

5. ANTIBIOTIC RESISTANCE

Summary

• The reporting of treatment data in trachoma endemic jurisdictions has improved from 2006 to 2008.

• There was no change in azithromycin resistance reported by the NTSRU between 2007 (27.4%) and 2008 (20.7%).

• The NTSRU data are comparable to national data collected by AGAR in 2005 (22.7%).

The reporting of azithromycin antibiotic treatment in trachoma endemic jurisdictions has improved from 2006 to 2008 (Table 5.1).

For the monitoring of antibiotic resistance, data were reported for the age groups and specimen sources of the Aboriginal people from which the S. pneumoniae isolates were collected (Table 5.2 and Table 5.3).

Overall, 53 of the 261 S. pneumoniae isolates (20.7%, 95% CI, 16%–26%) were reported to be resistant or have intermediate resistance to azithromycin (Table 5.4).

Overall, the 27.4% (95% CI, 18%–40%) and 20.7% (95% CI, 16%–26%) resistance found in isolates reported in this study in 2007 and 2008 is comparable to the 22.7% resistance (95% CI, 21%–25%) found in isolates in Australia reported in the AGAR survey (Table 5.5). 13

Table 5.1 Percentage of people treated with azithromycin (total treated/total requiring treatment) in jurisdictions where trachoma is regarded as endemic, 2006, 2007 and 2008. 2006* 2007 2008 † Northern Territory --/287 328/533 (62%) 3069 /4860 (63%) South Australia ‡ 19/20 (95%) 18/18 (100%) 7/7 (100%) Western Australia § 396/471 (84%) 1675/2084 (80%) 2917/3013 (97%) Total 415/778 (53%) 2235/2635 (85%) 5993 /7880 (76%) -- Data not reported * No jurisdiction reported the number of household or community contacts treated † An additional 871 people were treated in four communities in the Katherine region (NT) and they have not been included in the total because the number of people requiring treatment was not provided ‡ Number of children found to have active trachoma at the first screening have been reported; no household or community contacts were treated irrespective of the presence of trachoma § Treatment data were reported for only two of the four regions in 2006

49 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 5.2 Age of Aboriginal people that S. pneumoniae isolates were collected from, by pathology service, 2008. Age range (years) Number of isolates (%) Total IMVS NTGPS WDPS 0 to 4 0 27 (19%) 17 (16%) 44 (17%) 5 to 9 1 (7%) 6 (4%) 6 (6%) 13 (5%) 10 to 14 1 (7%) 5 (4%) 4 (4%) 10 (4%) 15 to 29 0 17 (12%) 7 (7%) 24 (9%) 30 to 64 9 (64%) 72 (51%) 60 (57%) 141 (54%) ≥ 65 3 (21%) 14 (10%) 12 (11%) 29 (11%) Total 14 (100%) 141 (100%) 106 (100%) 261 (100%) Source: Data provided by the Institute of Medical Veterinary Science (IMVS), Northern Territory Government Pathology Service (NTGPS) and Western Diagnostics Pathology Service (WDPS)

Table 5.3 Specimen source of S. pneumoniae isolates collected from Aboriginal people, by pathology service, 2008. Specimen source Number of isolates (%) Total IMVS NTGPS WDPS Aspirate 0 0 1 (1%) 1 (0%) Blood culture 0 18 (13%) 0 18 (7%) Breast 0 0 1 (1%) 1 (0%) Corneal scraping 0 1 (1%) 0 1 (0%) Cerebrospinal fluid 0 1 (1%) 0 1 (0%) Ear swab 0 9 (6%) 11 (10%) 20 (8%) Endocervical 0 0 1 (1%) 1 (0%) Endotrachial aspirate 0 1 (1%) 0 1 (0%) Eye swab 1 (7%) 14 (10%) 7 (7%) 22 (8%) Nasopharyngeal aspirate 0 3 (2%) 0 3 (1%) Nose swab 0 1 (1%) 8 (8%) 9 (3%) Pertioneal fluid 0 1 (1%) 0 1 (0%) Skin 0 0 2 (2%) 2 (1%) Sputum 13 (93%) 88 (62%) 72 (68%) 173 (66%) Ulcer 0 0 1 (1%) 1 (0%) Unspecified source 0 0 1 (1%) 1 (0%) Urine 0 2 (1%) 0 2 (1%) Vaginal swab 0 0 1 (1%) 1 (0%) Wound swab (eye) 0 1 (1%) 0 1 (0%) Wound swab (other) 0 1 (1%) 0 1 (0%) Total 14 (100%) 141 (100%) 106 (100%) 261 (100%) Source: Data provided by the Institute of Medical Veterinary Science (IMVS), Northern Territory Government Pathology Service (NTGPS) and Western Diagnostics Pathology Service (WDPS)

50 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table 5.4 Azithromycin resistance and susceptibility to S. pneumoniae isolates collected from Aboriginal people, by pathology service and region, 2008. Number of isolates (%) Total Resistant Intermediate Susceptible Institute of Medical Veterinary Science Goldfields 0 0 1 (100%) 1 (100%) Nganampa 3 (27%) 0 8 (73%) 11 (100%) Pika Wiya 0 0 2 (100%) 2 (100%) Subtotal 3 (21%) 0 11 (79%) 14 (100%) Northern Territory Government Pathology Service Alice Springs 11 (38%) 1 (3%) 17 (59%) 29 (100%) Alice Springs Remote 11 (30%) 0 26 (70%) 37 (100%) Darwin 1 (5%) 0 18 (95%) 19 (100%) Darwin Rural 4 (40%) 0 6 (60%) 10 (100%) East Arnhem 3 (27%) 0 8 (73%) 11 (100%) Goldfields 1 (50%) 0 1 (50%) 2 (100%) Katherine 3 (16%) 0 16 (84%) 19 (100%) Kimberley 0 0 1 (100%) 1 (100%) Nganampa 1 (14%) 0 6 (86%) 7 (100%) Queensland 0 0 1 (100%) 1 (100%) Unknown 0 0 5 (100%) 5 (100%) Subtotal 35 (25%) 1 (1%) 105 (74%) 141 (100%) Western Diagnostics Pathology Service Alice Springs 1 (100%) 0 0 1 (100%) Alice Springs Remote 4 (20%) 0 16 (80%) 20 (100%) Darwin 2 (10%) 0 19 (90%) 21 (100%) Darwin Rural 4 (12%) 0 29 (89%) 33 (100%) East Arnhem 2 (10%) 0 18 (90%) 20 (100%) Katherine 1 (10%) 0 9 (90%) 10 (100%) Perth 0 0 1 (100%) 1 (100%) Subtotal 14 (13%) 0 92 (87%) 106 (100%)

Total 52 (20%) 1 (0.4%) 208 (80%) 261 (100%) Source: Data provided by the Institute of Medical Veterinary Science (IMVS), Northern Territory Government Pathology Service (NTGPS) and Western Diagnostics Pathology Service (WDPS)

Table 5.5 Comparison of azithromycin resistance to invasive and non-invasive S. pneumoniae isolates collected from Aboriginal people (number resistant/total tested) by state and territory, 2005 to 2008. State/territory AGAR monitoring NTSRU monitoring 2005 2007 2008 % Number % Number % Number resistant/total resistant/total resistant/total tested tested tested New South Wales/ACT 27.8% 162/583 NR NR Northern Territory NR 23.4% 11/47 20.9% 48/230 Queensland 28.2% 80/284 NR 0% 0/1 South Australia 20.9% 82/392 40.0% 6/15 20.0 % 4/20 Victoria 14.5% 35/221 NR NR Western Australia 16.2% 48/296 NR 20.0% 1/5 Unknown 0 0 0% 0/5 Australia 22.7% 404/1776 27.4% 17/62 20.7% 53/256 (95%CI) (21,25) (18,40) (16,26) NR = Not reported

52 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 DISCUSSION

SUMMARY:

• Endemic trachoma still exists in remote Aboriginal communities in Australia. • Following the implementation of the CDNA guidelines and the establishment of the NTSRU, improvements have been made in the consistency of data collection and reporting.

• Although all children aged 1 to 9 years in Communities At Risk should be examined, the number of communities screened (51%) and the number of children examined (23%) still remains low. • Improvements have been made for the reporting of the Surgery, Antibiotics and Facial Cleanliness activities of the SAFE trachoma control strategy; however, these components still need to be strengthened. o An existing referral process for trichiasis surgery was reported by 57% of the communities that reported screening data in 2008 compared to 4% in 2007. o The surveillance data indicates that the distribution of antibiotic treatment according to the CDNA guidelines has improved – 78% of communities were treated according to the guidelines in 2008 compared to 48% in 2007.

o Many communities have tried to break the cycle of re-infection by

promoting facial cleanliness through the use of programs (70%) and

resources (49%).

• There has been no change in azithromycin resistance over two years (2007–2008) and the rates are comparable to the nation-wide rates established by AGAR in 2005.

• The inclusion of trichiasis screening into existing programs has made it possible

to monitor the later stages of trachoma; data will continue to improve as this is

adopted in more communities.

• The collaboration of health care workers and organisations involved in the monitoring of trachoma is a vital component in making the elimination of trachoma in Australia a priority.

government reports due to limited training of staff collecting the data. For this reason they have not been presented in this report. The HSAK program which provided data for other NT communities did not re-visit communities screened by the AGEI.

In the last three years (2006 to 2008) there has been much discussion regarding the best way to report screening coverage of children. The NTSRU has explored the reporting of ABS regional population data of resident children, ABS population data for children resident in Communities At Risk, and the estimated number of children in communities where screening was conducted (as provided by health care workers in the communities). Community statements of the children resident in each community can vary compared to the ABS data, in part due to the high mobility of Aboriginal people. We believe the best assessment of the denominator is given by the ABS population data for children resident in Communities At Risk of trachoma. This statistic was used to include the children in communities where screening should have been conducted but was not. For example, in SA, the majority of communities have not been screened and it is not known whether they have trachoma or not; by including the number of children in these communities we will have a better understanding of the number of children who are not being examined. There were increases and decreases in the regional screening coverage, although the overall coverage for each jurisdiction was similar across the three years. Less than half of the children residing in Communities At Risk are being examined, emphasising that there are still many gaps in the screening.

In each jurisdiction there are regions with endemic trachoma. Across all the jurisdictions the average prevalence of active trachoma in communities from which data were reported was 21% (p<0.05) compared to the 14% reported for 2007. There are no consistent changes in regional prevalence even though statistically significant increases and decreases (p<0.05) between 2006 and 2008 were found in some regions. Caution must be exercised due to variable coverage and small numbers. The majority of communities, 53 of the 77 where comparisons could be made (69%), showed no change. Overall, a decrease (p<0.05) in prevalence was found in SA (15% in 2006 and 2% in 2008) and WA (24% in 2006 and 15% in 2008), and an increase (p<0.05) was found in NT (13% in 2006 and 29% in 2008). In the NT, the significant increase in prevalence for two regions was in large part due to the better implementation of the HSAK program in Central Australia which led to more trachoma being diagnosed. On the other hand, reports of no active trachoma within some SA ACCHS should also be taken with caution because, in many of these areas, only very small numbers of children were examined and coverage is very variable as this was not part of a coordinated screening program.

Screening all children and providing appropriate azithromycin treatment to household and community members is a necessary component of trachoma control. The surveillance data indicates that household and community treatment has improved from 2006 to 2008 following the CDNA guidelines and the operation of the NTSRU. Treatment was reported to have been distributed according to the CDNA guidelines in 35 communities (85%) in the NT and 41 (79%) in WA; most of the regions within these jurisdictions treated >80% of the people who required treatment. However, SA has consistently examined few children at the schools and continues to treat only the children found to have active trachoma without providing household or community treatment as recommended by the CDNA guidelines. Family members can cause a cycle of ongoing re-infection. The issue of re-infection is something that has been considered by CDNA who propose cross-regional and cross-state treatment where people are known to move frequently across borders because of strong family/cultural links. 2 WA has implemented this coordinated approach to treatment, distributing azithromycin antibiotic treatment to most people who required treatment.

Poor facial hygiene is an important risk factor for trachoma and the promotion of facial cleanliness is a key component of the SAFE strategy. There has been a marked increase in the number of communities from which data were reported for trachoma and facial cleanliness, 93 (76%) in 2007 to 108 (89%) in 2008; data from communities in one region only were reported in 2006. In 2008, many communities have also reported the promotion of facial cleanliness through the use of programs and resources . Such programs are important in order to integrate behavioural change regarding hygiene and break the cycle of re-infection.

54 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

The reporting of trichiasis data has improved somewhat, although still only 4% of those At Risk were examined. In 2007 only one state reported the systematic screening for trichiasis. In 2008 almost every region reported at least some data on trichiasis screening, although in many regions this was still fragmentary. The inclusion of trichiasis screening into existing programs – such as the Adult Health Check and influenza vaccination programs – has made it possible to monitor the later stages of trachoma. This should lead to appropriate referrals for surgery when trichiasis is identified.

Improvements have been made for the reporting of the Surgery, Antibiotics and Facial Cleanliness activities of the SAFE trachoma control strategy; however, these components still need to be strengthened. In 2008, 57% of communities were reported as having an existing referral process for trichiasis surgery, a marked increase compared to the 4% that reported this information in 2007. Overall, of the communities where treatment was indicated, 78% treated according to the CDNA guidelines in 2008 compared to the 48% reported in 2007. It is apparent that activities for the Environmental improvement component of the SAFE strategy have not been comprehensively reported. However, there have been reports of the installation of new swimming pools in some of the remote Aboriginal communities. While research has shown considerable health and social benefits of the pools, efforts should also be made to improve housing sanitation, nutrition, education and access to health care. 6

While the reporting of treatment has improved from 2006 to 2008, no change in antibiotic resistance of S. pneumoniae has been detected over this time. A comparison of azithromycin resistance using the NTSRU data shows no statistically significant difference between 2007 and 2008, and these data were comparable to those collected by the nation-wide survey conducted by the AGAR in 2005. It is difficult to make comparisons for WA as PathWest pathology service was not able to provide the NTSRU with antibiotic resistance data in either year due to difficulties in obtaining the necessary clearances.

The trachoma surveillance process has enabled key representatives involved in trachoma programs from each jurisdiction to share successes and ideas relating to trachoma screening and management. A cross-regional ‘health blitz’ focusing on outreach screening and treatment of multiple conditions has been discussed by some jurisdictions to assist with the collection of data from communities that share borders. This also aims to deal with the cycle of re-infection caused by population mobility.

Future control activities would benefit from incorporating simple health messages such as ‘keep your face clean’ as part of existing programs aimed at children and families. It would also be valuable to have health promotion messages repeated during the year period by key members in the schools or communities to reinforce the importance of hygiene.

In summary, jurisdictions have attempted to collate data from both state-based and independent data collection authorities where trachoma is still thought to be present. There are still gaps and limitations in the reporting of data, however considerable improvements have been made over the last three years. Recommendations for the future include reviewing assumptions that Aboriginal 55 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

children in urban communities are Not At Risk, screening all Communities At Risk, examining at least all children 5 to 9 years in these communities whether they are attending school or not, and strengthening the implementation of trachoma control activities in these communities. Additional effort is required to ensure that azithromycin is appropriately and comprehensively distributed, facial cleanliness is actively promoted and that adults with trichiasis are detected and operated on. An increase in community and screening coverage will enable more stable and reliable estimates of the prevalence and distribution of trachoma, and strengthening the implementation of all four components of the WHO SAFE strategy will lead to the elimination of blinding endemic trachoma.

56 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 REFERENCES

1. Resnikoff S, Pascolini D, Etya'ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82 :844-851. 2. Communicable Diseases Network Australia. Guidelines for the public health management of trachoma in Australia. Canberra: Commonwealth of Australia, 2006. 3. Taylor HR. Trachoma: A blinding scourge from the Bronze Age to the Twenty First Century. Melbourne: Centre for Eye Research Australia, 2008. 4. Mariotti SP, Pararajasegaram R, Resnikoff S. Trachoma: Looking forward to Global Elimination of Trachoma by 2020 (GET 2020). Am J Trop Med Hyg 2003;69 :33-35. 5. Thylefors B, Dawson CR, Jones BR, et al. A simple system for the assessment of trachoma and its complications. Bull World Health Organ 1987;65 :477-483. 6. Hunter EM, Ellis RG, Campbell D, et al. The health of indigenous peoples. MJA 1992;156 :575- 577. 7. Tellis B, Keeffe JE, Taylor HR. Surveillance report for active trachoma, 2006: National Trachoma Surveillance and Reporting Unit. Commun Dis Intell 2007;31 :366-374. 8. Mak DB, O'Neill LM, Herceg A, et al. Prevalence and control of trachoma in Australia, 1997–2004. Commun Dis Intell 2006;30 :236-247. 9. Abbott T (Minister for Health and Ageing). New trachoma unit to combat eye disease. 2005;media release. 10. Chern KC, Shrestha SK, Cevallos V, et al. Alterations in the conjunctival bacterial flora following a single dose of azithromycin in a trachoma endemic area. Br J Ophthalmol 1999;83 :1332- 1335. 11. Leach AJ, Shelby-James TM, Mayo M, et al. A prospective study of the impact of community- based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae. Clin Infect Dis 1997;24 :356-362. 12. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Sixteenth Informational Supplement, January 2006. 13. Gotlieb T, Collignon P, Robson J, et al. Streptococcus pneumoniae Survey: 2005 Antimicrobial Susceptibility Report: The Australian Group on Antimicrobial Resistance http://antimicrobial- resistance.com , August 2006. 14. Tellis B, Dunn R, Keeffe JE, et al. Trachoma Surveillance Report 2006: National Trachoma Surveillance and Reporting Unit: Centre for Eye Research Australia www.health.gov.au 2007. 15. Tellis B, Dunn R, Keeffe JE, et al. Trachoma Surveillance Report 2007: National Trachoma Surveillance and Reporting Unit: Centre for Eye Research Australia www.health.gov.au , 2008. 16. Tellis B, Keeffe JE, Taylor HR. Trachoma surveillance annual report, 2007: A report by the National Trachoma Surveillance and Reporting Unit. Commun Dis Intell 2008;32 :388-399. 17. Performance Standards for Antimicrobial Susceptibility Testing; Seventeenth Informational Supplement. January 2007;26. 18. Bell SM, Gatus BJ, Pham JN, et al. Antibiotic susceptibility testing by the CDS method: A manual for medical and veterinary laboratories 2006: South Eastern Area Laboratory Services, http://web.med.unsw.edu.au/cdstest/ , May 2007. 19. Department of Employment Training and Education: Northern Territory Government. Education and Training Directory: http://directory.ntschools.net/DeetDirectory/SchoolSearch.aspx . 20. Department of Education and Children's Services: Government of South Australia. Sites and locations: http://www.decs.sa.gov.au/decs .

