National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

Chapter 6: Eye health
Trachoma and trichiasis
☰ Table of contents

Recommendations: Trachoma and trichiasis

Preventive intervention type

Who is at risk?

What should be done?

How often?

Level/ strength of evidence

References

Screening

 People living where trachoma is endemic (>5% prevalence of active trachoma in young children or >0.1% of the population have trichiasis) Implement a community screening program in partnership with regional population health units to assess the population prevalence of active trachoma

Ongoing community screening is not required once prevalence is below 5% in children aged 5–9 years for five consecutive years		 As per national guideline recommendations (refer to ‘Resources’) GPP 74
Adults aged >40 years raised in trachoma-endemic area Perform eye examination to ascertain corneal scarring and/or the presence of trichiasis* Two-yearly age 40–54 years, yearly age ≥55 years GPP 74, 100, 101
For those identified to have trichiasis, refer to an ophthalmologist for surgery   IIIB 38, 102

Behavioural

 All children from tracho-maendemic areas Recommend to families the importance of the following in the prevention and control of trachoma:
  • facial cleanliness of children
  • safe and functional washing facilities at home, in childcare and at school
  • regular screening, and treatment of infection
 Opportunistic and as part of an annual child health check


 		 IIB

 

Chemo-prophylaxis

 People living where trachoma is endemic (>5% prevalence of active trachoma in young children) Treat case and all household contacts, discuss with regional trachoma control program to plan and deliver treatment to community, depending on community prevalence/cluster pattern

Treat children who have been opportunistically found to have evidence of active trachoma infection and treat all household contacts		 As per state and territory protocols IA 74, 103

Environmental

 All people Assess the safety and functionality of the bathroom and washing facilities, and the housing situation for overcrowding, and refer to social support services for housing assistance if indicated (refer to Chapter 7: Hearing loss)   GPP 74
Remote communities Implement joint health promotion strategies with state/territory government public health units and local shire councils for maintaining functional washing facilities and other environmental health standards As per state/ territory government plans GPP 74
*Trichiasis is diagnosed when at least one eyelash rubs on the eyeball, or there is evidence of recently removed eyelashes because of eyelash in-turning.72


Background

Trachoma is a bacterial eye disease associated with socioeconomic factors including overcrowding and poor community hygiene.70 Classification of trachoma is via the World Health Organization (WHO) simplified trachoma grading system. Active trachoma (defined as trachoma follicular and/or trachoma inflammation) predominantly affects young children, and is a contagious infection of the eye by specific, non-genital strains of the bacteria Chlamydia trachomatis. Multiple infections cause conjunctival scarring (trachomatous scarring) leading to eyelid contraction and in-turned margin (entropion) over decades (trachomatous trichiasis). The resulting in-turned eyelashes rub on the eyeball, causing painful corneal scarring and corneal opacity. It is estimated that some 150 to 200 episodes of reinfection may be necessary to lead to blindness.71 As most of this transmission occurs in childhood, children may be reinfected several times a month.

Trachomatous trichiasis is defined as at least one eyelash rubbing on the eyeball, or there is evidence of recently removed eyelashes because of eyelash in-turning.72 If not treated with surgery to the eyelid to correct in-turned eyelashes, corneal scarring can end in blindness in later adult life. This can occur 20–40 years after the initial trachoma infections. Trachoma is the leading infectious cause of blindness, with blinding trachoma the result of a complex interaction between the actual infection and immune response.70

Australia is the only high-income country in the world that still has pockets of endemic trachoma and trichiasis.73 This occurs almost exclusively in remote Aboriginal communities in the NT, South Australia and Western Australia. Trachoma is classified as endemic if >5% of children aged 5–9 years have active trachoma or >0.2% of adults or 0.1% of the whole population has trichiasis.74 The prevalence of active trachoma in children in the endemic areas has fallen from 21% in 2008 to 4.6% in the latest figures from 2015.75,76 Screening and treatment for trichiasis have not been reported in a systematic way in most Australian control programs,34 but with the advent of a National Trachoma Surveillance and Reporting Unit this is improving.77 In the communities screened in 2015 as a part of the National Trachoma Surveillance, the prevalence of trichiasis was 0.5% in adults aged >15 years, and 0.9% in adults aged >40 years; however, it is suspected that screening coverage in this age group was low.78

