International Ophthalmology

, Volume 30, Issue 4, pp 367–375 | Cite as

Trachoma control in two Central Australian Aboriginal communities: a case study

  • Van C. LansinghEmail author
  • Bickol N. Mukesh
  • Jill E. Keeffe
  • Hugh R. Taylor
Original Paper


This prospective case study assessed the additional impact of environmental changes (E) within the SAFE strategy in controlling trachoma in two Aboriginal communities (populations 315 and 385) in Central Australia. Baseline levels for trachoma, facial cleanliness, and nasal discharge were measured in children <15 years old. Health and facial cleanliness promotion were initiated in each community and housing and environmental improvements were made in one community. Azithromycin was distributed to all members of each community (coverage 55–73%). Assessments of trachoma and facial cleanliness were made at 3, 6, and 12 months post-intervention. Baseline trachoma rates were similar for the two communities (48 and 50%). Rates were significantly lower at 3, 6, and 12 months compared to baseline, but there was no significant difference between the two communities. The A/F components of the SAFE strategy significantly reduced the prevalence of trachoma; however, while the E intervention did not bring any apparent benefits, several factors might have masked them.


Trachoma Children Prevalence SAFE intervention Australia Aboriginal 



We would like to thank the Christian Blind Mission International Australia, the Nganampa Health Council, its workers and supervisors, Health Habitat, and the Anangu Pitjantjatjara people for their support in this study.


  1. 1.
    Grayston JT, Wang SP, Yeh LJ et al (1999) Importance of reinfection in the pathogenesis of trachoma. Rev Infect Dis 7:717–725Google Scholar
  2. 2.
    Taylor HR, Johnson SL, Prendergast RA et al (1982) An animal model of trachoma II. The importance of repeated reinfection. Invest Ophthalmol Vis Sci 23:507–515PubMedGoogle Scholar
  3. 3.
    Burton MJ, Holland MJ, Faal N et al (2003) Which members of a community need antibiotics to control trachoma? Conjunctival Chlamydia trachomatis infection load in Gambian villages. Invest Ophthalmol Vis Sci 44:4215–4222CrossRefPubMedGoogle Scholar
  4. 4.
    Kuper H, Solomon AW, Buchan JC et al (2003) A critical review of the SAFE strategy for the prevention of blinding trachoma. Lancet Infect Dis 3:372–381CrossRefPubMedGoogle Scholar
  5. 5.
    West SK (2004) Trachoma: new assault on an ancient disease. Prog Retin Eye Res 23:381–401CrossRefPubMedGoogle Scholar
  6. 6.
    Mak DB (2006) Better late than never: a national approach to trachoma control. Med J Aust 184:487–488PubMedGoogle Scholar
  7. 7.
    Mariotti SP, Pararajasegaram R, Resnikoff S (2003) Trachoma: looking forward to global elimination of trachoma by 2020 (GET). Am J Trop Med Hyg 69(Suppl 5):33–35PubMedGoogle Scholar
  8. 8.
    Bailey R, Lietman T (2001) The SAFE strategy for the elimination of trachoma by 2020: will it work? Bull World Health Organ 79:233–236PubMedGoogle Scholar
  9. 9.
    Prüss A, Mariotti SP (2000) Preventing trachoma through environmental sanitation: a review of the evidence base. Bull World Health Organ 78:258–266PubMedGoogle Scholar
  10. 10.
    Emerson PM, Cairncross S, Bailey RL et al (2000) Review of the evidence base for the ‘F’ and ‘E’ components of the SAFE strategy for trachoma control. Trop Med Int Health 5:515–527CrossRefPubMedGoogle Scholar
  11. 11.
    Lansingh VC, Weih LM, Keeffe JE et al (2001) Assessment of trachoma prevalence in a remote mobile population in central Australia. Ophthalmic Epidemiol 8:97–108CrossRefPubMedGoogle Scholar
  12. 12.
    Thylefors B, Dawson CR, Jones BR et al (1987) A simple system for the assessment of trachoma and its implications. Bull World Health Organ 65:477–483PubMedGoogle Scholar
  13. 13.
    Taylor H, Lansingh VC (1999) Azithromycin: a new era for trachoma elimination? Track Trach 2:1–2Google Scholar
  14. 14.
    Commonwealth Department of Health and Aged Care (1999) National indigenous housing guide. The Department, Canberra, Australia Google Scholar
  15. 15.
    Australian Institute of Health and Welfare (2006) Accessed 16 April 2008
  16. 16.
    da Cruz L, Dadour IR, McAllister IL et al (2002) Seasonal variation in trachoma and bush flies in northwestern Australian Aboriginal Communities. Clin Exp Ophthalmol 30:80–83CrossRefGoogle Scholar
  17. 17.
    Reinhards J, Weber A, Nizetic B et al (1968) Studies in the epidemiology and control of seasonal conjunctivitis and trachoma in southern Morocco. Bull World Health Organ 39:497–545PubMedGoogle Scholar
  18. 18.
    Communicable Diseases Network Australia (2006) Guidelines for the public health management of trachoma in Australia. Commonwealth of Australia, Canberra. Accessed 23 June 2008
  19. 19.
    Solomon AW, Holland MJ, Alexander NDE et al (2004) Mass treatment with single-dose azithromycin for trachoma. N Engl J Med 351:1962–1971CrossRefPubMedGoogle Scholar
  20. 20.
    Melese M, Chidambaram JD, Alemayehu W et al (2004) Feasibility of eliminating ocular Chlamydia trachomatis with repeat mass antibiotic treatments. J Am Med Assoc 292:721–725CrossRefGoogle Scholar
  21. 21.
    Ewald DP, Hall GV, Franks CC (2003) An evaluation of a SAFE-style trachoma control program in Central Australia. Med J Aust 178:65–68PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Van C. Lansingh
    • 1
    • 2
    Email author
  • Bickol N. Mukesh
    • 3
  • Jill E. Keeffe
    • 1
    • 4
  • Hugh R. Taylor
    • 1
    • 4
  1. 1.Centre for Eye Research AustraliaUniversity of MelbourneEast MelbourneAustralia
  2. 2.IAPB/VISION 2020 LAVilla Rosa, Pilar 1629Argentina
  3. 3.Alcon LaboratoriesFort WorthUSA
  4. 4.Vision CRCSydneyAustralia

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