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21. Department of Education and Training: Government of Western Australia. Alphabetical list of Western Australian schools by Education district: http://www2.eddept.wa.edu.au/dev60cgi/sdrrwcgi.exe?sdr0860 . 22. Australian Bureau of Statistics. Australian Indigenous Geographical Classification Maps and Census Profiles, 2001. ABS Cat.No. 4706.0.30.001, 2002. 23. Australian Bureau of Statistics. 2006 Census of Population and Housing. Cat. No. 2068.0. Canberra: ABS, 2006. 24. Lehmann D, Tennant MT, Silva DT, et al. Benefits of swimming pools in two remote Aboriginal communities in Western Australia: intervention study. BMJ 2003;327 :415-419.

58 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008 APPENDICES

A. Northern Territory Community Level Data by Regions B. South Australia Community Level Data by Regions C. Western Australia Community Level Data by Regions D. National Indigenous Eye Health Survey Results E. Data Collection Forms F. National Trachoma Surveillance Reference Group Membership

60 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

A. NORTHERN TERRITORY COMMUNITY LEVEL DATA BY REGION

Community level data by region have been included in this Appendix. The results section of this report presents a national overview of the 2008 data and jurisdictional data by regions.

I. ALICE SPRINGS REMOTE

All 30 communities in the Alice Springs Remote region were categorised as being At Risk for trachoma by the trachoma coordinator (Table 2.1, page 18). Screening was conducted in 24 of these communities (80%), and data for 18 (75%) were reported for 2008 (Table A.1). Five of the six communities from which data were not reported were screened by the AGEI (Table 2.1).

Of the 459 Aboriginal children aged 1 to 9 years examined for trachoma, 157 (34%) had active trachoma (Table A.2). Of the 468 examined for facial cleanliness, 222 (47%) had clean faces (Table A.3).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in 14 of the 16 communities (88%) in which treatment for trachoma was indicated, including one community where active trachoma was found in 1/30 children aged 10 to 14 without being detected in children aged 1 to 9 years. Community-based treatment was given in four communities (29%), household- based treatment was given in nine (64%) and treatment was given in one (6%) where the strategy was not reported (Table A.4 and Table A.5). Treatment data were not reported for the remaining two communities where trachoma was indicated. Overall, 1608 (72%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table A.6).

Comparisons of prevalence of active trachoma were possible for 14 communities in which ≥10 children were examined in two or more years between 2006 and 2008 (Table A.1). No change in prevalence was found in 10 communities (71%) and a statistically significant increase (p<0.05) was found in four communities (29%) (Figure A.1 ). Community AS_27 showed no consistent trend even though a significant difference in prevalence was found between 2006 and 2007.

Data for trichiasis were provided for 12 of the 30 Communities At Risk (40%). Of the 3010 Aboriginal adults aged ≥30 years resident in Communities At Risk, 183 adults (6%) were examined for trichiasis, and 23 (13%) had trichiasis (Table A.7). Thirty-six adults were reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting.

In 2008 the SAFE trachoma control strategy was partially implemented in the 18 communities where screening was conducted; no information was reported for the additional 12 communities where screening was conducted but data were not reported. All 18 communities had an existing referral process for trichiasis surgery. Facial cleanliness was promoted through the use of resources in 15 communities (83%) and clean face programs in 16 (89%). Antibiotics for active trachoma were reported to have been distributed in 14 communities (78%) (Table A.8). Good environmental conditions were reported for one community only (6%). Although little information was reported for environmental improvements, four of the 30 communities in the Alice Springs Remote region (13%) had swimming pools (AS_11, 20, 27 and 28).

ALICE SPRINGS

Screening was conducted in a town camp in Alice Springs even though it was previously categorised as Not At Risk. Of the 45 children aged 1 to 9 years who were examined for trachoma, 18 (40%) had active trachoma, and 12 (27%) had clean faces. Treatment was reported to have been distributed in compliance with the CDNA guidelines using a household-based approach. Overall, 263 (83%) of the 315 children, and members of households or the community who required treatment were treated.

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Data for trichiasis were not provided for any of the 514 Aboriginal adults aged ≥30 years reported by the ABS to be resident in the town camps.

In 2008 the SAFE trachoma control strategy was partially implemented in the town camp where screening was conducted. This community had a referral process for trichiasis surgery, and antibiotics for active trachoma were distributed in the community. Facial cleanliness resources and programs were not available, and there was no information for environmental conditions or improvements in the community, although there was a swimming pool in the area.

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SCREENING FOR ACTIVE TRACHOMA

Table A.1 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Alice Springs Remote region, NT, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s code 2006 2007 2008 test used to calculate Communities = 27 Communities = 19 Communities = 18 significance % (95% CI) n % (95% CI) n % (95% CI) n AS_01 40% (23, 59) 25 SNDP AGEI AS_02 100% 1 0% (0, 35) 7 NS AS_03 25% 4 25% 4 NS AS_04* 0% 2 7% (1, 30) 15 0% (0, 14) 23 p = 0.40 AS_05 0% 1 0% 5 AGEI AS_06 0% 1 NS 70% (54, 83) 37 AS_07* 27% (11, 52) 15 -- 13% (4, 38) 15 p = 0.65 AS_08* 13% (5, 30) 30 0% 1 18% (5, 48) 11 p = 0.65 AS_09* 2% (0, 10) 54 36% (24, 50) 47 49% (38, 60) 74 ↑ p<0.05 AS_10* 30% (11, 60) 10 -- 0% (0, 22) 14 p = 0.59 AS_11* 5% (1, 17) 39 NS 71% (53, 85) 28 ↑ p<0.05 AS_12 0% 1 -- 9% (3, 24) 32 AS_13 13% (2, 47) 8 0% 1 0% (0, 16) 20 AS_14* 0% (0, 14) 24 22% (9, 45) 18 50% (27, 73) 14 ↑ p<0.05 AS_15* 35% (19, 55) 23 SNDP 100% (74, 100) 11 ↑ p<0.05 AS_16 13% (2, 47) 8 0% 1 NS AS_17 0% (0, 32) 8 0% 1 NS AS_18* 0% 2 37% (22, 56) 27 36% (15, 65) 11 p = 1.00 AS_20* 20% (12, 32) 64 SNDP 12% (6, 22) 60 p = 0.23 AS_21 0% 1 0% (0, 28) 10 AGEI AS_22 0% 1 AGEI AS_19 0% 1 AS_22 0% 2 AS_23 0% 1 AS_24 1% (0, 5) 103 -- NS AS_25* 18% (5, 48) 11 64% (35, 85) 11 NS p = 0.08 AS_26* 51% (36, 66) 41 29% (8, 64) 7 76% (55, 89) 21 p = 1.00 AS_27* 42% (29, 56) 50 14% (5, 35) 21 37% (24, 52) 41 p<0.05 † AS_28* -- 2% (0, 12) 45 4% (1, 20) 24 p = 1.00 AS_29 -- 0% 3 26% (12, 49) 19 AS_30 -- 0% (0, 39) 6 AGEI AS_31 -- -- 50% 4 AS_32 -- -- SNDP Total communities = 30 18% (15, 21) 530 20% (15, 26) 231 34% (30, 39) 459 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NS = Not screened AGEI = Screened by the Australian Government Emergency Intervention but the trachoma grading was not considered reliable by NT authorities and therefore the data were not included in this report SNDP = Screened but no data were provided -- Data not reported * Community reported to have examined ≥10 children on two or more occasions † There was no significant increase between 2007 and 2008; however, there was a significant decrease between 2006 and 2007 Source: Data were collected by the Healthy School Age Kids program

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Table A.2 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Alice Springs Remote region, NT, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 789 1028 1004 2821 in Communities At Risk † 690 887 916 2493

in Communities At Risk from 675 579 513 1767 which data were reported ‡ Active trachoma Children resident in 690 (87%) 887 (86%) 916 (91%) 2493 (88%) Communities At Risk (% of children resident in region)

Children examined (% of those 59 (9%) 400 (45%) 350 (38%) 809 (32%) currently resident in Communities At Risk) Active trachoma (%) 25 (42%) 132 (33%) 60 (17%) 217 (27%) Facial cleanliness Children examined 62 406 347 815 Clean faces (%) 22 (35%) 200 (49%) 227 (65%) 449 (55%)

* Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.4% low series population growth rate in the NT ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the Healthy School Age Kids program Source: Data regarding active trachoma and clean faces were collected by the Healthy School Age Kids program

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Table A.3 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Alice Springs Remote region, NT, 2008.

Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) AS_04 23 0 (0%) 17 9 (53%) AS_06 37 26 (70%) 37 6 (16%) AS_07 15 2 (13%) 15 8 (53%) AS_08 11 2 (18%) 11 6 (55%) AS_09 74 36 (49%) 74 41 (55%) AS_10 14 0 (0%) 14 14 (100%) AS_11 28 20 (71%) 28 2 (7%) AS_12 32 3 (9%) 47 42 (89%) AS_13 20 0 (0%) 20 8 (40%) AS_14 14 7 (50%) 14 11 (79%) AS_15 11 11 (100%) 11 1 (9%) AS_18 11 4 (36%) 11 5 (45%) AS_20 60 7 (12%) 60 29 (48%) AS_26 21 16 (76%) 21 3 (14%) AS_27 41 15 (37%) 41 17 (41%) AS_28 24 1 (4%) 24 8 (33%) AS_29 19 5 (26%) 19 12 (63%) AS_31 4 2 (50%) 4 0 (0%) Total communities n = 18 459 157 (34%) 468 222 (47%) Source: Data were collected by the Healthy School Age Kids program

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TREATMENT

Table A.4 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Alice Springs Remote region, NT, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) AS_04 0% Not required 0 AS_06 70% Community 275 224 (81%) 224 (81%) AS_07 13% Household 12 12 (100%) 12 (100%) AS_08 18% Household 32 32 (100%) 32 (100%) AS_09 49% Community 585 0 (0%) 522 (89%) AS_10 0% Not required 0 AS_11 71% Community 308 0 (0%) 206 (67%) AS_12 9% Household 3 -- -- AS_13* 0% Household 10 10 (100%) 10 (100%) AS_14 50% Household 37 36 (97%) 36 (97%) AS_15 100% Household 96 0 (0%) 80 (83%) AS_18 36% Household 38 38 (100%) 38 (100%) AS_20 12% Household 12 -- -- AS_26 76% Community 144 107 (74%) 107 (74%) AS_27 37% Not reported 616 0 (0%) 267 (43%) AS_28 4% Household 9 1 (11%) 8 (89%) AS_29 26% Household 28 28 (100%) 28 (100%) AS_31 50% Household 38 38 (100%) 38 (100%) Total communities n = 18 2243 526 (23%) 1608 (72%) -- Data not reported * Active trachoma was not found in children aged 1 to 9 years; however, household contacts were treated because 1/30 children aged 10 to 14 years had active trachoma Source: Data were collected by the Healthy School Age Kids program

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Table A.5 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Alice Springs Remote region, NT, 2008. Number of Total targeted for Number of Total number of communities treatment people treated people treated within 2 weeks Prevalence ≥10% Community 4 1312 331 (25%) 1059 (81%) Household 8 293 184 (63%) 264 (90%) Not reported 1 616 0 (0%) 267 (43%) Subtotal 13 2221 515 (23%) 1590 (72%) Prevalence 5%–<10% Community 0 Household 1 3 -- -- Not reported 0 Subtotal 1 3 -- -- Prevalence 1%–<5% Community 0 Household 1 9 1 (11%) 8 (89%) Not reported 0 Subtotal 1 9 1 (11%) 8 (89%)

Total 15 2233 516 (23%) 1598 (72%) Note: AS_13 was reported to have no active trachoma for children aged 1 to 9 years; however, because 1/30 children aged 10 to 14 years was found to have active trachoma, 10 people were treated (100% of those who required treatment) -- Data not reported Source: Data were collected by the Healthy School Age Kids program

Table A.6 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Alice Springs Remote region, NT, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 45 383 443 315 1057 2243 Treated within 2 0 (0%) 80 (21%) 131 (30%) 93 (30%) 222 (21%) 526 (23%) weeks (%)

Total treated (%) 13 (29%) 205 (54%) 333 (75%) 242 (77%) 815 (77%) 1608 (72%) Source: Data were collected by the Healthy School Age Kids program

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008

80%

70% *

60%

50% * * * 40% * 30% Prevalence and 95% confidencePrevalence intervals 20%

10% †

† † † NS 0% 0% 0% NS NR NR NR 0% SNDP SNDP

9 0 5 0 6 8 07 0 1 11 1 18 2 25 2 27 2 S_ S_ S_ S_ S_ AS_04 A AS_08 AS_ AS_ A AS_14 AS_ A AS_ A AS_ A AS_

Prevalence of active trachoma for 2006 and 2007

Figure A.1 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in 14 communities where ≥10 children were examined, Alice Springs Remote region, NT, 2006, 2007 and 2008. NR = Not reported NS = Not screened SNDP = Screened but no data were provided * p<0.05 statistically significant difference † <10 children examined Source: Data were collected by the Healthy School Age Kids program

TRICHIASIS

Table A.7 Trichiasis screening of Aboriginal adults aged ≥30 years, Alice Springs Remote region, NT, 2008. ABS projection Adults resident: in region* 3521 in Communities At Risk* 3010 Trichiasis ‡ Adults examined (% of the Resident adults in Communities At Risk) 183 (6%) Trichiasis (%) 23 (13%) Offered an ophthalmic consultation within 6 months of screening † 183 Trichiasis surgery within 12 months prior to the date of reporting 36 * Projected 2008 population data based on the ABS 1.4% low series population growth rate in NT † Adults were seen by an ophthalmologist during specialist outreach visits ‡ Age and gender breakdowns not provided Source: Data regarding trichiasis were collected by eye health professionals as part of specialist outreach visits

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TRACHOMA CONTROL ACTIVITIES

Table A.8 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Alice Springs Remote region, NT, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process AS_04 0% ✓ X ✓ ✓ -- AS_06 70% ✓ ✓ ✓ ✓ X AS_07 13% ✓ ✓ ✓ ✓ -- AS_08 18% ✓ ✓ ✓ ✓ -- AS_09 49% ✓ ■ ✓ ✓ -- AS_10 0% ✓ X ✓ ✓ -- AS_11 71% ✓ ■ ✓ ✓ -- AS_12 9% ✓ -- ✓ ✓ -- AS_13 0% ✓ ✓ ○ ✓ -- AS_14 50% ✓ ■ ✓ ✓ -- AS_15 100% ✓ ■ ○ ○ -- AS_18 36% ✓ ✓ ✓ ✓ -- AS_20 12% ✓ -- ✓ ✓ -- AS_26 76% ✓ ■ ✓ ✓ -- AS_27 37% ✓ ■ ------AS_28 4% ✓ ■ ✓ ✓ -- AS_29 26% ✓ ✓ ✓ ✓ ✓ AS_31 50% ✓ ✓ ✓ ✓ -- Total communities n = 18 18 (100%) 7 (39%) 15 (83%) 16 (89%) 1 (6%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Healthy School Age Kids program

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II. BARKLY

Of the nine communities in the Barkly region, one community (11%) was categorised as Not At Risk by the trachoma coordinator (Table 2.1, page 18). Of the eight Communities At Risk (89%), screening was conducted in six of these communities (75%), and data for two (33%) were reported for 2008 (Table A.9). Two of the four communities from which data were not reported were screened by the AGEI (Table 2.1).

Of the 87 Aboriginal children aged 1 to 9 years examined for trachoma, 58 (67%) had active trachoma (Table A.10), and 42 (48%) had clean faces (Table A.11).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in both communities in which treatment for trachoma was indicated; both were treated using a community- based approach (Table A.12 to Table A.13). Overall, 424 (82%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table A.14).

Comparisons of prevalence of active trachoma were possible for two communities in which ≥10 children were examined in two or more years between 2006 and 2008 (Table A.9). No change in prevalence was found in one and a statistically significant increase (p<0.05) was found in the other (Figure A.2).

Data for trichiasis were reported for two of the eight Communities At Risk (25%). Of the 542 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 23 adults (4%) were examined for trichiasis, and three (13%) had trichiasis (Table A.15). Three adults were reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting.

In 2008 the SAFE trachoma control strategy was partially implemented in the two communities where screening was conducted; no information was reported for the additional four communities where screening was conducted but data were not reported. Both these communities had an existing referral process for trichiasis surgery, had antibiotics for active trachoma distributed, and facial cleanliness was promoted through the use of resources and clean face programs (Table A.16). However, improvements to the communities’ environmental conditions were reported for one community only. Although there was little information on environmental conditions, one of the nine communities in the Barkly region (11%) had a swimming pool (BA_06).