In Australia, community-wide screening occurs in communities that are identified as at risk. At-risk communities are identified by prevalence of active trachoma of >5% in Aboriginal and Torres Strait Islander children aged 5–9 years in the last five years; or current data showing <5% prevalence but >5% prevalence recorded in the last five years; or, where no data are available, historical evidence of endemic trachoma.
74

 

Evidence of the effectiveness of preventive interventions

SAFE strategy

Australia is committed to the Alliance for Global Elimination of Trachoma by 2020 (GET2020), and as a result has developed guidelines for management of trachoma. The Communicable Diseases Network Australia Guidelines for the public health management of trachoma in Australia, 2014,74 are based on the WHO SAFE strategy.70,74 The acronym SAFE encompasses an integrated approach to prevention, including Surgery for trichiasis and entropion; Antibiotics to reduce community levels of chlamydial infection; Facial cleanliness for children; and Environmental measures to reduce trachoma transmission. There is good evidence to support all SAFE strategy components.74 Chlamydia vaccine development has been flagged as a possible complementary strategy to SAFE, but is currently many years away.79

Facial cleanliness

Facial cleanliness has been found to be linked with lower incidence of trachoma.70 Chlamydial infection is transmitted by sharing infected ocular and nasal secretions, so that every child with a dirty face is ‘a health hazard’. A clean face is defined as a face without dried ocular and nasal discharge. With the event of Australia’s commitment to GET2020, there have been health promotion initiatives in numerous remote communities to promote facial hygiene. Data from 2010 to 2015 indicates that the prevalence of facial hygiene is improving.80 Facial cleanliness can be promoted by a variety of methods, including by combining it with other hygiene practices such as nose blowing, hand hygiene and brushing teeth, and also by installation of mirrors so that children can see whether their face is clean.74 Facial cleanliness is not possible in the absence of functioning plumbing and washing facilities. Initial assessment of housing in 132 Aboriginal communities across Australia from January 1999 to November 2006 found that only 35% of households had a functioning shower.81 The Housing for Health project, a continuation of this assessment, has resulted in significant improvements in surveyed Aboriginal communities, resulting in a significant decline of the rates of trachoma in these communities.82–84 The Housing for Health project involved reviewing the housing hardware in certain communities using predetermined ‘healthy living practices’, reviewing this regularly and providing maintenance. Further detail can be found at Housing for Health (refer to ‘Resources’).82,83

Environmental strategies

Although flies, fingers and fomites are purported to be the three primary ways that trachoma is transmitted, the key is the transmission of infected ocular and nasal secretions from one child to another.85 As a result, environmental strategies, such as improved water access and safe and functional washing facilities or bathrooms, and reduced household overcrowding, play a key role in trachoma control.1,84,86

Within communities, trachoma is strongly clustered by households;32 and within households, clustered by sleeping rooms.33 This suggests continued transmission depends on close, prolonged contact. Close contact results in infected facial secretions spreading between people rapidly, allowing for the spread of Chlamydia trachomatis.87

Sanitation, as previously stated, is important in that it allows for facial cleanliness. Good sanitation also allows for the appropriate disposal of waste, preventing the build-up of flies.87 Although the provision of pit latrines has received much attention in African areas, subsequent work has shown that these have had little impact because most transmission occurs by the direct sharing of infected secretions.88,89 Access to appropriate laundry facilities prevents the spread of fomites via bedding and clothing.87 The Housing for Health project found that only 29% of assessed households had a laundry with services working, and 59% had a working toilet; with the project’s input into these communities, this has improved to 71% and 91% respectively.83 Australian studies have so far shown that fly population control and dust control have limited impact on the prevalence of trachoma;90,91 however, the long-term impact of such studies is unknown.92 Flies are believed to act as mechanical vectors, spreading nasal and eye secretions,93,94 with a review of studies largely performed overseas showing that measures to reduce fly populations by environmental improvements are associated with reductions in the rates of trachoma.95 Dust has also been implicated as a risk factor for trachoma.84,90 It is believed that dust causes eye irritation, resulting in rubbing eyes with fingers, discharge and inflammation.84 Dust control involves sealing roads, building of mounds and landscaping measures to protect from wind.84,90 However, as previously stated, in Australia the main emphasis should be on clean faces and access to safe and functional washing facilities.

Population mobility

With household spread and high mobility of families in remote areas, trachoma control and prevention may be better undertaken at a regional level with coordination of screening and mass treatment.74 In Australia, the transient migration of many members of remote communities may contribute to ongoing trachoma endemicity. Primary health practitioners have an important role in partnering with regional population health units to implement these programs, and they can be linked to other child health screening assessments  (eg anaemia and nutrition assessments).


