Funding gaps could lead to trachoma resurgence – Indigenous health experts

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Trachoma

More severe cases of trachoma are treated with antibiotics or surgery but the best way to prevent the disease is better hygiene. Photograph: The University Of Melbourne

A leading expert in Indigenous eye health has urged the federal government not to become complacent about rates of trachoma in remote Aboriginal communities, saying it will take constant pressure to meet Australia’s target of eradicating the disease by 2020.

Australia is the only developed nation that still has endemic rates of trachoma, a bacterial eye infection that is the world’s leading cause of preventable blindness, and all those affected are Aboriginal or Torres Strait Islanders.

It disappeared from the broader Australian community, as well as the rest of the developed world, with improved living conditions in the early 20th century, but remains endemic in some remote Aboriginal communities.

Professor Hugh Taylor, from Melbourne University’s school of population and global health, said Australia’s commitment to the World Health Organisation (WHO) goal of eliminating trachoma by 2020 was “eminently achievable” if it maintained current efforts, but warned that funding gaps caused by changed government programs could cause a resurgence in infection rates.

“We are making really good progress, we can really do this, but it needs constant funding,” Taylor said. “We know the number of positive verifications spiked for a year while the change in funding was sorted out.”

According to the 2014 Australian Trachoma Surveillance Report the prevalence of trachoma in children aged five to nine in screened communities was 4.7%, down from 14% in 2009.

But the report, produced by the Kirby Institute, also said rates of trachoma in at-risk communities increased slightly between 2013 and 2014, a difference it said might be attributable to a change in the communities subject to screening but was “a timely reminder of the need for all jurisdictions to maintain their commitment to the full implementation of the national guidelines for trachoma control”.

The bulk of affected communities were in the Northern Territory, where 44 of 78 communities deemed at risk of trachoma were screened. Worst affected was the Barkly region (around Tennant Creek) where 28.7% of children showed signs of infection.

Fifty-eight of the 59 West Australian communities deemed to be at risk required screening, and 13 communities in South Australia were also on the list.

Trachoma primarily spreads between children. It infects eye secretion and usually causes only a mild irritation, but serious infections can cause scarring inside the eyelid, which can in turn cause the upper eyelid to turn inwards, causing the eyelashes to rub on the cornea, eventually causing blindness.

More severe cases are treated with antibiotics or surgery but Taylor said the best way to prevent the disease, which spread in Europe through the trenches of the Napoleonic wars, was better hygiene. The NT runs a Clean Faces, Strong Eyes program, complete with goanna mascot, to encourage children in remote Aboriginal communities to wash daily, and the National Trachoma Screening Program involves a clean face check, which 83% of children passed in 2014.

Ensuring children have a place to wash in remote communities with overcrowded and poorly-maintained housing stock is part of that strategy.

“To get rid of trachoma we don’t need to put $3bn into overhauling housing, we just need to make sure that the taps work,” Taylor said.

“It’s the low-hanging fruit in Indigenous health. We can really do this and make a major difference.”

The opposition leader, Bill Shorten, highlighted Indigenous eye health in his reply to the Closing the Gap speech on Wednesday and promised an additional $9m to continue existing prevention strategies and increase the number of visiting optometry and ophthalmology services.

The federal government has funded a national trachoma surveillance and treatment program since 2009, allocating about $4m a year. The current funding commitment will lapse in mid-2017. Rural health minister Fiona Nash, the new deputy leader of the National party, has previously committed to meeting the WHO targets but did not respond to questions.

Prof Donna Mak, head of population and preventive health at the University of Notre Dame’s school of medicine, said improving hygiene standards was the “critical thing” in eradicating trachoma and required both community education programs and improved infrastructure to get children into the habit of washing daily.

She said the message was getting through after six years of regular screening.

“The kids are great because they are used to it and they often know how to flip back their own eyelids and they have done it for you before you get there,” Mak said.

“They are all lined up there with their eyelids flipped open waiting for you to look – it’s quite funny”

Mak said it was inaccurate to compare rates of trachoma in Australia with rates in 53 other countries with endemic rates, mostly in the developing world, because the Australian figures derive from a targeted screening of every child in a potentially infected community.

Prof John Kaldor, head of the Kirby Institute’s Aboriginal and Torres Strait Islander health program, agreed, saying that while there may be small rises in trachoma rates from individual communities, “it’s in the context of overall decline”.

That didn’t make Australia’s trachoma-positive status acceptable, he said.

“I think everyone is aware that we are the only developed country with endemic trachoma,” Kaldor said. “It’s a club of one that we don’t really want to be in.”