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SCREENING FOR ACTIVE TRACHOMA

Table A.9 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Barkly region, NT, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s code 2006 2007 2008 test used to calculate Communities = 6 Communities = 6 Communities = 2 significance % (95% CI) n % (95% CI) n % (95% CI) n BA_01 0% 1 0% 2 AGEI BA_02 0% 2 -- -- NS BA_03* 2% (0, 13) 41 38% (18, 64) 13 73% (60, 83) 56 ↑ p<0.05 BA_04* 47% (33, 61) 43 48% (31, 66) 27 55% (38, 71) 31 p = 0.82 BA_05 0% (0, 19) 16 0% 2 AGEI BA_06 50% 2 0% 4 NAR BA_07 -- 0% (0, 16) 20 SNDP BA_08 -- -- SNDP Total communities = 8 † 21% (14, 30) 105 26% (17, 38) 68 67% (56, 76) 87 ↑ p<0.05 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table AGEI = Screened by the Australian Government Emergency Intervention but the trachoma grading was not considered reliable by NT authorities and therefore the data were not included in this report n = Number of children examined NAR = Identified by key representatives as Not At Risk SNDP = Screened but no data were provided -- Data not reported * Community reported to have examined ≥10 children on two or more occasions † One community has not been included in the total because data were not provided for 2006, 2007 or 2008 Source: Data were collected by the Healthy School Age Kids program

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Table A.10 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Barkly region, NT, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 283 378 391 1052 in Communities At Risk † 153 188 172 513 in Communities At Risk from 86 81 61 228 which data were reported ‡ Active trachoma Children resident in 153 (54%) 188 (50%) 172 (44%) 513 (49%) Communities At Risk (% of children resident in region) Children examined (% of those 20 (13%) 67 (36%) 54 (31%) 141 (27%) currently resident in Communities At Risk) Active trachoma (%) 17 (85%) 41 (61%) 21 (39%) 79 (56%) Facial cleanliness Children examined 20 67 54 141 Clean faces (%) 4 (20%) 38 (57%) 31 (57%) 73 (52%)

Table A.11 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Barkly region, NT, 2008. Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) BA_03 56 41 (73%) 56 19 (34%) BA_04 31 17 (55%) 31 23 (74%) Total communities n = 2 87 58 (67%) 87 42 (48%) Source: Data were collected by the Healthy School Age Kids program

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TREATMENT

Table A.12 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Barkly region, NT, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) BA_03 73% Community 301 250 (83%) 250 (83%) BA_04 55% Community 218 174 (80%) 174 (80%) Total communities n = 2 519 424 (82%) 424 (82%) Source: Data were collected by the Healthy School Age Kids program

Table A.13 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Barkly region, NT, 2008. Number of Total targeted for Number of Total number of communities treatment people treated people treated within 2 weeks Prevalence ≥10% Community 2 519 424 (82%) 424 (82%) Household 0 Not reported 0 Subtotal 2 519 424 (82%) 424 (82%) Prevalence 5%–<10% Community 0 Household 0 Not reported 0 Subtotal 0 Prevalence 1%–<5% Community 0 Household 0 Not reported 0 Subtotal 0 Total 2 519 424 (82%) 424 (82%) Source: Data were collected by the Healthy School Age Kids program

Table A.14 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Barkly region, NT, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 0 102 129 81 207 519 Treated within 2 weeks (%) 73 (72%) 112 (87%) 76 (94%) 163 (79%) 424 (82%)

Total treated (%) 73 (72%) 112 (87%) 76 (94%) 163 (79%) 424 (82%) Source: Data were collected by the Healthy School Age Kids program

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008 80%

70%

60%

50% *

40%

30% Prevalence and 95% and confidencePrevalence intervals 20%

10%

3 4 0 0 _ _ A A B B Prevalence of active trachoma for 2006, 2007 and 2008

Figure A.2 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in two communities where ≥10 children were examined, Barkly region, NT, 2007 and 2008. * p<0.05 statistically significant difference Source: Data were collected by the Healthy School Age Kids program

TRICHIASIS

Table A.15 Trichiasis screening of Aboriginal adults aged ≥30 years, Barkly region, NT, 2008. ABS projection Adults resident: in region* 1301 in Communities At Risk* 542 Trichiasis ‡ Adults examined (% of the resident adults in Communities At 23 (4%) Risk) Trichiasis (%) 3 (13%) Offered an ophthalmic consultation within 6 months of screening † 23 Trichiasis surgery within 12 months prior to the date of reporting 3 * Projected 2008 population data based on the ABS 1.4% low series population growth rate in NT † Adults were seen by an ophthalmologist during specialist outreach visits ‡ Age and gender breakdowns not provided Source: Data regarding trichiasis were collected by eye health professionals as part of specialist outreach visits

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TRACHOMA CONTROL ACTIVITIES

Table A.16 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Barkly region, NT, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process BA_03 73% ✓ ■ ✓ ✓ -- BA_04 55% ✓ ■ ✓ ✓ ■ Total communities n = 2 2 (100%) 0 (0%) 2 (100%) 2 (100%) 0 (0%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Healthy School Age Kids program

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III. DARWIN RURAL

Of the 17 communities in the Darwin Rural region, one community (6%) was categorised as Not At Risk by the trachoma coordinator (Table 2.1, page 18). Of the 16 Communities At Risk (94%), screening was conducted in 13 of these communities (81%), and data for 11 (85%) were reported for 2008 (Table A.17).

Of the 907 Aboriginal children aged 1 to 9 years examined for trachoma, 183 (20%) had active trachoma (Table A.18). A total of 627 children were examined in five of the 11 communities (45%) where data were provided for facial cleanliness, and 497 (79%) had clean faces (Table A.19).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in nine of the 11 communities (85%) in which treatment for trachoma was indicated. Community-based treatment was given in two of these communities (22%), household-based treatment was given in six (67%) and treatment was given in another community where the treatment strategy was not reported (11%) (Table A.20 to Table A.21). No treatment data were reported for the remaining two communities where treatment for trachoma was indicated. Overall, 622 (60%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table A.22).

Comparisons of prevalence of active trachoma were possible for seven communities in which ≥10 children were examined in two or more years between 2006 and 2008 (Table A.17). No change in prevalence was found in three communities (43%), a statistically significant increase (p<0.05) was found in three (43%) and a decrease (p<0.05) was found in one (14%) (Figure A.3). Community DR_07 showed no consistent trend over time even though the prevalence was significantly different between years 2006 and 2007 and 2007 and 2008.

Data for trichiasis were not provided for any of the 3173 Aboriginal adults aged ≥30 years reported by the ABS to be resident in 16 Communities At Risk; however, seven adults were reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting.

In 2008 the SAFE trachoma control strategy was partially implemented in the 11 communities where screening was conducted; no information was reported for the additional two communities where screening was conducted but data were not reported. All communities had an existing referral process for trichiasis surgery, and facial cleanliness was promoted through the use of resources in seven communities (64%) and through clean face programs in nine (82%) (Table A.23). Antibiotics for active trachoma were reported to have been distributed in nine communities (82%). Good environmental conditions were reported in one community only (9%); however, eight of the 17 communities in the Darwin Rural region (47%) had swimming pools (DR_04, 06, 07, 10, 11, 12, 13 and 14).

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SCREENING FOR ACTIVE TRACHOMA

Table A.17 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Darwin Rural region, NT, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s code 2006 2007 2008 test used to calculate Communities = 16 Communities = 12 Communities = 11 significance % (95% CI) n % (95% CI) n % (95% CI) n DR_01* 8% (1, 35) 12 0% (0, 23) 13 SNDP p = 0.48 DR_02 0% 1 0% 2 NS DR_03 0% (0, 18) 17 NS NS NS DR_04 33% 3 0% (0, 39) 6 SNDP DR_06 0% 3 SNDP SNDP 1% (0, 6) 89 DR_07* 30% (21, 41) 77 3% (1, 9) 99 35% (24, 47) 66 p<0.05 DR_08* 0% 1 7% (3, 19) 41 11% (5, 22) 55 p = 0.73 DR_09* 0% 1 13% (3, 36) 16 46% (31, 62) 37 ↑ p<0.05 DR_10 12% (7, 18) 137 0% 2 17% (12, 24) 147 DR_11* 0% (0, 3) 107 7% (2, 18) 45 5% (2, 13) 74 ↑ p<0.05 DR_12* 81% (67, 90) 30% (17, 47) 33 22% (12, 38) 36 ↓ p<0.05 DR_05 100% 2 DR_12 78% (63, 88) 41 DR_13 20% 5 0% 1 17% (7, 37) 23 DR_14* 5% (2, 11) 113 3% (1, 8) 110 23% (19, 28) 315 ↑ p<0.05 DR_15 0% 1 11% (2, 43) 9 22% (11, 41) 27 DR_16 100% 1 -- NS DR_17 -- -- 42% (28, 58) 38 Total communities = 16 16% (13, 19) 522 7% (5, 10) 377 20% (18, 23) 907 ↑ p<0.05 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NS = Not screened SNDP = Screened but no data were provided -- Data not reported * Community reported to have examined ≥10 children on two or more occasions Source: Data were collected by the Healthy School Age Kids program

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Table A.18 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Darwin Rural region, NT, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 942 1204 1088 3234 in Communities At Risk † 877 1136 1031 3044 in Communities At Risk from 1177 1425 1242 3844 which data were reported ‡ Active trachoma Children resident in 877 (93%) 1136 (94%) 1031 (95%) 3044 (94%) Communities At Risk (% of children resident in region) Children examined (% of those 113 (13%) 794 (70%) 427 (41%) 1334 (44%) currently resident in Communities At Risk) Active trachoma (%) 18 (16%) 165 (21%) 88 (21%) 271 (20%) Facial cleanliness Children examined 86 541 281 908 Clean faces (%) 39 (45%) 458 (85%) 335 (119%) 832 (92%)

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Table A.19 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Darwin Rural region, NT, 2008. Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) DR_06 89 1 (1%) -- -- DR_07* 66 23 (35%) -- -- DR_08 55 6 (11%) 55 54 (98%) DR_09* 37 17 (46%) -- -- DR_10 147 25 (17%) 147 126 (86%) DR_11 74 4 (5%) 74 74 (100%) DR_12 36 8 (22%) 36 35 (97%) DR_13* 23 4 (17%) -- -- DR_14 315 73 (23%) 315 208 (66%) DR_15* 27 6 (22%) -- -- DR_17* 38 16 (42%) -- -- Total communities n = 11 907 183 (20%) 627 497 (79%) * The children who were examined with active trachoma were also reported to have been examined for clean faces; however, the number of children with clean faces was not provided -- Data not reported Source: Data were collected by the Healthy School Age Kids program

TREATMENT

Table A.20 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Darwin Rural region, NT, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) DR_06 1% Household 27 27 (100%) 27 (100%) DR_07 35% Not reported 64 0 (0%) 27 (42%) DR_08 11% Household 48 48 (100%) 48 (100%) DR_09 46% Household 206 161 (78%) 165 (80%) DR_10 17% Community 119 0 (0%) 49 (41%) DR_11 5% Household 9 0 (0%) -- DR_12 22% Household 62 62 (100%) 62 (100%) DR_13 17% Household 28 28 (100%) 28 (100%) DR_14 23% Community 110 0 (0%) -- DR_15 22% Household 35 35 (100%) 35 (100%) DR_17 42% Community 327 0 (0%) 181 (55%) Total communities n = 11 1035 361 (35%) 622 (60%) -- Data not reported Source: Data were collected by the Healthy School Age Kids program

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Table A.21 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Darwin Rural region, NT, 2008. Number of Total targeted for Number of Total number of communities treatment people treated people treated within 2 weeks Prevalence ≥10% Community 3 556 0 (0%) 230 (41%) Household 5 379 334 (88%) 338 (89%) Not reported 1 64 0 (0%) 27 (42%) Subtotal 9 999 334 (33%) 595 (60%) Prevalence 5%–<10% Community 0 Household 1 9 0 (0%) -- Not reported 0 Subtotal 1 9 0 (0%) -- Prevalence 1%–<5% Community 0 Household 1 27 27 (100%) 27 (100%) Not reported 0 Subtotal 1 27 27 (100%) 27 (100%)

Total 11 1035 361 (35%) 622 (60%) -- Data not reported Source: Data were collected by the Healthy School Age Kids program

Table A.22 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Darwin Rural region, NT, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 3 144 367 221 300 1035 Treated within 2 weeks (%) 3 (100%) 49 (34%) 110 (30%) 58 (26%) 141 (47%) 361 (35%)

Total treated (%) 3 (100%) 72 (50%) 180 (49%) 104 (47%) 263 (88%) 622 (60%) Source: Data were collected by the Healthy School Age Kids program

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008 80%

70%

60% * 50%

40% *

30% Prevalence confidence95%and Prevalence intervals 20% * * 10% *

†† SNDP 0% 0% 0%

1 7 8 9 1 2 4 0 0 0 0 1 1 1 ______R R R R R R R D D D D D D D Prevalence of active trachoma for 2006, 2007 and 2008

Figure A.3 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in seven communities where ≥10 children were examined, Darwin Rural region, NT, 2006, 2007 and 2008. SNDP = Screened but no data were provided * p<0.05 statistically significant difference † <10 children examined Source: Data were collected by the Healthy School Age Kids program

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TRACHOMA CONTROL ACTIVITIES

Table A.23 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Darwin Rural region, NT, 2008. Community Number of communities code Prevalence Surgery Antibiotics Facial cleanliness Environmental of active referral Resources Program conditions trachoma % process DR_06 1% ✓ ✓ ✓ ✓ -- DR_07 35% ✓ ■ ------DR_08 11% ✓ ✓ ✓ ✓ -- DR_09 46% ✓ ■ ○ ✓ ✓ DR_10 17% ✓ ■ ✓ ✓ -- DR_11 5% ✓ -- ■ ✓ -- DR_12 22% ✓ ✓ ✓ ✓ -- DR_13 17% ✓ ✓ ✓ ✓ -- DR_14 23% ✓ -- ✓ ✓ -- DR_15 22% ✓ ✓ ■ ○ -- DR_17 42% ✓ ■ ✓ ✓ -- Total communities n = 11 11 (100%) 5 (45%) 7 (64%) 9 (82%) 1 (9%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Healthy School Age Kids program

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IV. EAST ARNHEM

Of the 13 communities in the East Arnhem region, one community (8%) was categorised as Not At Risk by the trachoma coordinator (Table 2.1, page 18). Of the 12 Communities At Risk (92%), data for four (33%) were reported for 2008 (Table A.24). Data for the remaining eight communities (67%) were not provided; seven of these communities were reported to have been screened by the AGEI (Table 2.1).

Of the 232 Aboriginal children aged 1 to 9 years examined for trachoma, 10 (4%) had active trachoma (Table A.25). A total of 133 children were examined in two of the four communities (50%) where data were provided for facial cleanliness, and 112 (84%) had clean faces (Table A.26).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in three of the four communities (75%) in which treatment was indicated; household-based treatment was given in two (50%) and treatment was given in another community (25%) but the treatment strategy was not reported (Table A.27 to Table A.28). No treatment data were reported for the remaining community where treatment for trachoma was indicated. Overall, 110 (92%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table A.29).

Comparisons of prevalence of active trachoma were possible for eight communities in which ≥10 children were examined in two or more years between 2006 and 2008 (Table A.24). No change in prevalence was found in seven communities (88%) and a statistically significant increase (p<0.05) was found in one community (13%) (Figure A.4). Community EA_08 showed no consistent trend over time even though the prevalence was significantly different between 2006 and 2007 and 2007 and 2008.

Data on trichiasis were not provided for any of the 2315 Aboriginal adults aged ≥30 years reported by the ABS to be resident in 12 Communities At Risk.

In 2008 the SAFE trachoma control strategy was partially implemented in the four communities where screening was conducted; no information was reported for the additional seven communities where screening was conducted but data were not reported. All communities had an existing referral process for trichiasis surgery, and antibiotics for active trachoma were reported to have been distributed in three (75%) (Table A.30). Facial cleanliness was promoted through the use of clean face resources and programs in two of the communities (50%). Information regarding environmental conditions and improvements being made was not reported; however, three of the 13 communities in the East Arnhem region (23%) had swimming pools (EA_01, 12, and one which was Not At Risk).

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SCREENING FOR ACTIVE TRACHOMA

Table A.24 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, East Arnhem region, NT, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s test code 2006 2007 2008 used to calculate Communities = 12 Communities = 12 Communities = 4 significance % (95% CI) n % (95% CI) n % (95% CI) n EA_01* 8% (2, 24) 26 2% (0, 11) 46 AGEI p = 0.29 EA_02 8% (1, 33) 13 0% (0, 35) 7 NS EA_03* 3% (1, 6) 212 10% (5, 18) 82 AGEI ↑ p<0.05 EA_04* 1% (0, 4) 140 2% (0, 11) 48 6% (2, 19) 35 p = 0.09 EA_05 2% (0, 11) 48 0% 2 AGEI EA_06* 0% (0, 5) 70 0% (0, 8) 42 AGEI EA_07* 7% (4, 14) 98 3% (1, 10) 68 4% (1, 15) 45 p = 0.52 EA_08* 1% (0, 4) 127 17% (10, 27) 66 3% (1, 10) 67 p<0.05 EA_09 0% (0, 5) 81 0% 1 5% (2, 11) 85 p = 0.12 EA_10 0% 1 0% 3 AGEI EA_11* 6% (2, 17) 48 0% (0, 12) 28 AGEI p = 0.29 EA_12* 0% (0, 20) 15 0% (0, 5) 72 AGEI NA Total communities = 12 3% (2, 4) 879 5% (3, 7) 465 4% (2,8) 232 p = 0.20 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NA = Not available NS = Not screened AGEI = Screened by the Australian Government Emergency Intervention but the trachoma grading was not considered reliable by NT authorities and therefore the data were not included in this report * Community reported to have examined ≥10 children on two or more occasions Source: Data were collected by the Healthy School Age Kids program

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Table A.25 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, East Arnhem region, NT, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 792 1124 870 2786 in Communities At Risk † 473 682 581 1736 in Communities At Risk from 288 436 359 1083 which data were reported ‡ Active trachoma Children resident in 473 (60%) 682 (61%) 581 (67%) 1736 (62%) Communities At Risk (% of children resident in region) Children examined (% of those 26 (5%) 206 (30%) 171 (29%) 403 (23%) currently resident in Communities At Risk) Active trachoma (%) 1 (4%) 9 (4%) 3 (2%) 13 (3%) Facial cleanliness Children examined 8 125 79 212 Clean faces (%) 4 (50%) 108 (86%) 72 (91%) 184 (87%)

Table A.26 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, East Arnhem region, NT, 2008.

Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) EA_04 35 2 (6%) -- EA_07 45 2 (4%) 48 29 (60%) EA_08 67 2 (3%) -- EA_09 85 4 (5%) 85 83 (98%) Total communities n = 4 232 10 (4%) 133 112 (84%) -- Data not reported Source: Data were collected by the Healthy School Age Kids program

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TREATMENT

Table A.27 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, East Arnhem region, NT, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) EA_04 6% Not reported 4 -- -- EA_07 4% Household 23 23 (100%) 23 (100%) EA_08 3% Not reported 16 16 (100%) 16 (100%) EA_09 5% Household 76 0 (0%) 71 (93%) Total communities n = 4 119 39 (33%) 110 (92%) -- Data not reported Source: Data were collected by the Healthy School Age Kids program

Table A.28 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, East Arnhem region, NT, 2008. Number of Total targeted for Number of Total number of communities treatment people treated people treated within 2 weeks Prevalence ≥10% Community 0 Household 0 Not reported 0 Subtotal 0 Prevalence 5%–<10% Community 0 Household 1 76 0 (0%) 71 (93%) Not reported 1 4 -- -- Subtotal 2 80 0 (0%) 71 (89%) Prevalence 1%–<5% Community 0 Household 1 23 23 (100%) 23 (100%) Not reported 1 16 16 (100%) 16 (100%) Subtotal 2 39 39 (100%) 39 (100%)

Total 4 119 39 (33%) 110 (92%) -- Data not reported Source: Data were collected by the Healthy School Age Kids program

Table A.29 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, East Arnhem region, NT, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 0 12 32 21 54 119 Treated within 2 weeks (%) 8 (67%) 12 (38%) 7 (33%) 12 (22%) 39 (33%)

Total treated (%) 12 (100%) 26 (81%) 18 (86%) 54 (100%) 110 (92%) Source: Data were collected by the Healthy School Age Kids program

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008 80%

70%

60%

50%

40%

30% * Prevalence and 95% confidence95% and intervals Prevalence 20%

10% * SNDP SNDP SNDP SNDP SNDP 0% 0% 0% 0% 0% 0%

1 3 4 6 7 8 1 2 0 0 0 0 0 0 1 1 ______A A A A A A A A E E E E E E E E Prevalence of active trachoma for 2006, 2007 and 2008

Figure A.4 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in eight communities where ≥10 children were examined, East Arnhem region, NT, 2007 and 2008. SNDP = Screened but no data were provided * p<0.05 statistically significant difference Source: Data were collected by the Healthy School Age Kids program

TRACHOMA CONTROL ACTIVITIES

Table A.30 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, East Arnhem region, NT, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process EA_04 6% ✓ ------EA_07 4% ✓ ✓ ✓ ✓ -- EA_08 3% ✓ ✓ ------EA_09 5% ✓ ■ ✓ ✓ -- Total communities n = 4 4 (100%) 2 (50%) 2 (50%) 2 (50%) 0 (0%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Healthy School Age Kids program

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V. KATHERINE

Of the 22 communities in the Katherine region, two communities (9%) were categorised as Not At Risk by the trachoma coordinator (Table 2.1, page 18). Of the 20 Communities At Risk (91%), data for seven (35%) were reported for 2008 (Table A.31). Four of the Communities At Risk had not provided any data for the three years of surveillance.

Of the 732 Aboriginal children aged 1 to 9 years examined for trachoma, 287 (39%) had active trachoma (Table A.32); this total included children aged 10 to 15 for four of the seven communities where age breakdowns were not provided. A total of 133 children were examined in two of the seven communities (29%) where data were provided for facial cleanliness, and 119 (89%) had clean faces (Table A.33).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in six of the seven communities (86%) in which treatment for trachoma was indicated, including one community where active trachoma was found in 1/15 children aged 10 to 14 years without being detected in children aged 1 to 9 years (Table A.34 and Table A.35). Community-based treatment was given in one community (17%), household-based treatment in another (17%), and treatment was given in four (67%) where the treatment strategy and the number of people requiring treatment were not reported. No treatment data were reported for the remaining community where treatment for trachoma was indicated. Overall, 42 (7%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table A.36); an additional 871 children, their households contacts and community members were treated in four communities where the number of people requiring treatment was not reported.

Comparisons of prevalence of active trachoma were possible for two communities in which ≥10 children were examined in two or more years between 2006 and 2008 (Table A.31). A statistically significant increase (p<0.05) in prevalence was found in one community and a decrease (p<0.05) was found in the other (Figure A.5). Comparisons of prevalence of active trachoma were not possible for four of the seven communities where data were provided for children aged 0 to 15 years – instead of 1 to 9 years – and age breakdowns were not provided.

Data for trichiasis were not provided for any of the 2038 Aboriginal adults aged ≥30 years reported by the ABS to be resident in 20 Communities At Risk.

In 2008 the SAFE trachoma control strategy was partially implemented in the seven communities where screening was conducted. Three communities (43%) had an existing referral process for trichiasis surgery and antibiotics for active trachoma were reported to have been distributed in six communities (86%). Few communities reported promoting facial cleanliness, one (14%) used facial cleanliness resources, and three (43%) implemented clean face programs. Information regarding the environmental conditions or improvements being made in the community was not reported for any of the communities; however, three of the 22 communities in the Katherine region (14%) had swimming pools (KA_02, 04 and 08).

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SCREENING FOR ACTIVE TRACHOMA

Table A.31 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Katherine region, NT, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s code 2006 2007 2008 test used to calculate Communities = 11 Communities = 11 Communities = 7 significance % (95% CI) n % (95% CI) n % (95% CI) n KA_01 0% 3 -- -- NS KA_02* 49% (40, 58) 115 26% (18, 35) 101 34% (25, 44) 100 ↓ p<0.05 KA_03 0% 1 2% (0, 10) 50 NS KA_04 50% 4 33% (10, 70) 6 NAR KA_05 ‡ 0% 3 0% 2 37% (30, 44) 186 KA_06 100% 1 NS NS KA_07 67% 3 15% (10, 23) 117 NS KA_08 17% (5, 45) 12 0% (0, 39) 6 NS KA_09 0% 1 -- NS KA_10* 100% 2 6% (2, 18) 36 97% (84, 99) 31 ↑ p<0.05 KA_11 0% (0, 5) 73 NS NS KA_12 -- 0% (0, 14) 24 NS ‡ KA_13 -- 35% (26, 45) 97 41% (33, 49) 128 KA_14 -- 17% (9, 31) 41 NS ‡ KA_15 -- 18% (11, 28) 82 44% (36, 52) 146 KA_16 -- -- 0% (0, 12) 29 ‡ KA_17 -- -- 35% (27, 44) 112 Total communities = 17 † 30% (24, 36) 218 19% (16, 22) 562 39% (36, 43) 732 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NAR = Identified by key representatives as Not At Risk NS = Not screened -- Data not reported * Community reported to have examined ≥10 children on two or more occasions † Five communities have not been included in the total because they did not provide data for 2006, 2007 or 2008 – four of these were categorised as being At Risk for trachoma ‡ The data are for children aged 0 to 15 years; comparisons could not be made due to the different age categories Source: Data were collected by the Healthy School Age Kids program

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Table A.32 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Katherine region, NT, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Age not specified (0–15 yrs) § Population data Children resident: in region † 894 1097 963 -- 2954 in Communities At Risk † 651 809 679 -- 2139 in Communities At Risk from 219 224 222 924 1589 which data were reported ‡ Active trachoma Children resident in 651 (73%) 809 (74%) 679 (71%) -- 2139 (72%) Communities At Risk (% of children resident in region) Children examined (% of those 14 (2%) 146 (18%) 84 (12%) 572 (27%) 816 (38%) currently resident in Communities At Risk) Active trachoma (%) 1 (7%) 63 (43%) 21 (25%) 223 (39%) 308 (38%) Facial cleanliness Children examined 16 117 70 -- 203 Clean faces (%) 11 (69%) 108 (92%) 65 (93%) -- 184 (91%) -- Data not reported * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.4% low series population growth rate in the NT ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the Healthy School Age Kids program § In four communities age breakdowns were not provided for children who were examined; data for children aged 0–15 years were reported Source: Data regarding active trachoma and clean faces were collected by the Healthy School Age Kids program

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Table A.33 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Katherine region, NT, 2008.

Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) KA_02 100 34 (34%) 100 88 (88%) KA_05 † 186 68 (37%) -- -- KA_10* 31 30 (97%) -- -- KA_13 † 128 52 (41%) -- -- KA_15 † 146 64 (44%) -- -- KA_16 29 0 (0%) 33 31 (94%) KA_17 † 112 39 (35%) -- -- Total communities n = 7 732 287 (39%) 133 119 (89%) -- Data not reported * The children who were examined with active trachoma were also reported to have been examined for clean faces; however, the number of children with clean faces was not provided † The data provided were for children aged 0–15 years Source: Data were collected by the Healthy School Age Kids program

TREATMENT

Table A.34 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Katherine region, NT 2008. Community Prevalence of Treatment Treatment code active strategy Required Within 2 Total (%) trachoma % weeks (%) KA_02 34% Community 477 0 (0%) -- KA_05 37% Not reported -- -- 335 KA_10 97% Community 144 34 (24%) 34 (24%) KA_13 41% Not reported -- -- 217 KA_15 44% Not reported -- -- 218 KA_16* 0% Household 8 8 (100%) 8 (100%) KA_17 35% Not reported -- -- 101 Total communities n = 7 629 42 (7%) 42 (7%) † -- Data not reported * Active trachoma was not found in children aged 1 to 9 years; however, household contacts were treated because 1/15 children aged 10 to 14 years had active trachoma † Excludes communities not reporting number of people requiring treatment Source: Data were collected by the Healthy School Age Kids program

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Table A.35 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Katherine region, NT, 2008. Number of Total targeted for Number of Total number of communities treatment people treated people treated within 2 weeks Prevalence ≥10% Community 2 621 34 (5%) 34 (5%) Household 0 Not reported 4 -- -- 871 Subtotal 6 621 34 (5%) 34 (5%)* Prevalence 5%–<10% Community 0 Household 0 Not reported 0 Subtotal 0 Prevalence 1%–<5% Community 0 Household 0 Not reported 0 Subtotal 0

Total 6 621 34 (5%) 34 (5%)* Note: KA_16 reported no active trachoma for children aged 1 to 9 years; however, because active trachoma was found in 1/15 children aged 10 to 14 years, eight people were treated (100% of those who required treatment) -- Data not reported * Excludes communities not reporting number of people requiring treatment Source: Data were collected by the Healthy School Age Kids program

Table A.36 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Katherine region, NT, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Age not Total specified Requiring treatment 0 169 248 210 2 -- 629 Treated within 2 2 (1%) 26 (10%) 12 (16%) 2 (100%) -- 42 (7%) weeks (%)

Total treated (%) 2 (1%) 26 (10%) 12 (16%) 2 (100%) 871 913* -- Data not reported * Includes 871 people who were treated in four communities in the Katherine region, the number of people requiring treatment was not provided Source: Data were collected by the Healthy School Age Kids program

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008 80%

70%

60%

50% * *

40%

30% Prevalence and 95% and confidencePrevalence intervals 20%

10%

† 0%

2 0 0 1 _ _ A A K K Prevalence of active trachoma for 2006, 2007 and 2008

Figure A.5 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in two communities where ≥10 children were examined, Katherine region, NT, 2007 and 2008. * p<0.05 statistically significant difference † <10 children examined Source: Data were collected by the Healthy School Age Kids program

TRACHOMA CONTROL ACTIVITIES

Table A.37 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Katherine region, NT, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process KA_02 34% ✓ -- ■ ✓ -- KA_05* 37% -- ■ ------KA_10 97% ✓ ■ ○ ✓ -- KA_13* 41% -- ■ ------KA_15* 44% -- ■ ------KA_16 0% ✓ ✓ ✓ ✓ -- KA_17* 35% -- ■ ------Total communities n = 7 3 (43%) 1 (14%) 1 (14%) 3 (43%) 0 (0%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported * Prevalence of active trachoma reported for children aged 0–15 years Source: Data were collected by the Healthy School Age Kids program

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B. SOUTH AUSTRALIA COMMUNITY LEVEL DATA BY REGION

Community level data by region have been included in this Appendix. The results section of this report presents a national overview of the 2008 data and jurisdictional data by regions.

SCREENING FOR ACTIVE TRACHOMA

Table B.1 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years for Screening 1, by community, SA ACCHS, 2006, 2007 and 2008. Aboriginal Community 2007 2008 Prevalence of active trachoma Fisher’s test used Controlled Health Service community community 2006 2007 2008 to calculate (ACCHS) code code Communities = 17 Communities = 8 Communities = 11 significance % (95% CI) n % (95% CI) n % (95% CI) n Ceduna/Koonibba SA_01 CE_01* 6% (1, 26) 18 6% (1, 28) 16 0% (0, 3) 121 p = 0.05 Tullawon SA_02 25% (13, 43) 28 SA_22 TU_01 † 19% (7, 43) 16 0% (0, 30) 9 Oak Valley SA_09 OV_01* † 22% (9, 45) 18 13% (3, 36) 16 p = 0.66 Umoona Tjutagku SA_03 UT_01 17% (3, 56) 6 0% 2 0% (0, 20) 15 Nganampa SA_04 25% 4 SA_10 NG_01* † 14% (5, 33) 22 7% (1, 31) 14 p = 1.00 SA_11 NG_02 † 0% (0, 35) 7 4% (1, 20) 25 SA_12 NG_03* † 9% (3, 24) 33 0% (0, 11) 31 p = 0.24 SA_05 18% (6, 41) 17 SA_13 NG_04* † 29% (12, 55) 14 7% (2, 23) 28 p = 0.16 SA_14 NG_05 † NS SA_15 NG_06 † NS SA_06 17% (3, 56) 6 SA_16 NG_07 † NS 0%(0, 13) 26 SA_17 NG_08 † NS 0% (0, 8) 43 Pika Wiya SA_07 31% (13, 57) 13 NS SA_18 PW_01 SA_19 PW_02 SA_20 PW_03 SA_21 PW_04 SA_08 PW_05* 5% (1, 17) 38 NS 0% (0, 9) 37 p = 0.49

Total 15% (10, 23) 130 14% (9, 21) 128 2% (1, 4) 365 ↓ p<0.05 Note: For communities with ≤5 children examined 95% CI were very large and have not been included in the table NS = Not screened * Community reported to have examined ≥10 children on two or more occasions † 2006 data were reported with another community Source: Data were collected by the EH&CDSSP coordinator and the screening team

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Table B.2 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, SA ACCHS, 2008. ACCHS Community Trachoma Clean faces Code Examine Active Clean face d trachoma (%) Examined (%) Ceduna/Koonibba CE_01 121 0 (0%) 121 121 (100%) Nganampa NG_01 14 1 (7%) 14 4 (29%) NG_02 25 1 (4%) 25 12 (48%) NG_03 31 0 (0%) 31 10 (32%) NG_04 28 2 (7%) 28 11 (39%) NG_07 26 0 (0%) 26 20 (77%) NG_08 43 0 (0%) 43 21 (49%) Oak Valley OV_01 16 2 (13%) 16 0 (0%) Pika Wiya PW_05 37 0 (0%) 37 37 (100%) Tullawon TU_01 9 0 (0%) 9 9 (100%) Umoona Tjutagku UT_01 15 0 (0%) 15 15 (100%) Total Total ACCHS communities n = 6 n = 11 365 6 (2%) 365 260 (71%) Source: Data were collected by the EH&CDSSP coordinator and the screening team

COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008 80%

70%

60%

50%

40%

30% Prevalence andintervals confidence 95% Prevalence 20%

10%

† † † †† 0% 0% NS 0% 0%

1 1 1 3 4 5 0 0 0 0 0 0 ______E V G G G W C O N N N P CEDUNA/ OAK VALLEY NGANAMPA PIKA WIYA KOONIBBA Prevalence of active trachoma for 2006, 2007 and 2008

Figure B.1 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in six communities where ≥10 children were examined, SA ACCHS, 2006, 2007 and 2008. NS = Not screened * p<0.05 statistically significant difference † 2006 data were reported with another community Source: Data were collected by the EH&CDSSP coordinator and the screening team

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SAFE TRACHOMA CONTROL ACTIVITIES

Table B.3 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, SA ACCHS, 2008. ACCHS Community Prevalence Number of communities code of active trachoma % Surgery Antibiotics Facial cleanliness Environmental referral Resources Program conditions process Ceduna/ CE_01 0% -- X ------Koonibba Nganampa ------NG_01 7% ✓

------NG_02 4% ✓ NG_03 0% -- X ------

-- ✓ ------NG_04 7% NG_07 0% -- X ------NG_08 0% ✓ X ○ ○ -- Oak Valley OV_01 13% ✓ ✓ ○ ○ Pika Wiya PW_05 0% -- X ------Tullawon TU_01 0% ✓ ✓ ○ ○

Umoona UT_01 0% ✓ X ✓ ○ -- Tjutagku Total Total ACCHS communities n = 6 n = 11 4 (36%) 5 (45%) 1 (9%) 0 (0%) 0 (0%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the EH&CDSSP coordinator and the screening team

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I. CEDUNA/KOONIBBA

All 21 communities in regions serviced by the Ceduna/Koonibba ACCHS were categorised At Risk by the EH&CDSSP coordinator (Table 3.1, page 30); includes communities in the Eyre school district in SA, and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted. Data for one community (5%) were reported for 2008 (Table B.1).

Of the 121 Aboriginal children aged 1 to 9 years examined for trachoma, none had active trachoma, and all of the children had clean faces (Table B.2 and Table B.4).

A comparison of prevalence of active trachoma was made for that one community between 2006 and 2008 (Table B.1). No statistically significant change in prevalence was found over time, 6% for each of 2006 and 2007, to 0% for 2008 (Figure B.1).

Data for trichiasis were collected by the EH&CDSSP coordinator and the National Indigenous Eye Health Survey at the clinics; however, these data have not been provided for inclusion in this report (Table B.5).

In 2008, no information was reported for the implementation of the SAFE trachoma control strategy (Table B.3).

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SCREENING FOR ACTIVE TRACHOMA

Table B.4 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Ceduna/Koonibba ACCHS, SA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in ACCHS region † 827 1256 1199 3282 in Communities At Risk † 827 1256 1199 3282 in Communities At Risk from 0 121 87 208 which data were reported‡ Active trachoma Children resident in 827 (100%) 1256 (100%) 1199 (100%) 3282 (100%) Communities At Risk (% of children resident in region) Children examined (% of those 0 (0%) 121 (10%) 87 (7%) 208 (6%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Facial cleanliness Children examined 0 121 87 208 Clean faces (%) 0 (100%) 121 (100%) 87 (100%) 208 (100%) Note: All communities were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same. Population data include children from communities in the Eyre school district in SA and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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TRICHIASIS

Table B.5 Trichiasis screening of Aboriginal people, regions serviced by the Ceduna/Koonibba ACCHS, SA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 yrs 50+ yrs ABS projection People resident: in ACCHS region* 3004 1214 667 2632 1163 524 9204 in Communities At 3004 1214 667 2632 1163 524 9204 Risk* Trichiasis People examined ------(% of the resident people in Communities At Risk) Trichiasis (%) ------Ophthalmic ------consultation offered within 6 months of screening † Trichiasis surgery ------within 12 months prior to the date of reporting Note: All communities were considered At Risk, therefore the number of adults resident in the region and in Communities At Risk is the same. Population data include people from communities in the Eyre school district in SA and incorporates communities serviced by the Port Lincoln ACCHS region where screening has not been conducted -- Data not reported * Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA † People were seen by the ophthalmologist in the screening team when they were examined in the clinics Source: Data were collected by the EH&CDSSP coordinator and the screening team

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II. NGANAMPA

All 10 communities in regions serviced by the Nganampa ACCHS were categorised as being At Risk for trachoma by the EH&CDSSP coordinator (Table 3.1, page 30), and data for six (60%) were reported for 2008 (Table B.1).