Interventions

The diagnosis of trachoma is based on clinical grounds (refer to ‘Resources’: WHO trachoma grading card; University of Melbourne, Indigenous Eye Health online resources and training).

The ‘3Ts’ need to be remembered for the trichiasis examination:
Think to do it, use a Thumb to lift the lid so the lashes lift away from the eye, and use a Torch to provide enough light to see the dark lashes.

Laboratory tests to confirm trachoma infection are currently not recommended except perhaps to exclude other viral or bacterial infection.96 Although laboratory tests are improving, their cost and timeliness in providing a result remain significant impediments to routine use for trachoma screening.70 As a result, although clinical signs often persist beyond active infection, clinical examination remains the recommended tool for diagnosis.70
There is no evidence that opportunistic examination and treatment for trachoma in individual children improves community trachoma outcomes, but it may relieve symptoms or prompt/inform discussions about the need for treatment of households and mass treatment programs. If treatment is provided, it should be given to all people living in the same house(s) as the affected child.

The 2014 CDNA national guidelines for public health management of trachoma suggest that treatment of cases should be dependent on screening outcomes.74 Screening is recommended for Aboriginal and Torres Strait Islander children aged 5–9 years who are residents of the community based on school enrolments, child health nurse records and other sources. Treatment strategy is determined by the prevalence of active trachoma cases within the community at time of screening, and may involve treating all household contacts or mass treatment of the whole community. There may be a requirement for repeat treatments on an annual basis depending on the disease prevalence in the community.74 Should a spontaneous case be detected outside of community-wide screening, the index case and their household require treatment.74 There is strong evidence to support community-wide treatment/ mass drug administration in reducing the prevalence of trachoma.97,98

The decision to screen and treat individuals and their contacts should, therefore, be based on patient origin from endemic area, age and symptoms, as well as liaison with regional trachoma control programs. Discussion with regional trachoma programs will help in determining the frequency and extent of screening, as well as treatment regime.74

Aboriginal and Torres Strait Islander adults aged >40 years and who are current or past residents of remote communities should be screened annually for evidence of trichiasis as part of the MBS item 715 health check. This can be done by the primary care provider as part of an annual health assessment, and need not be part of community-based programs.74 All cases of trichiasis identified on screening or opportunistically should be referred for ophthalmological assessment.74 Blindness due to trichiasis is irreversible once it has occurred, but progression to blindness can be halted by surgery because it stops eyelash rubbing and therefore prevents corneal opacity.99 Surgery, however, does not necessarily stop further progression of trichiasis. Therefore, postsurgery, patients should be followed up annually to screen for recurrence.38 Other trichiasis complications such as dry eyes need symptomatic treatment to prevent further complications.

Although not a notifiable disease, data from screening should be de-identified and passed onto the National
Trachoma Surveillance and Reporting Unit by nationally agreed procedures.74
 

Resources
 
National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

 





 
 
