Trachoma

Trachoma is still endemic in some remote Aboriginal communities of northern and central Australia. Control depends on reducing the reservoir of infection by treating identified cases and their family contacts. In high-prevalence areas this will equate to full community-wide treatment. To determine how widespread trachoma is requires screening of primary school children (aged 5-9 years), using the simplified World Health Organization (WHO) criteria for diagnosis. All members of the families of those children found to have trachoma should be treated with a single dose of azithromycin. Treatment for their family unit, including maternal caregivers, siblings, and other family members, should be provided. If the prevalence of active trachoma in children exceeds 10%, consideration should be given to treating the entire community and repeating treatment at 6-monthly intervals until prevalence falls to below 5%. There should be community awareness of the need for environmental control strategies, such as access to water, facial cleanliness, and fly control. Of these, the most important and the most amenable to immediate change is facial cleanliness. Opportunistic screening for trichiasis is recommended in the older Aboriginal population. This is best implemented as part of the periodic health examination in the integrated assessment of health status or by regular surveys (2-3 years) of the over 40-50 year old population