Of the 167 Aboriginal children aged 1 to 9 years examined for trachoma, 4 (2%) had active trachoma, and 78 (47%) had clean faces (Table B.2 and Table B.6).

Treatment was reported to have been distributed in the three communities in which treatment for trachoma was indicated, to children who were found to have active trachoma at the examination. Household contacts and community members were not treated irrespective of the presence of trachoma; this is a clear lapse of the CDNA guidelines.

Comparisons of prevalence of active trachoma for three communities in which ≥10 children were examined in 2007 and 2008 found no change in prevalence over time; comparisons were not made for data reported in 2006 because data for groups of communities were provided (Table B.1 and Figure B.1).

Data for trichiasis were provided for six of the 10 Communities At Risk (60%). Of the 673 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 221 adults (33%) were examined for trichiasis, and one (0.5%) had trichiasis (Table B.7). One adult was reported to have undergone trichiasis surgery within 12 months of the last screening.

In 2008 the SAFE trachoma control strategy was partially implemented for four of the six communities (67%) where children were examined for trachoma. One community (17%) had an existing referral process for trichiasis surgery, and antibiotics for active trachoma were reported to have been distributed in three communities (50%), but not to household and community contacts (Table B.3). Information regarding the promotion of facial cleanliness was not known, and environmental conditions were not reported.

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SCREENING FOR ACTIVE TRACHOMA

Table B.6 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Nganampa ACCHS, SA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in ACCHS region † 154 180 179 513 in Communities At Risk † 154 180 179 513 in Communities At Risk from 49 172 163 384 which data were reported ‡ Active trachoma Children resident in 154 (100%) 180 (100%) 179 (100%) 513 (100%) Communities At Risk (% of children resident in region) Children examined (% of those 30 (19%) 137 (76%) 69 (39%) 236 (46%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 4 (3%) 0 (0%) 4 (2%) Facial cleanliness Children examined 30 137 69 236 Clean faces (%) 5 (17%) 73 (53%) 62 (90%) 140 (59%) Note: All communities were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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TRICHIASIS

Table B.7 Trichiasis screening of Aboriginal people, regions serviced by the Nganampa ACCHS, SA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 yrs 50+ yrs ABS projection People resident: in ACCHS 530 232 111 493 234 96 1696 region* in Communities 530 232 111 493 234 96 1696 At Risk* Trichiasis People examined 32 (6%) 67 (29%) 88 (79%) 13 (3%) 24 (10%) 42 (44%) 266 (16%) (% of the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (2%) 1 (0.4%) Ophthalmic 32 67 88 13 24 42 266 consultation offered within 6 months of screening † Trichiasis surgery 0 0 0 0 0 1 1 within 12 months prior to the date of reporting Note: All communities were considered At Risk, therefore the number of adults resident in the region and in Communities At Risk is the same * Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA † People were seen by the ophthalmologist in the screening team when they were examined in the clinics Source: Data were collected by the EH&CDSSP coordinator and the screening team

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III. OAK VALLEY (MARALINGA TJARUTJA)

The one community in the area serviced by the Oak Valley ACCHS was categorised as being At Risk for trachoma by the EH&CDSSP coordinator (Table 3.1, page 30), and data were reported for 2008 (Table B.1).

Of the 16 Aboriginal children aged 1 to 9 years examined for trachoma, two (13%) had active trachoma, and none had clean faces (Table B.2 and Table B.8).

Treatment was given to the children who were found to have active trachoma at the examination. Household contacts and community members were not treated irrespective of the presence of trachoma; this is a clear lapse of the CDNA guidelines.

A comparison of prevalence of active trachoma was made for that community between 2007 and 2008; however, no change in prevalence was found (Figure B.1). Comparisons were not made for 2006 prevalence because data was reported with another community (Table B.1).

Data for trichiasis were not provided for any of the 34 Aboriginal adults aged ≥30 years reported to be resident in the Community At Risk.

In 2008 the SAFE trachoma control strategy was partially implemented for the one community that examined children for trachoma. This community had an existing referral process for trichiasis surgery, and antibiotics for active trachoma were reported to have been distributed, but not to household and community contacts (Table B.3). Information regarding the promotion of facial cleanliness was not known, and environmental conditions were not reported.

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SCREENING FOR ACTIVE TRACHOMA

Table B.8 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Oak Valley ACCHS, SA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in ACCHS region † 6 3 15 24 in Communities At Risk † 6 3 15 24 in Communities At Risk from 7 34 32 73 which data were reported ‡ Active trachoma Children resident in 6 (100%) 3 (100%) 15 (100%) 24 (100%) Communities At Risk (% of children resident in region) Children examined (% of those 2 (33%) 14 (467%) 5 (33%) 21 (88%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 2 (14%) 0 (0%) 2 (10%) Facial cleanliness Children examined 2 14 5 21 Clean faces (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Note: All communities were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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IV. PIKA WIYA

All of the 33 communities in regions serviced by the Pika Wiya ACCHS were categorised as being At Risk for trachoma by the EH&CDSSP coordinator (Table 3.1, page 30); includes communities in the Flinders school district in SA and two communities from the Northern Country school district which were reassigned by the EH&CDSSP coordinator. Data for one community (3%) were reported for 2008 (Table B.1).

Of the 37 Aboriginal children aged 1 to 9 years examined for trachoma, none had active trachoma, and all had clean faces (Table B.2 and Table B.9).

A comparison of prevalence of active trachoma was made for that community between 2006 and 2008; however, no change in prevalence was found (Table B.1and Figure B.1).

Data for trichiasis were provided for one of the 33 Communities At Risk (3%). Of the 11,772 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 26 adults (0.2%) were examined for trichiasis and no reported cases of trichiasis were found (Table B.10).

In 2008 no information was reported for the implementation of the SAFE trachoma control strategy (Table B.3).

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SCREENING FOR ACTIVE TRACHOMA

Table B.9 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Pika Wiya ACCHS, SA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in ACCHS region † 2999 3688 3340 10,027 in Communities At Risk † 2999 3688 3340 10,027 in Communities At Risk from 0 194 88 282 which data were reported ‡ Active trachoma Children resident in 2999 (100%) 3688 (100%) 3340 (100%) 10,027 (100%) Communities At Risk (% of children resident in region) Children examined (% of those 1 (0.03%) 36 (1%) 24 (1%) 61 (1%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Facial cleanliness Children examined 1 36 24 61 Clean faces (%) 1 (100%) 36 (100%) 24 (100%) 61 (100%) Note: All communities were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same . Population data include children from communities in the Flinders school district in SA and two communities from the Northern Country school district which were reassigned by the EH&CDSSP coordinator. * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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TRICHIASIS

Table B.10 Trichiasis screening of Aboriginal people, regions serviced by the Pika Wiya ACCHS, SA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 yrs 50+ yrs ABS projection People resident: in ACCHS 8814 3904 2384 8595 3797 1687 29,181 region* in Communities 8814 3904 2384 8595 3797 1687 29,181 At Risk* Trichiasis People examined 0 (0%) 7 (0.2%) 9 (0.4%) 0 (0%) 5 (0.1%) 5 (0.3%) 26 (0.1%) (% of the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Ophthalmic consultation offered within 6 months of screening † Trichiasis surgery within 12 months prior to the date of reporting Note: All communities were considered At Risk, therefore the number of adults resident in the region and in Communities At Risk is the same . Population data include people from communities in the Flinders school district in SA and two communities from the Northern Country school district which were reassigned by the EH&CDSSP coordinator. * Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA Source: Data were collected by the EH&CDSSP coordinator and the screening team

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V. TULLAWON

The one community in the area serviced by the Tullawon ACCHS was categorised as being At Risk for trachoma by the EH&CDSSP coordinator (Table 3.1, page 30), and data were reported for 2008 (Table B.1).

Of the nine Aboriginal children aged 1 to 9 years examined for trachoma, none had active trachoma, and all had clean faces (Table B.2 and Table B.11).

Treatment was given to a child aged 10 to 14 years who was found to have active trachoma at the examination. Household contacts and community members were not treated irrespective of the presence of trachoma; this is a clear lapse of the CDNA guidelines.

Data on trichiasis were not provided for any of the 28 Aboriginal adults aged ≥30 years reported by the ABS to be resident in the Community At Risk.

In 2008 the SAFE trachoma control strategy was partially implemented in the one community that examined children for trachoma. This community had an existing referral process for trichiasis surgery, and antibiotics for active trachoma were reported to have been distributed, but not to household and community contacts (Table B.3). Information regarding the promotion of facial cleanliness was not known, and environmental conditions were not reported.

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SCREENING FOR ACTIVE TRACHOMA

Table B.11 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Tullawon ACCHS, SA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in ACCHS region † 15 3 7 25 in Communities At Risk † 15 3 7 25 in Communities At Risk from 0 34 46 80 which data were reported ‡ Active trachoma Children resident in 15 (100% 3 (100%) 7 (100%) 25 (100%) Communities At Risk (% of children resident in region) Children examined (% of those 0 (0%) 9 (300%) 9 (129%) 18 (72%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 0 (0%) 1 (11%) 1 (6%) Facial cleanliness Children examined 0 9 9 18 Clean faces (%) 0 (0%) 9 (100%) 9 (100%) 18 (100%) Note: All communities were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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VI. UMOONA TJUTAGKU

All six communities in regions serviced by the Umoona Tjutagku ACCHS were categorised as being At Risk for trachoma by the EH&CDSSP coordinator (Table 3.1, page 30), and data for one community (17%) were reported for 2008 (Table B.1).

Of the 15 Aboriginal children aged 1 to 9 years examined for trachoma, none had active trachoma, and all had clean faces (Table B.2 and Table B.12).

In the one community where prevalence of active trachoma was provided, ≥10 children were examined in 2008 only (Table B.1), therefore comparisons of prevalence over time could not be made.

Data for trichiasis were provided for one of the six Communities At Risk (17%). Of the 206 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 51 adults (25%) were examined for trichiasis, and no reported cases of trichiasis were found (Table B.13).

In 2008 the SAFE trachoma control strategy was partially implemented in the one community that examined children for trachoma. This community has an existing referral process for trichiasis surgery, and resources to promote facial cleanliness were being used (Table B.3). Information regarding clean face programs was not known, and environmental conditions were not reported.

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SCREENING FOR ACTIVE TRACHOMA

Table B.12 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, regions serviced by the Umoona Tjutagku ACCHS, SA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in ACCHS region † 35 52 59 146 in Communities At Risk † 35 52 59 146 in Communities At Risk from ------which data were reported ‡ Active trachoma Children resident in 35 (100%) 52 (100%) 59 (100%) 146 (100%) Communities At Risk (% of children resident in region) Children examined (% of those 0 (0%) 15 (29%) 8 (14%) 23 (16%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Facial cleanliness Children examined 0 15 8 23 Clean faces (%) 0 (0%) 15 (100%) 8 (100%) 23 (100%) Note: All communities were considered At Risk, therefore the number of children resident in the region and in Communities At Risk is the same -- Data not reported * Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the EH&CDSSP coordinator and the screening team Source: Data regarding active trachoma and clean faces were collected by the EH&CDSSP coordinator and the screening team

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TRICHIASIS

Table B.13 Trichiasis screening of Aboriginal people, regions serviced by the Umoona Tjutagku ACCHS, SA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 yrs 50+ yrs ABS projection People resident: in ACCHS 138 84 22 129 73 27 473 region* in Communities 138 84 22 129 73 27 473 At Risk* Trichiasis People examined 3 (2%) 15 (18%) 16 (73%) 1 (1%) 3 (4%) 17 (63%) 55 (12%) (% of the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Ophthalmic 3 15 16 1 3 17 55 consultation offered within 6 months of screening † Trichiasis surgery 0 0 0 0 0 0 0 within 12 months prior to the date of reporting Note: All communities were considered At Risk, therefore the number of adults resident in the region and in Communities At Risk is the same * Projected 2008 population data based on the ABS 1.9% low series population growth rate in SA † People were seen by the ophthalmologist in the screening team when they were examined in the clinics Source: Data were collected by the EH&CDSSP coordinator and the screening team

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C. WESTERN AUSTRALIA COMMUNITY LEVEL DATA BY REGION

Community level data by region have been included in this Appendix. The results section of this report presents a national overview of the 2008 data and jurisdictional data by regions.

I. GOLDFIELDS

Of the 29 communities in the Goldfields region, nine (31%) were categorised as Not At Risk by the Population Health Unit (Table 4.1, page 42). Of the 20 Communities At Risk (69%), screening was conducted in 14 of these communities (70%) and data for 13 (93%) were reported for 2008 (Table C.1).

Of the 238 Aboriginal children aged 1 to 9 years examined for trachoma, 18 (8%) had active trachoma (Table C.2). Of the 235 examined for facial cleanliness, 169 (72%) had clean faces (Table C.3).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in three of the six communities (50%) in which treatment for trachoma was indicated. Community-based treatment was given in one community (33%) and household-based treatment was given in two (67%) (Table C.4 to Table C.5). In the remaining three communities where treatment was not distributed according to the CDNA guidelines, treatment was given to only the affected children in two, and treatment data were not reported for the other. Overall, 95 (119%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table C.6).

Comparisons of prevalence of active trachoma were possible for six communities in which ≥10 children were examined in two or more years between 2006 and 2008. No change in prevalence was found in four communities (67%) and a statistically significant decrease (p<0.05) was found in two (33%) (Table C.1 and Figure C.1).

Data for trichiasis were provided for 11 of the 29 Communities At Risk (38%). Of the 1761 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 67 adults (4%) were examined for trichiasis, and three (4%) had trichiasis (Table C.7).

In 2008 the SAFE trachoma control strategy was partially implemented in the 13 communities where screening was conducted; no information was reported for the additional community where screening was conducted but data were not reported. Seven communities (54%) had an existing referral process for trichiasis surgery, and antibiotics for active trachoma were distributed in five communities (38%) (Table C.8). Facial cleanliness was promoted through the use of clean face programs in nine communities (69%), but no information was reported about resources for facial cleanliness. Good environmental conditions were reported for three communities (23%), and in seven (54%) improvements to environmental conditions were being made.

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SCREENING FOR ACTIVE TRACHOMA

Table C.1 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Goldfields region, WA, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s code 2006 2007 2008 test used to calculate Communities = 6 Communities = 7 Communities = 13 significance % (95% CI) n % (95% CI) n % (95% CI) n † GOL_01 0% (0, 16) 20 0% (0, 32) 8 GOL_01&05 11% (3, 31) 19 GOL_02* 0% (0, 15) 21 † 0% (0, 23) 13 GOL_03* 38% (24, 55) 34 † 4% (1, 18) 27 ↓ p<0.05 GOL_02&03 10% (4, 26) 29 GOL_04* 32% (20, 46) 47 9% (3, 24) 33 5% (1, 23) 21 ↓ p<0.05 GOL_05* 39% (22, 59) 23 † 28% (12, 51) 18 p = 0.52 GOL_06* 7% (3, 14) 86 0% (0, 15) 21 0% (0, 16) 20 p = 0.59 GOL_07* -- 0% (0, 8) 42 3% (1,17) 29 p = 0.41 GOL_08 -- 0% (0, 15) 21 NAR GOL_09&11 -- 0% (0, 6) 62 GOL_09 † 0% (0, 43) 5 GOL_11 -- † 0% (0, 7) 49 ‡ GOL_12 -- 24% (11, 43) 25 GOL_15 -- -- SNDP GOL_16 -- -- 0% (0, 32) 8 GOL_17 -- -- 29% (12, 55) 14 GOL_18 -- -- 0% 1 Total communities = 15 § 19% (15, 25) 231 4% (2, 7) 227 8% (5, 12) 238 ↓ p<0.05 Note: For communities with ≤ 5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NAR = Identified by key representatives as Not At Risk SNDP = Screened but no data were provided -- Data not reported * Community reported to have examined ≥10 children on two or more occasions † 2007 data were reported with another community ‡ Data for trichiasis screening were reported only § Six Communities At Risk have not been included in the total because data were not provided for 2006, 2007 or 2008 Source: Data were collected by the Goldfields Population Health Unit

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Table C.2 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Goldfields region, WA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 512 672 610 1794 in Communities At Risk † 441 576 508 1525 in Communities At Risk from 29 211 164 404 which data were reported ‡ Active trachoma Children resident in 441 (86%) 576 (86%) 508 (83%) 1525 (85%) Communities At Risk (% of children resident in region) Children examined (% of those 23 (5%) 215 (37%) 166 (33%) 404 (26%) currently resident in Communities At Risk) Active trachoma (%) 1 (4%) 17 (8%) 8 (5%) 26 (6%) Facial cleanliness Children examined 22 213 164 399 Clean faces (%) 12 (55%) 157 (74%) 155 (95%) 324 (81%)

* Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the Goldfields Population Health Unit Source: Data regarding active trachoma and clean faces were collected by the Goldfields Population Health Unit

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Table C.3 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Goldfields region, WA, 2008. Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) GOL_01 8 0 (0%) 8 7 (88%) GOL_02 13 0 (0%) 13 8 (62%) GOL_03 27 1 (4%) 27 13 (48%) GOL_04 21 1 (5%) 21 17 (81%) GOL_05* 18 5 (28%) 18 5 (28%) GOL_06 20 0 (0%) 20 12 (60%) GOL_07 29 1 (3%) 29 22 (76%) GOL_09 † 5 0 (0%) 5 4 (80%) GOL_11 49 0 (0%) 49 44 (90%) GOL_12 25 6 (24%) 21 20 (95%) GOL_16 † 8 0 (0%) 8 6 (75%) GOL_17 14 4 (29%) 15 10 (67%) GOL_18 1 0 (0%) 1 1 (100%) Total communities n = 13 238 18 (8%) 235 169 (72%) * At the time of screening children were not allowed to shower due to ‘cultural business’; the children are usually fairly clean at other times of the year † Many children were away at the time of screening because they were either at ‘sorry camp’ or involved in ‘business’ in another community Source: Data were collected by the Goldfields Population Health Unit

TREATMENT

Table C.4 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Goldfields region, WA, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) GOL_01 0% Not required 0 GOL_02 0% Not required 0 GOL_03 4% Household* 2 2 (100%) 2 (100%) GOL_04 5% Household 21 21 (100%) 21 (100%) GOL_05 28% Community 22 35 (159%) 42 (191%) GOL_06 0% Not required 0 GOL_07 3% Household 23 22 (96%) 22 (96%) GOL_09 0% Not required 0 GOL_11 0% Not required 0 GOL_12 24% Household* 8 8 (100%) 8 (100%) GOL_16 0% Not required 0 GOL_17 29% Not reported 4 -- -- GOL_18 0% Not required 0 Total communities n = 13 80 88 (110%) 95 (119%) -- Data not reported * Reported household-based strategy but treated children only Source: Data were collected by the Goldfields Population Health Unit