  1. Foreman J, Keel S, Xie J, van Wijngaarden P, et al. National Eye Health Survey. Vision 2020 Australia, 2016.
  2. US Preventive Services Task Force. Guide to clinical preventive services. Report of the USPSTF. 2nd edn. Baltimore, MD: Williams and Wilkins, 1996.
  3. Anjou MD, Boudville AI, Taylor HR. Correcting Indigenous Australians’ refractive error and presbyopia. Clin Exp Ophthalmol 2013;41(4):320–28.
  4. National Indigenous Eye Health Survey Team. Minum Barreng (Tracking Eyes) Full Report: National Indigenous Eye Health Survey. Version 2, 2009.  [Accessed 10 November 2017].
  5. Japp D, Robson C, Colledge N. 13 strategies to improve visual assessment in patients attending a day hospital: A closed audit loop. Age Ageing 2014;43(Suppl 1):i3–i.
  6. Green C, Goodfellow J, Kubie J. Eye care in the elderly. Aust Fam Physician 2014;43(7):447.
  7. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016.
  8. Christ SL, Zheng DD, Swenor BK, et al. Longitudinal relationships among visual acuity, daily functional status, and mortality: The Salisbury Eye Evaluation Study. JAMA Ophthalmol 2014;132(12):1400–06.
  9. Nevitt M, et al. Risk factors for injurious falls: A prospective study. J Gerontol 1991;46:164–70.
  10. Taylor HR, et al. Updates in medicine: Ophthalmology. Med J Aust 2002;176(29).
  11. Liu E, Ng SK, Kahawita S, et al. Ten year all‐cause mortality and its association with vision among indigenous Australians within central Australia: The central Australian ocular health study. Clin Exp Ophthalmol 2016.
  12. Landers J, Henderson T, Craig J. The prevalence and causes of visual impairment in indigenous Australians within central Australia: The Central Australian Ocular Health Study. Br J Ophthalmol 2010;94(9):1140–44.
  13. Arnold ALM, Goujon N, Busija L, et al. Near‐vision impairment and unresolved vision problems in Indigenous Australian adults. Clin Exp Ophthalmol 2013;41(3):223–30.
  14. Randall DA, Reinten T, Maher L, et al. Disparities in cataract surgery between Aboriginal and non‐Aboriginal people in New South Wales, Australia. Clin Exp Ophthalmol 2014;42(7):629–36.
  15. Mathers M, Keyes M, Wright M. A review of the evidence on the effectiveness of children’s vision screening. Child Care Health Dev 2010;36(6):756–80.
  16. Centre for Community Child Health. National children’s vision screening project discussion paper. Melbourne: Centre for Community Child Health, 2008.
  17. Hopkins S, Sampson GP, Hendicott P, Wood JM. Review of guidelines for children’s vision screenings. Clin Exp Optom 2013;96(5):443–49.
  18. Hopkins S, Sampson GP, Hendicott PL, Wood JM. A visual profile of Queensland Indigenous children. Optom Vis Sci 2016;93(3):251–58.
  19. Central Australian Rural Practitioners Association. CARPA standard treatment manual. 7th edn. Alice Springs: Centre for Remote Health, 2017.  [Accessed 6 November 2017].
  20. Queensland Health, Royal Flying Doctor Service Australia (Queensland Section), Apunipima Cape York Health Council. Chronic conditions manual: Prevention and management of chronic conditions in Australia. Cairns: Rural and Remote Clinical Support Unit, Torres and Cape Hospital and Health Service, 2015. [Accessed 10 October 2017].
  21. Western Australia Department of Health. Community Health Manual. Guideline: Birth to school aged children. Government of Western Australia, 2007 (updated 2014). [Accessed 10 November 2017].
  22. Central Australian Rural Practitioners Association, Central Australian Aboriginal Congress, CRANAplus, Centre for Remote Health. Minymaku Kutju Tjukurpa – Women’s business manual: Standard treatment manual for women’s business in remote and Indigenous health services in Central and Northern Australia. 6th edn. Alice Springs: Centre for Remote Health, 2017.  [Accessed 6 November 2017].
  23. Murray A, Jones L, Milne A, et al. A systematic review of the safety and efficacy of elective photorefractive surgery for the correction of refractive error 2005. 
  24. US Preventive Services Task Force. Screening for impaired visual acuity in older adults: Recommendation statement. Ann Intern Med 2009;151:37–43.
  25. Department of Health. Medicare Benefits Schedule. Canberra: MBS Online, 2017.  [Accessed 10 November].
  26. CRANAplus, Central Australian Aboriginal Congress, Central Austalian Rural Practitioners Association Flinders University through the Centere for Remote Health. Clinical procedures manual for remote and rural practice. 3rd edn. Alice Springs: Centre for Remote Health, 2014. [Accessed 15 May 2017].
