ADVOCACY: Australia Trachoma Surveillance Report 2023

The Kirby Institute has published a report on Trachoma in Australia, an eye disease. Australia is the only high-income country with endemic trachoma.

Australia is the only developed country with blinding trachoma. It remains an important cause of blindness in Aboriginal adults. To eliminate trachoma, The World Health Organisation recommends a multi-faceted strategy called SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) – from NT Health.

From the Australian Trachoma Surveillance Report

Australia is the only high-income country with endemic trachoma. It has continued to occur primarily in remote and very remote Indigenous communities in the NT, SA and WA. For each of these jurisdictions, the estimated overall trachoma prevalence in 2023 among children aged 5-9 years residing in communities ever designated as at risk of trachoma was below 5%, the threshold specified in the World Health Organization (WHO)’s definition of “elimination as a public health problem”.1 Within these jurisdictions, 10 out of 12 regions with at risk communities recorded overall prevalences below 5%.

From the report showing remote Aus bearing the brunt of a poor functioning living environment.

What is Trachoma?

Trachoma is the world’s leading infectious cause of preventable blindness, caused by infection with the Chlamydia trachomatis (C. trachomatis) bacteria, particularly serovars AC. 2, 3 Repeated infections with C. trachomatis, especially during childhood, may lead to scarring of the eyelid, causing it to contract and distort, leading to the upper eyelashes turning inwards – a phenomenon called trichiasis – and scratching of the outer surface of the cornea. The resulting damage to the cornea by trichiasis is the main pathway by which trachoma leads to vision loss and blindness.4, 5 Trichiasis scarring is irreversible but if early signs of in-turned eyelashes are found, surgery to the eyelid is usually effective in preventing further damage to the cornea. As of April 2023, trachoma remains endemic in at least 40 countries, with an estimated 1.5 million persons experiencing the most severe forms of vision impairment related to the disease. (1)

Healthabitat has some history of dealing with Trachoma. Below shows how Healthabitat addressed this in a remote Aboriginal community in the 1990s.

1. Trachoma, a developing world bug that leads to blindness was present in 95% of school aged children in the late 1990’s. 2. Skilled trades and local teams fix showers and put face washing facilities in the school so kids can wash the bugs out. 3. Dust scours the eye which lets the bug in. We get the Doctor of Dust to figure out that most dust is within one metre of the ground. We build dirt mounds to stop dust. 4. We get the Fly Doctor (real person) to determine the one fly carrying the bug. We use dung beetles to eat the fly habitat and change the environment. 5. A healthy eye. A rapid and lasting drop in Trachoma.

SAFE Strategy

The World Health Organisation and the Communicable Disease Network Australia recommend the SAFE strategy:

• Surgery – surgical correction for trichiasis
• Antibiotics – azithromycin for cases of active trachoma and their contacts (that is all household members)
• Facial cleanliness – promote clean faces to reduce spread of infection
• Environmental improvements – Improve overcrowding, water and sanitation facilities. It is especially important to address barriers to face washing(2).

HH suggests these should be re-ordered so that Environmental Improvements be first on the list. We know that the key prevention of trachoma is face washing and reducing crowding. Lack of functional health hardware means this simple method is hard to achieve.

Healthabitat is glad to see an ongoing reduction in Trachoma but advocates for more focus on environmental health particularly in remote communities.