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Table C.5 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Goldfields, WA, 2008. Number of Total targeted for Number of Total number of communities treatment people treated people treated within 2 weeks Prevalence ≥10% Community 1 22 35 (159%) 42 (191%) Household* 1 8 8 (100%) 8 (100%) Not reported 1 4 -- -- Subtotal 3 34 43 (126%) 50 (147%) Prevalence 5%–<10% Community Household 1 21 21 (100%) 21 (100%) Not reported Subtotal 1 21 21 (100%) 21 (100%) Prevalence 1%–<5% Community Household* 2 25 24 (96%) 24 (96%) Not reported Subtotal 2 25 24 (96%) 24 (96%)

Total 6 80 88 (110%) 95 (119%) -- Data not reported * One community was reported to have been treated using a household-based strategy but treated children only Source: Data were collected by the Goldfields Population Health Unit

Table C.6 Completeness and timeliness of active trachoma treatment, by age group, Goldfields region, WA, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 1 4 23 12 40 80 Treated within 2 weeks (%) 0 (0%) 8 (200%) 26 (113%) 20 (167%) 34 (85%) 88 (110%) Total treated (%) 1 (100%) 8 (200%) 27 (117%) 20 (167%) 39 (98%) 95 (119%) Source: Data were collected by the Goldfields Population Health Unit

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COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100%

2006 90% 2007 2008 80%

70%

60%

50%

40%

30%

Prevalence and 95% confidence intervals confidence 95% and Prevalence * 20% *

10%

† † † 3% NR 0% 0% 0% 0% 0% 0%

2 3 4 5 6 7 0 0 0 0 0 0 ______L L L L L L O O O O O O G G G G G G Prevalence of active trachoma for 2006, 2007 and 2008

Figure C.1 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in six communities where ≥10 children were examined, Goldfields region, WA, 2006, 2007 and 2008. NR = Not reported * p<0.05 statistically significant difference † Reported as a pair Source: Data were collected by the Goldfields Population Health Unit

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TRICHIASIS

Table C.7 Trichiasis screening of Aboriginal people, Goldfields region, WA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 yrs 50+ yrs ABS projection Resident people: in region* 1645 721 364 1700 641 337 5408 in Communities At 1363 588 321 1388 567 285 4512 Risk* Trichiasis People examined 0 (0%) 15 (3%) 24 (7%) 0 (0%) 11 (2%) 17 (6%) 67 (1%) (% of the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 2 (13%) 0 (0%) 0 (0%) 0 (0%) 1 (6%) 3 (4%) Ophthalmic ------consultation offered within 6 months of screening (% examined with trichiasis) Trichiasis surgery ------within 12 months prior to the date of reporting -- Data not reported * Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA Source: Data were collected by the Goldfields Population Health Unit

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TRACHOMA CONTROL ACTIVITIES

Table C.8 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Goldfields region, WA, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process GOL_01 0% ✓ X -- ✓ ■ GOL_02 0% -- X -- ✓ ■ GOL_03 4% ✓ ✓ -- -- ■ GOL_04 5% ✓ ✓ -- ✓ ■ GOL_05 28% ✓ ✓ -- X X GOL_06 0% -- X -- ✓ ■ GOL_07 3% ✓ ■ -- ✓ ✓ GOL_09 0% ✓ X -- ✓ X GOL_11 0% -- X -- ✓ ✓ GOL_12 24% ✓ ✓ -- ✓ ■ GOL_16 0% ■ X -- X ■ GOL_17 29% ■ -- -- X X GOL_18 0% ■ X -- ✓ ✓ Total communities n = 13 7 (54%) 4 (31%) 0 (0%) 9 (69%) 3 (23%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Goldfields Population Health Unit

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II. KIMBERLEY

Of the 35 communities in the Kimberley region, one community (3%) was categorised as Not At Risk by the Population Health Unit (Table 4.1, page 42). Of the 34 Communities At Risk (97%), screening was conducted in 33 of these communities (97%), and data for 32 (97%) were provided for 2008. More communities have been screened and reported in 2008, including two that were categorised as Not At Risk in 2007; two communities that were counted in previous years do not have schools and thus have been left out of the total communities in 2008 (Table C.9).

Of the 1169 Aboriginal children aged 1 to 9 years examined for trachoma, 175 (15%) had active trachoma (Table C.10). Of the 1182 examined for facial cleanliness, 952 (81%) had clean faces (Table C.11).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in all 26 communities in which treatment for trachoma was indicated. Community-based treatment was given in 17 communities (65%) and household-based treatment was given in nine (35%) (Table C.12 and Table C.13). In some communities treatment was distributed to more people than what was originally estimated (Table C.12). Overall, 2333 (96%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table C.14).

Comparisons of prevalence of active trachoma were possible for 17 communities in which ≥10 children were examined in 2007 and 2008 (Table C.9 and Figure C.2). Data for prevalence of active trachoma reported in 2006 could not be included in the comparison because the number of children examined from each community was not provided. No change in prevalence was found in 11 communities (65%), a statistically significant increase (p<0.05) was found in three communities (18%) and a decrease (p<0.05) was found in three (18%).

Data for trichiasis were provided for 15 of the 34 Communities At Risk (44%); two of these communities did not provide data for active trachoma because there were no schools and children attended schools in neighbouring locations. Of the 3321 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 442 adults (13%) were examined for trichiasis, and 5% had trichiasis (21 people) (Table C.15). Two adults were reported to have undergone surgery for trichiasis within 12 months prior to the date of reporting.

In 2008 the SAFE trachoma control strategy was partially implemented in the 32 communities where screening was conducted; no information was reported for the additional community where screening was conducted but data were not reported. Nineteen communities (59%) had an existing referral process for trichiasis surgery. In 15 communities (47%), children, household and community contacts requiring treatment received it within two weeks of the screening (Table C.16). Facial cleanliness was promoted through the use of resources in 18 communities (56%), and clean face programs in 28 (88%). Improvements to environmental conditions were reported for 19 communities (59%).

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SCREENING FOR ACTIVE TRACHOMA

Table C.9 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Kimberley region, WA, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s code test used to 2006* 2007 2008 calculate significance Communities = 31 Communities = 27 Communities = 32 % n % (95% CI) n % (95% CI) n

KIM_01 7% -- NAR 4% (1, 19) 26 KIM_02 8% -- NAR 23% (11, 42) 26 † KIM_03 13% -- 12% (5, 26) 41 45% (29, 62) 31 ↑ p<0.05 † KIM_04 17% -- 35% (25, 46) 74 15% (8, 27) 59 ↓ p<0.05 KIM_05 † -- -- 11% (8,15) 299 7% (5,11) 267 p = 0.14 KIM_05 7% -- KIM_06 8% -- KIM_11 37% -- KIM_07 31% -- SNDP 34% (22, 48) 50 KIM_08 100% -- 0% 4 0% (0, 39) 6 † KIM_09 11% -- 0% (0, 20) 15 6% (1, 28) 16 p = 1.00 KIM_10 42% -- SNDP NS KIM_12 33% -- 0% (0, 35) 7 0% (0, 39) 6 KIM_13 13% -- 0% 2 No school † KIM_14 30% -- 28% (18, 40) 61 13% (6, 26) 45 p = 0.10 † KIM_15 27% -- 8% (3, 18) 62 8% (4, 18) 59 p = 1.00 KIM_16 0% -- 0% 4 60% (23, 88) 5 † KIM_17 17% -- 13% (4, 31) 24 23% (12, 41) 30 p = 0.48 KIM_18 27% -- 0% (0, 28) 10 56% (27, 81) 9 KIM_19 30% -- 0% (0, 32) 8 0% (0, 32) 8 KIM_20 37% -- 14% (4, 40) 14 78% (45, 94) 9 † KIM_21 34% -- 27% (15, 43) 37 33% (18, 53) 24 p = 0.77 † KIM_22 50% -- 36% (16, 61) 14 8% (1, 33) 13 p = 0.17 KIM_23 21% -- SNDP 50% (31, 69) 24 † KIM_24 4% -- 9% (5, 16) 100 3% (1, 9) 98 p = 0.13 † KIM_25 9% -- 41% (25, 59) 27 11% (4, 27) 28 ↓ p<0.05 † KIM_27 34% -- 10% (4, 23) 41 34% (22, 48) 50 ↑ p<0.05 † KIM_28 -- 6% (1, 26) 18 44% (23, 67) 16 ↑ p<0.05 KIM_29 82% -- -- 34% (21, 50) 38 -- KIM_30 64% 48% (30, 67) 25 SNDP KIM_31 † 55% -- 43% (26, 63) 23 7% (1, 31) 14 ↓ p<0.05 KIM_32 -- 27% (11, 52) 15 0% (0, 39) 6 † KIM_33 -- 37% (19, 59) 19 10% (3, 30) 20 p = 0.07 † KIM_34 3% -- 0% (0, 15) 22 0% (0, 23) 13 NA † KIM_35 3% -- 0% (0, 10) 36 2% (0, 9) 57 p = 1.00 KIM_38 -- 0% 4 No school KIM_39 -- -- 46% (23, 71) 13 KIM_40 -- NAR 0% (0,7) 55 KIM_41 -- NAR 2% (0,11) 48 Total communities = 37 18% 1048 16% (14, 18) 1006 15% (13, 17) 1169 p = 0.51 Note: For communities with ≤ 5 children examined 95% CI were very large and have not been included in the table n = Number of children examined NA = Not available NAR = Identified by key representatives as Not At Risk SNDP = Screened but no data were provided -- Data not reported * The number of children examined within each community was not reported (NR) in 2006; therefore there are no confidence intervals and prevalence from 2006 cannot be used in the comparisons † Community reported to have examined ≥10 children on two or more occasions Source: Data regarding active trachoma and clean faces were collected by the Kimberley Population Health Unit National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table C.10 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Kimberley region, WA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 1199 1676 1359 4234 in Communities At Risk † 917 1199 1006 3122 in Communities At Risk from 302 1607 1260 3169 which data were reported ‡ Active trachoma Children resident in 917 (76%) 1199 (72%) 1006 (74%) 3122 (74%) Communities At Risk (% of children resident in region) Children examined (% of those 124 (14%) 1045 (87%) 782 (78%) 1951 (62%) currently resident in Communities At Risk) Active trachoma (%) 15 (12%) 160 (15%) 64 (8%) 239 (12%) Facial cleanliness Children examined 135 1047 779 1961 Clean faces (%) 106 (79%) 846 (81%) 767 (98%) 1719 (88%)

* Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the Kimberley Population Health Unit Source: Data regarding active trachoma and clean faces were collected by the Kimberley Population Health Unit

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Table C.11 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Kimberley region, WA, 2008. Community code Trachoma Clean faces Examined Active trachoma % Examined Clean face (%) KIM_01 26 1 (4%) 26 21 (81%) KIM_02 26 6 (23%) 26 22 (85%) KIM_03 31 14 (45%) 31 26 (84%) KIM_04 59 9 (15%) 59 50 (85%) KIM_05 267 19 (7%) 264 218 (83%) KIM_07 50 17 (34%) 50 45 (90%) KIM_08 6 0 (0%) 6 6 (100%) KIM_09 16 1 (6%) 16 16 (100%) KIM_12 6 0 (0%) 6 6 (100%) KIM_14 45 6 (13%) 45 40 (89%) KIM_15 59 5 (8%) 59 6 (10%) KIM_16 5 3 (60%) 5 5 (100%) KIM_17 30 7 (23%) 30 18 (60%) KIM_18 9 5 (56%) 9 7 (78%) KIM_19 8 0 (0%) 8 8 (100%) KIM_20 9 7 (78%) 9 7 (78%) KIM_21 24 8 (33%) 27 18 (67%) KIM_22 13 1 (8%) 13 12 (92%) KIM_23 24 12 (50%) 24 23 (96%) KIM_24 98 3 (3%) 99 90 (91%) KIM_25 28 3 (11%) 31 29 (94%) KIM_27 50 17 (34%) 50 31 (62%) KIM_28 16 7 (44%) 16 5 (31%) KIM_29 38 13 (34%) 38 31 (82%) KIM_31 14 1 (7%) 14 13 (93%) KIM_32 6 0 (0%) 6 5 (83%) KIM_33 20 2 (10%) 20 20 (100%) KIM_34 13 0 (0%) 13 13 (100%) KIM_35 57 1 (2%) 54 49 (91%) KIM_39 13 6 (46%) 16 3 (19%) KIM_40 55 0 (0%) 55 55 (100%) KIM_41 48 1 (2%) 57 54 (95%) Total communities n = 32 1169 175 (15%) 1182 952 (81%) Source: Data were collected by the Kimberley Population Health Unit

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TREATMENT

Table C.12 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Kimberley region, WA, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) KIM_01 4% Household 8 8 (100%) 8 (100%) KIM_02 23% Community 137 114 (83%) 114 (83%) KIM_03 45% Community 143 105 (73%) 105 (73%) KIM_04 15% Community 268 236 (88%) 236 (88%) KIM_05 7% Household 272 231 (85%) 231 (85%) KIM_07 34% Community 234 224 (96%) 224 (96%) KIM_08 0% Not required 0 KIM_09 6% Household 8 8 (100%) 8 (100%) KIM_12 0% Not required 0 KIM_14 13% Community 65 65 (100%) 76 (117%) KIM_15 8% Household 60 60 (100%) 71 (118%) KIM_16 60% Community 26 26 (100%) 33 (127%) KIM_17 23% Community 92 92 (100%) 92 (100%) KIM_18 56% Community 37 37 (100%) 43 (116%) KIM_19 0% Not required 0 KIM_20 78% Community 30 30 (100%) 30 (100%) KIM_21 33% Community 80 80 (100%) 80 (100%) KIM_22 8% Household 6 6 (100%) 7 (117%) KIM_23 50% Community 157 155 (99%) 155 (99%) KIM_24 3% Household 42 35 (83%) 35 (83%) KIM_25 11% Community 70 60 (86%) 60 (86%) KIM_27 34% Community 215 255 (119%) 255 (119%) KIM_28 44% Community 57 50 (88%) 50 (88%) KIM_29 34% Community 287 287 (100%) 287 (100%) KIM_31 7% Household 8 8 (100%) 8 (100%) KIM_32 0% Not required 0 KIM_33 10% Community 46 46 (100%) 46 (100%) KIM_34 0% Not required 0 KIM_35 2% Household 29 24 (83%) 24 (83%) KIM_39 46% Community 56 48 (86%) 48 (86%) KIM_40 0% Not required 0 KIM_41 2% Household 7 7 (100%) 7 (100%) Total communities n = 32 2440 2297 (94%) 2333 (96%)

Source: Data were collected by the Kimberley Population Health Unit

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Table C.13 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Kimberley region, WA, 2008. Number of Total targeted Number of Total number communities for treatment people of people treated within treated 2 weeks Prevalence ≥10% Community 17 2000 1910 (96%) 1934 (97%) Household Not reported Subtotal 17 2000 1910 (96%) 1934 (97%) Prevalence 5%–<10% Community Household 5 354 313 (88%) 325 (92%) Not reported Subtotal 5 354 313 (88%) 325 (92%) Prevalence 1%–<5% Community Household 4 86 74 (86%) 74 (86%) Not reported Subtotal 4 86 74 (86%) 74 (86%)

Total 26 2440 2297 (94%) 2333 (96%) Source: Data were collected by the Kimberley Population Health Unit

Table C.14 Completeness and timeliness of active trachoma treatment, by age group, Kimberley region, WA, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 63 274 714 462 927 2440 Treated within 2 55 (87%) 240 (88%) 695 (97%) 444 (96%) 863 (93%) 2297 (94%) weeks (%) Total treated (%) 55 (87%) 243 (89%) 714 (100%) 458 (99%) 863 (93%) 2333 (96%) Source: Data were collected by the Kimberley Population Health Unit

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COMPARISON OF 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2007 90% 2008 80%

70%

60%

50%

40% *

30% * *

Prevalence and Prevalence confidence 95% intervals * * 20% *

10%

0% 0% 0% 0% 0%

3 4 5 9 4 5 7 1 5 0 0 0 0 1 _1 _1 _2 _2 IM_ IM IM IM IM_22 IM_24 IM IM_27 IM_28 IM_34 KIM_ K KIM_ KIM_ K KIM_ K K K K K K K KIM_31 KIM_33 K KIM_35 Prevalence of active trachoma for 2007 and 2008

Figure C.2 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in 17 communities where ≥10 children were examined, Kimberley region, WA, 2007 and 2008. * p<0.05 statistically significant difference Source: Data were collected by the Kimberley Population Health Unit

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TRICHIASIS

Table C.15 Trichiasis screening of Aboriginal people, Kimberley region, WA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 yrs 50+ yrs ABS projection People resident: in region* 2831 1195 689 2977 1200 467 9359 in Communities 2866 1149 607 2751 1019 546 8938 At Risk* Trichiasis People examined 99 (3%) 116 (10%) 124 (20%) 95 (3%) 91 (9%) 111 (20%) 636 (7%) (% of the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 2 (2%) 13 (10%) 0 (0%) 2 (2%) 4 (4%) 21 (3%)

Ophthalmic 2 (100%) 13 (100%) 2 (100%) 4 (100%) 21 (100%) consultation offered within 6 months of screening (% examined with trichiasis) Trichiasis surgery 0 1 0 1 2 within 12 months prior to the date of reporting

* Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA Source: Data were collected by the Kimberley Population Health Unit

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TRACHOMA CONTROL ACTIVITIES

Table C.16 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Kimberley region, WA, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions (%) process KIM_01 4% ✓ ✓ ✓ ✓ ■ KIM_02 23% ✓ ■ ✓ ✓ ■ KIM_03 45% ✓ ■ ✓ ✓ ■ KIM_04 15% ✓ ■ ✓ ✓ ■ KIM_05 7% ○ ■ ✓ ○ ■ KIM_07 34% ✓ ■ ✓ ✓ -- KIM_08 0% ✓ X ✓ ✓ -- KIM_09 6% ✓ ✓ ○ ○ -- KIM_12 0% ✓ X ○ ○ -- KIM_14 13% ○ ✓ ■ ✓ ■ KIM_15 8% ○ ✓ ■ ✓ ■ KIM_16 60% ○ ✓ ■ ✓ ■ KIM_17 23% ○ ✓ ■ ✓ ■ KIM_18 56% ○ ✓ ■ ✓ ■ KIM_19 0% ○ X ■ ✓ ■ KIM_20 78% ○ ✓ ■ ✓ ■ KIM_21 33% ○ ✓ ■ ✓ ■ KIM_22 8% ○ ✓ ■ ✓ ■ KIM_23 50% ✓ ■ ✓ ✓ ■ KIM_24 3% ✓ ■ ✓ ✓ ■ KIM_25 11% ✓ ■ ✓ ✓ ■ KIM_27 34% ✓ ✓ ✓ ✓ ○ KIM_28 44% -- ■ ------KIM_29 34% ○ ✓ X ✓ ■ KIM_31 7% ✓ ✓ ✓ ✓ ■ KIM_32 0% ✓ X ✓ ✓ -- KIM_33 10% ✓ ✓ ✓ ✓ -- KIM_34 0% ✓ X ✓ ✓ -- KIM_35 2% ✓ ■ ✓ ✓ -- KIM_39 46% ○ ■ ■ ✓ ○ KIM_40 0% ✓ X ✓ ✓ -- KIM_41 2% ✓ ✓ ✓ ✓ ○ Total communities n = 32 19 (59%) 15 (47%) 18 (56%) 28 (88%) 0 (0%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Kimberley Population Health Unit

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III. MIDWEST

Of the 36 communities in the Midwest region, 30 communities (83%) were categorised as Not At Risk by the Population Health Unit (Table 4.1, page 42). Of the six Communities At Risk (17%), data for all were provided for 2008; however, in half of the communities <10 children were examined (Table C.17).