  27. Chou R, Dana T, Bougatsos C. Screening for visual impairment in older adults: Systematic review to update the 1996 US Preventive Services Task Force recommendation. Rockville, MD: Agency for Healthcare Research and Quality, 2009.
  28. Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for impaired visual acuity in older adults: US Preventive Services Task Force recommendation statement. JAMA 2016;315(9):908–14.
  29. International Council of Ophthalmology. Visual standards: Aspects and ranges of vision loss with emphasis on population surveys. Report prepared for the International Council of Ophthalmology at the 29th International Congress of Ophthalmology. Sydney, 2002.
  30. Powe NR, Schein OD, Gieser Sc, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994;112:239–52.
  31. Agramunt S, Meuleners LB, Fraser ML, Morlet N, Chow KC, Ng JQ. Bilateral cataract, crash risk, driving performance, and self-regulation practices among older drivers. J Cataract Refract Surg 2016;42(5):788–94.
  32. Owsley C, McGwin G Jr, Sloane M, Wells J, Stalvey BT, Gauthreaux S. Impact of cataract surgery on motor vehicle crash involvement by older adults. JAMA 2002;288(7):841–49.
  33. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9(11).
  34. Karlsson MK, Magnusson H, von Schewelov T, Rosengren B. Prevention of falls in the elderly—a review. Osteoporosis Int 2013;24(3):747–62.
  35. Hewitt A, Verman N, Gruen R. Visual outcomes for remote Australian Aboriginal people after cataract surgery. Clin Exp Ophthalmol 2001;29(2):68–74.
  36. Kang JH, Wu J, Cho E, et al. Contribution of the Nurses’ Health Study to the epidemiology of cataract, age-related macular degeneration, and glaucoma. Am J Public Health 2016;106(9):1684–89.
  37. Prepared for the National Health and Medical Research Council by Biotext Pty Ltd. Risk factors for eye disease and injury. Literature review, 2008. [Accessed 10 November 2017].
  38. Office for Aboriginal and Torres Strait Islander Health. Specialist eye health guidelines for use in Aboriginal and Torres Strait Islander populations. Cataract, diabetic retinopathy, trachoma. Canberra: Department of Health, 2001.
  39. West S. Ocular ultraviolet B exposure and lens opacities: A review. J Epidemiol 1999;9(6 Suppl):S97–101.
  40. McCarty CA, Taylor HR. A review of the epidemiologic evidence linking ultraviolet radiation and cataracts. Dev Ophthalmol 2002;35:21–31.
  41. Robman L, Taylor H. External factors in the development of cataract. Eye 2005;19(10):1074–82.
  42. Tan JS, Wang JJ, Younan C, Cumming RG, Rochtchina E, Mitchell P. Smoking and the long-term incidence of cataract: The Blue Mountains Eye Study. Ophthalmic Epidemiol 2008;15(3):155–61.
  43. Goujon N, Brown CM, Xie J, et al. Self‐reported vision and health of indigenous Australians. Clin Exp Ophthalmol 2010;38(8):796–804.
  44. Kostis JB, Dobrzynski JM. Prevention of cataracts by statins: A meta-analysis. J Cardiovasc Pharmacol Ther 2014;19(2):191–200.
  45. Landers J, Henderson T, Abhary S, Craig J. Prevalence and associations of diabetic retinopathy in indigenous Australians within central Australia: The Central Australian Ocular Health Study. Clin Exp Ophthalmol 2010;38(4):393–97.
  46. Tapp RJ, Shaw JE, Harper CA, et al. The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 2003;26(6):1731–37.
  47. Central Australian Aboriginal Congress, Central Australian Rural Practitioners Association Inc, CRANAplus Inc, Flinders University through the Centre for Remote Health. Reference book for the remote primary health care manuals. Alice Springs: Centre for Remote Health, 2014.  [Accessed 10 November 2017].
  48. Landers J, Henderson T, Abhary S, Craig J. Incidence of diabetic retinopathy in indigenous Australians within Central Australia: The Central Australian Ocular Health Study. Clin Exp Ophthalmol 2012;40(1):83–87.
  49. McKay R, McCarty CA, Taylor HR. Diabetic retinopathy in Victoria, Australia: The visual impairment project. Br J Ophthalmol 2000;84(8):865– 70.
  50. National Health and Medical Research Council and Australian Diabetes Society. Guidelines for the management of diabetic retinopathy. Canberra: NHMRC, 2008.
  51. Morris D. Prevention and treatment of diabetic retinopathy. Nurse Prescribing 2012;10(1):22–24.