Of the 122 Aboriginal children aged 1 to 9 years examined for trachoma, 12 (10%) had active trachoma (Table C.18), and 100 (82%) had clean faces (Table C.19).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in all six communities in which treatment for trachoma was indicated; including one community where active trachoma was found in 2/12 children aged 10 to 14 without being detected in children aged 1 to 9 years. Household-based treatment was given in all six communities (Table C.20 and Table C.21). Overall, 69 (92%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table C.22). An additional two households were treated within two weeks of the screening; however, the number of people was not provided and therefore could not be included in these data.

Comparisons of prevalence of active trachoma were possible for five communities in which ≥10 children were examined in two or more years between 2006 and 2008. No change in prevalence was found in two communities (40%), a statistically significant increase (p<0.05) was found in one (20%) and a decrease (p<0.05) was found in two (40%) (Table C.17 and Figure C.3).

Data for trichiasis were provided for five of the six Communities At Risk (83%). Of the 406 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 210 adults (52%) were examined for trichiasis, and one (0.5%) had trichiasis (Table C.23).

In 2008 the SAFE trachoma control strategy was partially implemented in the six communities where screening was conducted. Antibiotics for active trachoma were reported to have been distributed in all six communities, and facial cleanliness was promoted through the use of resources and programs for one community only (17%) (Table C.24). Good environmental conditions were reported for one community (17%), but improvements were being made in three (50%); a swimming pool in MID_06 was one of these improvements. No information was reported regarding a referral process for trichiasis surgery.

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SCREENING FOR ACTIVE TRACHOMA

Table C.17 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Midwest region, WA, 2006, 2007 and 2008.

Community Prevalence of active trachoma Fisher’s test code used to 2006 2007 2008 calculate Communities = 6 Communities = 5 Communities = 6 significance % (95% CI) n % (95% CI) n % (95% CI) n MID_01* 14% (7, 26) 56 30% (17, 47) 33 1% (0, 8) 67 ↓ p<0.05 MID_02 50% (28, 72) 16 11% (2, 43) 9 25% (7, 59) 8 MID_03* 8% (1, 33) 13 19% (8, 40) 21 38% (14, 69) 8 p = 0.67 MID_04* 39% (22, 59) 23 16% (9, 29) 49 0% (0, 32) 8 ↓ p<0.05 MID_05* 29% (14, 50) 21 -- 21% (8, 48) 14 p = 0.71 MID_06* 0% (0, 9) 38 33% (15, 58) 15 18% (6, 41) 17 ↑ p<0.05 Total communities = 6 19% (14, 26) 167 22% (16, 30) 127 10% (6, 16) 122 ↓ p<0.05 n = Number of children examined -- Data not reported * Community reported to have examined ≥10 children on two or more occasions Source: Data were collected by the Midwest Population Health Unit

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Table C.18 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Midwest region, WA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 477 762 757 1996 in Communities At Risk † 72 120 127 319 in Communities At Risk from 78 173 186 437 which data were reported ‡ Active trachoma Children resident in 72 (15%) 120 (16%) 127 (17%) 319 (16%) Communities At Risk (% of children resident in region) Children examined (% of those 34 (47%) 88 (73%) 125 (98%) 247 (77%) currently resident in Communities At Risk) Active trachoma (%) 0 (0%) 12 (14%) 14 (11%) 26 (11%) Facial cleanliness Children examined 34 88 125 247 Clean faces (%) 31 (91%) 69 (78%) 115 (92%) 215 (87%)

* Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the Midwest Population Health Unit Source: Data regarding active trachoma and clean faces were collected by the Midwest Population Health Unit

Table C.19 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Midwest region, WA, 2008. Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) MID_01 67 1 (1%) 67 66 (99%) MID_02 8 2 (25%) 8 8 (100%) MID_03 8 3 (38%) 8 8 (100%) MID_04 8 0 (0%) 8 8 (100%) MID_05 14 3 (21%) 14 10 (71%) MID_06 17 3 (18%) 17 0 (0%) Total communities n = 6 122 12 (10%) 122 100 (82%) Source: Data were collected by the Midwest Population Health Unit

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TREATMENT

Table C.20 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Midwest region, WA, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) MID_01 1% Household 4 2 (50%) 2 (50%) MID_02 25% Household 14 7 (50%) 14 (100%) MID_03 38% Household 9 (0%) 5 (56%) MID_04* 0% Household 5 2 (40%) 5 (100%) MID_05 21% Household 16 8 (50%) 16 (100%) MID_06 † 18% Household 27 24 (89%) 27 (100%) Total communities n = 6 75 43 (57%) 69 (92%) * No active trachoma was found in children aged 1 to 9 years, but treatment was given because 2/12 children aged 10 to 14 had active trachoma † An additional two households were treated within two weeks of the screening; however, the number of people was not provided and therefore could not be included in these data Source: Data were collected by the Midwest Population Health Unit

Table C.21 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Midwest region, WA, 2008. Number of Total targeted Number of Total number communities for treatment people of people treated within treated 2 weeks Prevalence ≥10% Community 0 Household 4 66 39 (59%) 62 (94%) Not reported 0 Subtotal 4 66 39 (59%) 62 (94%) Prevalence 5%–<10% Community 0 Household 0 Not reported 0 Subtotal 0 Prevalence 1%–<5% Community 0 Household 1 4 2 (50%) 2 (50%) Not reported 0 Subtotal 1 4 2 (50%) 2 (50%)

Total 5 70 41 (59%) 64 (91%) Note: Community MID_04 had no active trachoma in children aged 1 to 9 years but five people were treated because 2/12 children aged 10 to 14 had active trachoma; the data do not appear in this table Source: Data were collected by the Midwest Population Health Unit

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Table C.22 Completeness and timeliness of active trachoma treatment, by age group, Midwest region, WA, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Age not Total specified* Requiring treatment -- 0 24 28 2 21 75 Treated within 2 weeks (%) -- 0 9 (38%) 13 (46%) (0%) 21 (100%) 43 (57%) Total treated (%) -- 0 20 (83%) 26 (93%) 2 (100%) 21 (100%) 69 (92%) -- Data not reported * Twenty-one people from community MID_06 were treated; however, ages were not specified Source: Data were collected by the Midwest Population Health Unit

COMPARISON OF 2006, 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2006 90% 2007 2008 80%

70%

60%

50%

40%

30% * Prevalence and 95% confidence intervals confidence 95% and Prevalence 20% * * 10% NR

†† 0% 0%

1 3 4 5 6 0 0 0 0 0 _ _ _ _ _ ID ID ID ID ID M M M M M Prevalence of active trachoma for 2006, 2007 and 2008

Figure C.3 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in five communities where ≥10 children were examined, Midwest region, WA, 2006, 2007 and 2008. NR = Not reported * p<0.05 statistically significant difference † <10 children examined Source: Data were collected by the Midwest Population Health Unit

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TRICHIASIS

Table C.23 Trichiasis screening of Aboriginal people, Midwest region, WA, 2008. Females Males Total <30 yrs 30–49 yrs 50+ yrs <30 yrs 30–49 50+ yrs yrs ABS projection People resident: in region* 1803 713 439 1711 689 344 5699 in Communities At 261 144 80 259 122 60 926 Risk* Trichiasis People examined (% of 6 (2%) 50 (35%) 69 (86%) 3 (1%) 37 (30%) 54 (90%) 219 (24%) the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 0 (0%) 1 (1%) 0 (0%) 0 (0%) 0 (0%) 1 (0.5%) Ophthalmic -- -- consultation offered within 6 months of screening (% examined with trichiasis) Trichiasis surgery -- -- within 12 months prior to the date of reporting -- Data not reported * Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA Source: Data were collected by the Midwest Population Health Unit

TRACHOMA CONTROL ACTIVITIES

Table C.24 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Midwest region, WA, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process MID_01 1% -- ■ ✓ ✓ ■ MID_02 25% -- ■ ■ X ✓ MID_03 38% -- ■ ○ ○ ■ MID_04 0% -- ■ ■ X X MID_05 21% -- ■ ■ X X MID_06 18% -- ■ -- X ■ Total communities n = 6 -- 0 (0%) 1 (17%) 1 (17%) 1 (17%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening – in compliance with CDNA guidelines − (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Midwest Population Health Unit 137 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

IV. PILBARA

Of the 23 communities in the Pilbara region, seven (30%) were categorised as Not At Risk by the Population Health Unit (Table 4.1, page 42). Of the 16 Communities At Risk (70%), data for all communities were provided for 2008 (Table C.25).

Of the 294 Aboriginal children aged 1 to 9 years examined for trachoma, 73 (25%) had active trachoma (Table C.26), and 212 (72%) had clean faces (Table C.27).

Treatment was reported to have been distributed in compliance with the CDNA guidelines in six of the 14 communities (43%) in which treatment for trachoma was indicated. Community-based treatment was given in two communities (33%) and household-based treatment was given in four (67%) (Table C.28 and Table C.29). In one community treatment was reported to have been distributed to more people than what was originally estimated. In the remaining eight communities where treatment was not distributed according to the CDNA guidelines, treatment was given to only the affected children in seven communities, and treatment data were not reported for the other community. Overall, 420 (100%) people requiring treatment were treated; this included children found to have active trachoma, their household contacts and community members (Table C.30).

Comparisons of prevalence of active trachoma were possible for ten communities in which ≥10 children were examined in 2007 and 2008 (Table C.25 and Figure C.4). Data for prevalence of active trachoma reported in 2006 could not be included in the comparison because the grading criteria were changed. No change in prevalence was found in nine communities (90%) and a statistically significant decrease (p<0.05) was found in one community (10%).

Data for trichiasis were provided for nine of the 26 Communities At Risk (56%); two of these nine communities did not provide data for active trachoma because the children were examined at other communities. Of the 1585 Aboriginal adults aged ≥30 years reported by the ABS to be resident in Communities At Risk, 184 adults (12%) were examined for trichiasis, and no trichiasis was found (Table C.31).

In 2008 the SAFE trachoma control strategy was partially implemented in the 16 communities where screening was conducted. No information was provided regarding a referral processes for trichiasis surgery (Table C.32). Antibiotics for active trachoma were reported to have been distributed in 13 communities (81%). Facial cleanliness was promoted through the use of resources in 12 communities (75%) and programs in 15 (94%). Good environmental conditions were reported for five communities (31%), and improvements were being made in eight (50%); swimming pools in PIL_02 and PIL_03 were among the improvements being made.

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SCREENING FOR ACTIVE TRACHOMA

Table C.25 Prevalence of active trachoma in Aboriginal children aged 1 to 9 years, by community, Pilbara region, WA, 2006, 2007 and 2008. Community Prevalence of active trachoma Fisher’s test code 2006* 2007 2008 used to calculate Communities = 10 Communities = 15 Communities = 16 significance % (95% CI) n % (95% CI) n % (95% CI) n PIL_01 † 9% (3, 23) 34 0% (0, 26) 11 6% (1, 27) 17 p = 1.00 PIL_02 † 59% (42, 74) 34 31% (13, 58) 13 0% (0, 22) 14 ↓ p<0.05 PIL_03 † 61% (44, 75) 33 38% (22, 57) 26 41% (26, 57) 37 p = 1.00 PIL_04 † 39% (24, 58) 28 17% (8, 32) 36 21% (8, 48) 14 p = 1.00 PIL_05 † 75% (47, 91) 12 38% (21, 57) 24 35% (19, 55) 23 p = 1.00 PIL_06 0% 4 0% 4 17% (5, 45) 12 PIL_07 64% (35, 85) 11 NAR NAR PIL_08 43% (21,67) 14 0% (0, 22) 29 75% 4 PIL_09 † 69% (59, 78) 94 10% (5, 20) 62 21% (13, 32) 67 p = 0.09 PIL_10 † 56% (27, 81) 9 0% (0, 14) 24 11% (3, 31) 19 p = 0.19 PIL_11 † -- 54% (29, 77) 13 53% (30, 75) 15 p = 1.00 PIL_12 -- 0% 1 43% (16, 75) 7 PIL_14 † -- 0% (0, 11) 30 0% (0, 16) 20 NA PIL_15 -- 0% (0, 32) 8 33% (12, 65) 9 PIL_17 † -- 28% (14, 48) 25 55% (28, 79) 11 p = 0.15 PIL_19 -- 0% (0, 26) -- 80% (38, 96) 5 PIL_20 -- 31% (13, 58) -- 5% (1, 24) 20 Total communities = 17 53% (47, 59) 273 16% (12, 21) 306 25% (21, 30) 294 ↑ p<0.05 Note: For communities with ≤ 5 children examined 95% CI were very large and have not been included in the table n = Number of children examined -- Data not reported NA = Not available NAR = Identified by key representatives as Not At Risk * In 2006 active trachoma was graded as the presence of one or more follicles under the upper eyelid; therefore prevalence from 2006 cannot be used in the comparisons † Community reported to have examined ≥10 children on two or more occasions Source: Data were collected by the Pilbara Population Health Unit

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Table C.26 The number of resident Aboriginal children aged 1 to 14 years, and those examined for active trachoma and facial cleanliness, Pilbara region, WA, 2008. Number of Aboriginal children Total 1–4 yrs* 5–9yrs 10–14 yrs Population data Children resident: in region † 500 699 660 1859 in Communities At Risk † 339 448 417 1204 in Communities At Risk from 67 284 253 604 which data were reported ‡ Active trachoma Children resident in 339 (68%) 448 (64%) 417 (63%) 1204 (65%) Communities At Risk (% of children resident in region) Children examined (% of those 66 (19%) 228 (51%) 192 (46%) 486 (40%) currently resident in Communities At Risk) Active trachoma (%) 13 (20%) 60 (26%) 35 (18%) 108 (22%) Facial cleanliness Children examined 66 228 192 486 Clean faces (%) 39 (59%) 173 (76%) 183 (95%) 395 (81%)

* Children in the 1 to 4 age group were less likely to be examined because they were less likely to be at school † Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA ‡ Reported number of children currently in Communities At Risk from which data were reported was provided by the Pilbara Population Health Unit Source: Data regarding active trachoma and clean faces were collected by the Pilbara Population Health Unit

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Table C.27 Prevalence of active trachoma and facial cleanliness in Aboriginal children aged 1 to 9 years, by community, Pilbara region, WA, 2008. Community code Trachoma Clean faces Examined Active trachoma (%) Examined Clean face (%) PIL_01 17 1 (6%) 17 17 (100%) PIL_02 14 0 (0%) 14 14 (100%) PIL_03 37 15 (41%) 37 9 (24%) PIL_04 14 3 (21%) 14 13 (93%) PIL_05 23 8 (35%) 23 14 (61%) PIL_06 12 2 (17%) 12 12 100%) PIL_08 4 3 (75%) 4 4 (100%) PIL_09 67 14 (21%) 67 57 (85%) PIL_10 19 2 (11%) 19 9 (47%) PIL_11 15 8 (53%) 15 8 (53%) PIL_12 7 3 (43%) 7 3 (43%) PIL_14 20 0 (0%) 20 20 (100%) PIL_15 9 3 (33%) 9 7 (78%) PIL_17 11 6 (55%) 11 4 (36%) PIL_19 5 4 (80%) 5 4 (80%) PIL_20 20 1 (5%) 20 17 (85%) Total communities n = 16 294 73 (25%) 294 212 (72%) Source: Data were collected by the Pilbara Population Health Unit

TREATMENT

Table C.28 Prevalence of active trachoma, treatment strategy, and completeness and timeliness of treatment of children, household and community contacts, by community, Pilbara region, WA, 2008. Community code Prevalence of Treatment Treatment active strategy Required Within 2 Total (%) trachoma % weeks (%) PIL_01 6% Not reported* 1 1 (100%) 1 (100%) PIL_02 0% Not required 0 PIL_03 41% Household 19 19 (100%) 19 (100%) PIL_04 21% Not reported* 4 4 (100%) 4 (100%) PIL_05 35% Community 54 11 (20%) 54 (100%) PIL_06 17% Not reported* 2 2 (100%) 2 (100%) PIL_08 75% Not reported* 3 3 (100%) 3 (100%) PIL_09 21% Household 255 255 (100%) 255 (100%) PIL_10 11% Not reported* 6 6 (100%) 6 (100%) PIL_11 53% Community 24 8 (33%) 24 (100%) PIL_12 43% Household 20 14 (70%) 29 (145%) PIL_14 0% Not required 0 PIL_15 33% Household 11 5 (45%) 11 (100%) PIL_17 55% Not reported* 7 0 0 PIL_19 80% Not reported* 4 4 (100%) 4 (100%) PIL_20 5% Household 8 2 (25%) 8 (100%) Total communities n = 16 418 334 (80%) 420 (100%) * The treatment strategy was not reported, only the affected children were treated Source: Data were collected by the Pilbara Population Health Unit