  52. Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: A position statement by the American Diabetes Association. Diabetes Care 2017;40(3):412–18.
  53. Morrison JL, Hodgson LA, Lim LL, Al‐Qureshi S. Diabetic retinopathy in pregnancy: A review. J Clin Exp Ophthalmol 2016;44(4):321– 34.
  54. The Royal Australian College of General Practitioners. General practice management of type 2 diabetes: 2016–18: East Melbourne, Vic: RACGP, 2016.  [Accessed 14 November 2017].
  55. Mohamed Q, Gillies MC,Wong TY. Management of diabetic retinopathy: A systematic review. JAMA 2007;298(8):902–16.
  56. Centre for Eye Research Australia. Diabetic retinopathy: Fact sheet. East Melbourne, Vic: CERA, 2008.  [Accessed 10 October 2011].
  57. Ku J, Landers J, Henderson T, Craig JE. The reliability of single-field fundus photography in screening for diabetic retinopathy: The Central Australian Ocular Health Study. Med J Aust 2013;198(2):93–96.
  58. Tapp RJ, Svoboda J, Fredericks B, Jackson AJ, Taylor HR. Retinal photography screening programs to prevent vision loss from diabetic retinopathy in rural and urban Australia: A review. Ophthalmic Epidemiol 2015;22(1):52–59.
  59. Bragge P, Gruen RL, Chau M, Forbes A, Taylor HR. Screening for presence or absence of diabetic retinopathy: A meta-analysis. Arch Ophthalmol 2011;129(4):435–44.
  60. Aiello LP, DCCT/EDIC research Group. Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/ epidemiology of diabetes interventions and complications study. Diabetes Care 2014;37(1):17–23.
  61. The Royal College of Opthamologists. Diabetic retinopathy guidelines. London: RCOPHTH, 2012. [Accessed 15 November 2017].
  62. Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: Global prevalence, major risk factors, screening practices and public health challenges: A review. Clin Exp Ophthalmol 2016;44(4):260–77.
  63. Marozas LM, Fort PE. Diabetic retinopathy – Update on prevention techniques, present therapies, and new leads. US Ophthalmic Rev 2014;7(1):54–58.
  64. Chew EY, Davis MD, Danis RP, et al. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology 2014;121(12):2443–51.
  65. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy. JAMA 1988;260:2864–71.
  66. Pan American Association of Opthamology. Guidelines for diabetic eye care. International Council of Ophthalmology, 2016.  [Accessed 15 November 2017].
  67. Force UPST. Vision screening for children 1 to 5 years of age: US Preventive Services Task Force Recommendation statement. Pediatrics 2011;127(2):340–46.
  68. McCarty CA, Taylor HR. A review of the epidemiologic evidence linking ultraviolet radiation and cataracts. Dev Ophthalmol 2002;35:21–31.
  69. West S. Ocular ultraviolet B exposure and lens opacities: A review. J Epidemiol 1999;9(6 Suppl):S97–101.
  70. Taylor HR, Burton MJ, Haddad D, West S, Wright H. Trachoma. Lancet 2014;384(9960):2142–52.
  71. Gambhir M, Basáñez M-G, Burton MJ, et al. The development of an age-structured model for trachoma transmission dynamics, pathogenesis and control. PLoS neglected tropical diseases 2009;3(6):e462.
  72. Thylefors B, Dawson CR, Jones BR, West SK, Taylor HR. A simple system for the assessment of trachoma and its complications. Bull World Health Organ 1987;65(4):477–83.
  73. Mak DB, O’Neill LM, Herceq A, McFarlane H. Prevalence and control of trachoma in Australia, 1997–2004. Commun Dis Intell Q Rep 2006;30(2):236–47.
  74. Communicable Diseases Network Australia. CDNA national guidelines for the public health management of trachoma. Canberra: Department of Health, 2014.  [Accesssed 17 October 2017].
  75. Australian trachoma surveillance report. Sydney: The Kirby Institute, UNSW, 2014.
  76. Tellis B, Fotis K, Keeffe JE, Taylor HR. Trachoma surveillance annual report, 2008. A report by the National Trachoma Surveillance Reporting Unit. Commun Dis Intell Q Rep 2009;33(3):275–90.
  77. Department of Health and Ageing. Surveillance reports for active trachoma annual reports. Canberra: Department of Health and Ageing, 2010.  [Accessed 15 November 2017].
  78. Department of Health. National framework for action to promote eye health and prevent avoidable blindness and vision loss. Canberra: Department of Health, 2015.  [Accessed 15 November 2017].
  79. World Health Organization. 10th meeting of GET2020 report. Making progress toward the global elimination of blinding trachoma. Geneva: WHO, 2006.