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Table C.29 Completeness and timeliness of treatment of children, household and community contacts, by prevalence of active trachoma in Aboriginal children aged 1 to 9 years, Pilbara region, WA, 2008. Number of Total targeted Number of Total number communities for treatment people of people treated within treated 2 weeks Prevalence ≥10% Community 2 78 19 (24%) 78 (100%) Household 4 305 293 (96%) 314 (103%) Not reported* 6 26 19 (73%) 19 (73%) Subtotal 12 409 331 (81%) 411 (100%) Prevalence 5%–<10% Community 0 Household 1 8 2 (25%) 8 (100%) Not reported* 1 1 1 (100%) 1 (100%) Subtotal 2 9 3 (33%) 9 (100%) Prevalence 1%–<5% Community 0 Household 0 Not reported 0 Subtotal 0

Total 14 418 334 (80%) 420 (100%) * The treatment strategy was not reported, only the affected children were treated Source: Data were collected by the Pilbara Population Health Unit

Table C.30 Completeness and timeliness of active trachoma treatment of children, household and community contacts, by age group, Pilbara region, WA, 2008. Treatment <1 yr 1–4 yrs 5–9yrs 10–14 yrs 15+ yrs Total Requiring treatment 10 35 109 101 163 418 Treated within 2 weeks (%) 6 (60%) 21 (60%) 84 (77%) 79 (78%) 144 (88%) 334 (80%) Total treated (%) 10 (100%) 35 (100%) 109 (100%) 103 (102%) 163 (100%) 420 (100%) Source: Data were collected by the Pilbara Population Health Unit

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COMPARISON OF 2007 AND 2008 ACTIVE TRACHOMA DATA

100% 2007 90% 2008

80%

70%

60%

50%

40%

30% * Prevalence and95% confidence intervals Prevalence 20%

10%

0% 0% 0% 0% 0% 0%

2 4 9 0 0 05 0 10 14 17 ______IL IL IL PIL_01 P PIL_03 P PIL P PIL PIL_11 PIL PIL Prevalence of active trachoma for 2007 and 2008

Figure C.4 Prevalence of active trachoma for Aboriginal children aged 1 to 9 years in 10 communities where ≥10 children were examined, Pilbara region, WA, 2007 and 2008. * p<0.05 statistically significant difference Source: Data were collected by the Pilbara Population Health Unit

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TRICHIASIS

Table C.31 Trichiasis screening of Aboriginal people, Pilbara region, WA, 2008. Females Males Total <30 yrs 30–49 50+ yrs <30 30–49 50+ yrs yrs yrs yrs ABS projection People resident: in region* 1659 762 445 1827 842 335 5870 in Communities At 1066 496 310 1137 533 246 3788 Risk* Trichiasis People examined (% 0 (0%) 34 (7%) 77 (25%) 0 (0%) 16 (3%) 57 (23%) 184 (5%) of the resident people in Communities At Risk) Trichiasis (%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Ophthalmic consultation offered within 6 months of screening (% examined with trichiasis) Trichiasis surgery within 12 months prior to the date of reporting

* Projected 2008 population data based on the ABS 1.8% low series population growth rate in WA Source: Data were collected by the Pilbara Population Health Unit

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TRACHOMA CONTROL ACTIVITIES

Table C.32 Implementation of trachoma control activities (SAFE strategy), and prevalence of active trachoma, by community, Pilbara region, WA, 2008. Community Prevalence Number of communities code of active Surgery Antibiotics Facial cleanliness Environmental trachoma referral Resources Program conditions % process PIL_01 6% -- ✓ ✓ ✓ ✓ PIL_02 0% -- X ✓ ✓ ✓ PIL_03 41% -- ✓ ✓ ✓ ■ PIL_04 21% -- ✓ ✓ ✓ ✓ PIL_05 35% -- ■ ✓ ✓ ■ PIL_06 17% -- ✓ ○ ✓ ✓ PIL_08 75% -- ✓ ○ ✓ -- PIL_09 21% -- ✓ ✓ ✓ ■ PIL_10 11% -- ✓ ✓ ✓ ■ PIL_11 53% -- ■ ✓ ✓ ■ PIL_12 43% -- ■ ✓ ✓ ■ PIL_14 0% -- X ✓ ✓ ○ PIL_15 33% -- ■ ✓ ✓ ✓ PIL_17 55% -- X ✓ ✓ ■ PIL_19 80% -- ✓ ○ ○ ■ PIL_20 5% ○ ■ X ✓ X Total communities n = 16 0 (0%) 8 (50%) 12 (75%) 15 (94%) 5 (31%) ✓ Available, implemented or antibiotics distributed within two weeks of the screening – in compliance with CDNA guidelines − (generally good environmental conditions) ■ Available, but not implemented, or antibiotics not distributed within two weeks of the screening (variable environmental conditions but improvements are being made) X Not available, not being implemented or antibiotics not distributed (very poor environmental conditions) ○ Do not know if resources or programs exist -- Data not reported Source: Data were collected by the Pilbara Population Health Unit

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D. NATIONAL INDIGENOUS EYE HEALTH SURVEY RESULTS

The Centre for Eye Research Australia (CERA) conducted the National Indigenous Eye Health Survey (NIEHS) in 2008–2009. Children aged 5 to 15 years and adults aged ≥40 years from 30 randomly selected sites around Australia – and a pilot site – (Figure D.1) were eligible to participate in the survey and were examined for trachoma as part of this survey. The survey was designed to determine the prevalence and main causes of vision impairment, the utilisation of eye care services, barriers to use of health care, and the impact of vision impairment on people. The summary of the trachoma findings from the NIEHS are included here for comparison with the data collected routinely by the NTSRU (Table D.1).

Figure D.1 Indigenous sites visited by the National Indigenous Eye Health Survey in 2008. Note: For more details about the data collected at each site see Table D1.

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Table D.1 Summary of trachoma prevalence in children aged 5 to 9, 5 to 15 years and adults >40 years collected by the National Indigenous Eye Health Survey, 2008 . Code* ABS region Number of people examined (% coverage) † Children Adults Children Adults TF (%) TS (%) TT (%) CO (%) NTSRU >40 yrs >40 yrs >40 yrs TT (%) 5–9yrs† 5-15 yrs >40yrs 5–9yrs 5-15 yrs NTSRU ≥30 yrs 5-14yrs New South Wales 1 Coffs Harbour 28 56 (46%) 33 (45%) 2 (7%) 2 (4%) NA 0 (0%) 0 (0%) 0 (0%) NA 2 Sydney 19 35 (34%) 27 (35%) 0 (0%) 0 (0%) NA 1 (4%) 0 (0%) 0 (0%) NA 3 Sydney 26 62 (40%) 45 (63%) 1 (4%) 1 (2%) NA 3 (7%) 0 (0%) 0 (0%) NA 4 Tamworth 7 29 (35%) 39 (49%) 0 (0%) 0 (0%) NA 2 (5%) 0 (0%) 0 (0%) NA 5 Wagga Wagga 7 20 (21%) 24 (24%) 0 (0%) 0 (0%) NA 0 (0%) 0 (0%) 0 (0%) NA 6 ACT 20 45 (38%) 26 (26%) 0 (0%) 0 (0%) NA 3 (12%) 0 (0%) 0 (0%) NA 7 Dubbo 13 29 (24%) 52 (50%) 0 (0%) 0 (0%) NA 6 (12%) 0 (0%) 0 (0%) NA 31 Moree (pilot site) 10 17 (52%) 69 (246%) 0 (0%) 0 (0%) NA 8 (12%) 1 (1%) 0 (0%) NA Total 130 293 (35%) 315 (50%) 3 (2%) 3 (1%) 23 (7%) 1 (0.3%) 0 (0%) Northern Territory 26 (DR_10) Jabiru 48 82 (152%) 59 (109%) 1 (2%) 1 (1%) 28 (14%) 1 (2%) 0 (0%) 0 (0%) --

27 (DR_07) Jabiru 20 52 (50%) 50 (82%) 0 (0%) 1 (2%) 35 (38%) 17 (34%) 0 (0%) 0 (0%) -- 28 (KA_13) Katherine 35 61 (81%) 48 (79%) 9 (26%) 14 (23%) SNDP 27 (56%) 7 (15%) 1 (2%) -- 29 (AS_14) Apatula 18 44 (76%) 38 (83%) 0 (0%) 2 (5%) 9 (31%) 21 (55%) 3 (8%) 0 (0%) 13% Total 121 239 (82%) 195 (88%) 10 (8%) 18 (8%) 66 (34%) 10 (5%) 1 (1%) Queensland 10 Brisbane 5 12 (6%) 15 (7%) 0 (0%) 0 (0%) NA 1 (7%) 0 (0%) 0 (0%) NA 11 Brisbane 23 44 (26%) 36 (55%) 0 (0%) 0 (0%) NA 7 (19%) 0 (0%) 0 (0%) NA 12 Cape York 21 43 (61%) 50 (65%) 3 (14%) 4 (9%) NA 6 (12%) 1 (2%) 0 (0%) NA 13 Rockhampton 64 112 (78%) 59 (57%) 0 (0%) 0 (0%) NA 1 (2%) 0 (0%) 0 (0%) NA 14 Roma 21 44 (53%) 20 (34%) 0 (0%) 0 (0%) NA 0 (0%) 0 (0%) 0 (0%) NA 15 Torres Strait Indigenous 49 79 (71%) 72 (66%) 7 (14%) 8 (10%) NA 2 (3%) 0 (0%) 0 (0%) NA Total 183 334 (43%) 252 (41%) 10 (5%) 12 (4%) 17 (7%) 1 (0.4%) 0 (0%) NA = Not applicable NAR = Identified by key representatives as Not At Risk NS = Not screened SNDP = Screened but no data were provided -- Data not reported * The code refers to the site number on Figure D1 and the corresponding NTSRU community code from which data were reported by the state or territory † The denominator for the screening coverage was based on ABS 2006 Census data ‡ A denominator of children aged 5 to 9 years was not established 148 National Trachoma Surveillance and Reporting Unit Trachoma Surveillance Report 2008

Table D.1 (continued) Code* ABS region Number of people examined (% coverage) † Children Adults Children Adults TF (%) TS (%) TT (%) CO (%) NTSRU >40 yrs >40 yrs >40 yrs TT (%) 5–9yrs † 5-15 yrs >40yrs 5–9yrs 5-15 yrs NTSRU 5-14 yrs ≥30 yrs

South Australia 16 (CE_01) Ceduna 66 100 (64%) 82 (78%) 1 (2%) 1 (1%) 0 (0%) 14 (17%) 1 (1%) 0 (0%) SNDP 17 (PW_05) Port Augusta 37 64 (79%) 46 (31%) 2 (5%) 2 (3%) 0 (0%) 13 (28%) 0 (0%) 0 (0%) 0% Total 103 164 (69%) 128 (50%) 3 (3%) 3 (2%) 27 (21%) 1 (1%) 0 (0%) Tasmania

25 Tasmania 14 32 (22%) 42 (29%) 0 (0%) 0 (0%) NA 0 (0%) 0 (0%) 0 (0%) NA Total 14 32 (22%) 42 (29%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Victoria

8 Melbourne 1 1 (1%) 4 (5%) 0 (0%) 0 (0%) NA 0 (0%) 0 (0%) 0 (0%) NA

9 Non-metropolitan 15 32 (39%) 24 (30%) 0 (0%) 0 (0%) NA 0 (0%) 0 (0%) 0 (0%) NA

Total 16 33 (20%) 28 (18%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Western Australia

18 Perth 55 106 (76%) 43 (43%) 1 (2%) 1 (1%) NA 3 (7%) 0 (0%) 0 (0%) NA 19 Perth 27 44 (48%) 25 (49%) 0 (0%) 0 (0%) NA 1 (4%) 0 (0%) 0 (0%) NA 20 (KIM_20) Broome 30 61 (127%) 46 (148%) 0 (0%) 1 (2%) 7 (16%) 1 (2%) 0 (0%) 0 (0%) 4% 21 Southern 27 44 (34%) 25 (36%) 0 (0%) 0 (0%) NA 3 (12%) 1 (4%) 0 (0%) NA 22 (PIL_08&15) South Headland 49 94 (125%) 27 (43%) 9 (18%) 12 (13%) 5 (28%) 8 (30%) 0 (0%) 0 (0%) NA 23 (PIL_04) South Headland 40 82 (126%) 22 (44%) 3 (8%) 3 (4%) 4 (12%) 6 (27%) 0 (0%) 0 (0%) 0% 24 (GOL_08) Kalgoorlie 38 85 (65%) 32 (32%) 0 (0%) 3 (4%) NAR 2 (6%) 0 (0%) 0 (0%) 0% 30 (PIL_03) South Headland 39 73 (104%) 60 (111%) 6 (15%) 8 (11%) 16 (32%) 35 (58%) 3 (5%) 2 (3%) NA

Total 305 589 (79%) 280 (54%) 19 (6%) 28 (5%) 59 (21%) 4 (1%) 2 (1%)

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E. DATA COLLECTION FORMS

Form 1: Community/school summary form for screening of children for active trachoma

Form 2: Community/school summary form for treatment of household and community/school contacts with azithromycin

Form 3: Community/school summary form for trachoma control activities implemented

Form 4: Community/school summary form for trichiasis in Aboriginal adults

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FORM 1 COMMUNITY/SCHOOL SUMMARY FORM FOR SCREENING OF CHILDREN FOR ACTIVE TRACHOMA

State/Territory

Population Health Unit Region

Community/school

Screening Strategy School Community

Date(s) of Screening

Form completed by Name Date

Number of Aboriginal children: 1-4 years 5-9 years 10-14 years

Total number in community/school

Total number enrolled in school

Examined for trachoma and clean face*

With TF

With active trachoma (TF and/or TI)

With TS

With clean face*

Requiring azithromycin for active trachoma (TF and/or TI)

Received azithromycin for active trachoma (TF and/or TI) within 2 weeks of screening

* Defined as the absence of dirt, dust or crusting on the cheeks and forehead

TF:Trachomatous inflammation – FOLLICULAR TI:Trachomatous inflammation – INTENSE TS:Trachomatous SCARRING Based on World Health Organization simplified grading classification system, Source: World Health Organization, 1987

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FORM 2 COMMUNITY/SCHOOL SUMMARY FORM FOR TREATMENT OF HOUSEHOLD AND COMMUNITY CONTACTS WITH AZITHROMYCIN

State/Territory

Population Health Unit Region

Community/school

Date(s) of Screening

Form completed by Name Date

Date of first treatment

TREATMENT STRATEGY (Tick one box only) The treatment strategies are based on CDNA Guidelines recommendations.

Prevalence ≥10% in children

NO obvious clustering in the community Treatment Strategy : Treat all Aboriginal children in the community aged 6 months–14 years and all household contacts aged 6 months and over

Cases obviously clustered in several households in the community and all household contacts are easily identified Treatment Strategy : Treat all household contacts aged 6 months and over (community wide treatment not required) Prevalence <10% in children

Prevalence <10% but ≥5% Treatment Strategy : Treat all household contacts aged 6 months and over

Prevalence <5% Treatment Strategy: Treat all household contacts aged 6 months and over

Number of contacts <1 1–4 5–9 10–14 15+ Year Years years years years Requiring treatment with azithromycin

Treated with azithromycin within two weeks of starting distribution of treatment

Total treated with azithromycin

Completion date of last treatment

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FORM 3 COMMUNITY/SCHOOL SUMMARY FORM FOR TRACHOMA CONTROL ACTIVITIES IMPLEMENTED

State/Territory

Population Health Unit Region

Community/school

Date(s) of Screening

Form completed by Name Date

Description of activity Completeness of Intersectoral implementation partnerships ‘S’ Surgery

‘A’ Antibiotics

‘F’ Facial Cleanliness

‘E’ Environmental conditions

Other

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FORM 4 COMMUNITY/SCHOOL SUMMARY FORM FOR TRICHIASIS IN ABORIGINAL ADULTS

State/Territory

Population Health Unit Region

Community/school

Date(s) of Screening

Form completed by Name Date

Number of Aboriginal adults: <30 years 30-49 years 50+ years male female male female male female Examined for trichiasis

With trichiasis

In the screening target group (i.e. number of Aboriginal adults in the screened age group in communities/towns targeted for screening)

In the community/school in the screened age group (from census data)

With trichiasis who were offered an ophthalmological consultation within 6 months of the previous screening

Please report the number of Aboriginal adults <30 years 30-49 years 50 + years who underwent trichiasis surgery in the male female male female male female previous year

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F. NATIONAL TRACHOMA SURVEILLANCE REFERENCE GROUP MEMBERSHIP

Table F.1 National Trachoma Surveillance Reference Group members, 2008. Organisation/State/Territory Name Position Department of Health and Ms Tarja Chair Ageing, Office for Aboriginal and Saastamoinen Assistant Secretary, Torres Strait Islander Health Family Health and Well Being Branch (OATSIH) Ms Anthea Raven Secretariat, Ms Sheree Munro Eye and Ear Health Section Mr Rajan Martin Director, Eye and Ear Health Section Dr Geetha Isaac-Toua Senior Medical Advisor, Public Health Advisory Unit Office of Health Protection Dr Katrina Roper Assistant Director, Surveillance Policy and Systems Section National Aboriginal Community Dr Sophie Couzos Public Health Officer, Controlled Health Organisation NACCHO (NACCHO) Dr John Boffa Public Health Medical Officer, NACCHO Northern Territory (NT) Dr Steven Skov Public Health Physician Centre for Disease Control, Darwin Dr Rosalie Schultz Public Health Medical Officer, Centre for Disease Control, Alice Springs Ms Cate Coffey Trachoma Coordinator, Centre for Disease Control, Alice Springs Ms Robyn Puls Database co-ordinator, Centre for Disease Control, Alice Springs South Australia (SA) Dr Peter Chapman Chief Medical Advisor, Country Health SA Mr Rob Zadow Director Aboriginal Health, Country Health SA Ms Desley Culpin Eye Health Coordinator, Eye Health and Chronic Disease Specialist Support Program, Aboriginal Health Council, SA Western Australia (WA) Dr Donna Mak Communicable Disease Control Directorate, Health Department of WA Ms Mary Whitty Trachoma Program Coordinator, Kimberley Population Health Unit Dr Carole Reeve Public Health Medical Officer, Kimberley Population Health Unit Dr Gary Lum is a co-opted member representing the Public Health Laboratory Network (PHLN)

Past members: Ms Elissa Greenham, Secretariat (Sep 08–Mar 09) Ms Bridget Greetham, Secretariat (Jan 09–Mar 09) Ms Emily Featherston, Secretariat (Feb 09–May 09)

The National Trachoma Surveillance Reference Group provides advice on and approves the annual trachoma surveillance reports. Staff from the NTSRU also attend the National Trachoma Surveillance Reference Group meetings .

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