  80. Lange FD, Jones K, Ritte R, Brown HE, Taylor HR. The impact of health promotion on trachoma knowledge, attitudes and practice (KAP) of staff in three work settings in remote Indigenous communities in the Northern Territory. PLoS Negl Trop Dis 2017;11(5):e0005503.
  81. Torzillo PJ, Pholeros P, Rainow S, et al. The state of health hardware in Aboriginal communities in rural and remote Australia. Aust N Z J Public Health 2008;32(1):7–11.
  82. Pholeros P. How design can help fight poverty. Sydney: TEDx, 2013.
  83. Health Habitat. How do the houses perform before a Housing for Health project? [Accessed 15 April 2017].
  84. Lansingh V. Primary health care approach to trachoma control in Aboriginal communities in central Australia [PhD thesis]. Melbourne: University of Melbourne, 2005.
  85. Cook GC, Zumla AI. Ophthalmology in the tropics and subtropics. In: Cook GC, Zumla AI, editors. Manson’s tropical diseases. 22nd edn. Saunders, 2009.
  86. Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC. Effect of water, sanitation, and hygiene on the prevention of trachoma: A systematic review and meta-analysis. PLoS Med 2014;11(2):e1001605.
  87. Taylor HR, Matthew A. Chapter 35: Trachoma and inclusion conjunctivitis. In: Magill AJ, Strickland GT, Maguire JH, Ryan ET, Solomon T, editors. Hunter’s tropical medicine and emerging infectious disease. 9th edn. Elsevier Health Sciences, 2012.
  88. Rabiu M, Alhassan MB, Ejere HO, Evans JR. Environmental sanitary interventions for preventing active trachoma. Cochrane Database Syst Rev 2012;(2):CD004003. 
  89. Last AR, Burr SE, Weiss HA, et al. Risk factors for active trachoma and ocular Chlamydia trachomatis infection in treatment-naïve trachoma-hyperendemic communities of the Bijagos Archipelago, Guinea Bissau. PLoS Negl Trop Dis 2014;8(6):e2900.
  90. Lavett DK, Lansingh VC, Carter MJ, Eckert KA, Silva JC. Will the SAFE strategy be sufficient to eliminate trachoma by 2020? Puzzlements and possible solutions. Scientific World Journal 2013.
  91. Warren JM, Birrell AL. Trachoma in remote Indigenous Australia: A review and public health perspective. Aust N Z J Public Health 2015;40(S1):S48–S51.
  92. Lansingh VC, Mukesh BN, Keeffe JE, Taylor HR. Trachoma control in two central Australian Aboriginal communities: A case study. Int Ophthalmol 2010;30(4):367–75.
  93. Emerson PM, Bailey RL. Trachoma and fly control. Community Eye Health 1999;12(32):57.
  94. Ramesh A, Bristow J, Kovats S, et al. The impact of climate on the abundance of Musca sorbens, the vector of trachoma. Parasit Vectors 2016;9(1):48.
  95. Prüss A, Mariotti SP. Preventing trachoma through environmental sanitation: A review of the evidence base. Bull World Health Organ 2000;78(2):267–73.
  96. Mabey DC, Solomon AW, Foster A. Trachoma. Lancet 2003;362:323–29.
  97. Evans JR, Solomon AW. Antibiotics for trachoma. Cochrane Database Syst Rev 2011;(3):CD001860.
  98. Liu B, Cowling C, Hayen A, et al. Relationship between community drug administration strategy and changes in trachoma prevalence, 2007 to 2013. PLoS Negl Trop Dis 2016;10(7):e0004810.
  99. World Health Organization. London School of Hygiene and Tropical Medicine and the International Trachoma Initative. Trachoma control: A guide for program managers. Geneva: WHO, 2006.
  100. Department of Health and Ageing. Surveillance reports for active trachoma annual reports. Canberra: Department of Health and Ageing, 2010. [Accessed 15 November 2017].
  101. Tellis B, Fotis K, Keeffe JE, Taylor HR. Trachoma surveillance annual report, 2008. A report by the National Trachoma Surveillance Reporting Unit. Commun Dis Intell 2009;33(3):275–90.
  102. World Health Organization. London School of Hygiene and Tropical Medicine and the International Trachoma Initative. Trachoma control: A guide for program managers. Geneva: WHO, 2006.
  103. Taylor HR. Global Evidence Mapping Initiative. Antibiotic treatments of trachoma: A systematic review. Melbourne: University of Melbourne and Monash University, 2010.

Downloads

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (PDF 9.8 MB)

 Evidence base to a preventive health assessment in Aboriginal and Torres Strait Islander people (PDF 9.4 MB)

 National Guide Lifecycle chart (child) (PDF 555 KB)

 National Guide Lifecycle chart (young) (PDF 1 MB)

 National Guide Lifecycle chart (adult) (PDF 1 MB)