RESUMEN
IMPORTANCE: Australia is the only developed country to still have pockets of endemic trachoma. The research provides up-to-date, population-based prevalence data of later complications of trachoma amongst a national sample of Indigenous adults. BACKGROUND: To report the prevalence of trachomatous trichiasis (TT) in Indigenous Australians aged 40 years and older. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 1738 (41% male) Indigenous Australians aged 40 years or older, living amongst 30 randomly selected Australian sites, stratified by remoteness. METHODS: Anterior segment examination was performed and trachoma grading for the presence of TT and corneal opacification (CO) was conducted using the WHO (WHO) simplified grading system. MAIN OUTCOME MEASURES: Prevalence of TT. RESULTS: A total of three (0.17%) participants had TT, and there were no confirmed cases of trachomatous CO in the NEHS. All three participants with TT were female and aged 40 years or older. Although they had likely spent their childhoods in more remote areas, two of the three confirmed cases resided in an urban and outer regional area at the time of their examinations. CONCLUSIONS AND RELEVANCE: Our data are in line with ongoing national trachoma surveillance reports that suggest the prevalence of late sequences of trachoma appear to be decreasing in Australia.
Asunto(s)
Infecciones Bacterianas del Ojo/etnología , Encuestas Epidemiológicas , Nativos de Hawái y Otras Islas del Pacífico , Vigilancia de la Población , Población Rural , Tracoma/etnología , Triquiasis/etnología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios RetrospectivosRESUMEN
PURPOSE: Trachoma, caused by the bacterium Chlamydia trachomatis, is a chronic, recurrent inflammatory disease that affects the cornea and conjunctiva. Trachoma is the leading infectious cause of avoidable blindness worldwide. Its prevalence is higher among individuals of low socioeconomic status, and trachoma is common in indigenous communities. The present study presents aspects of the epidemiological profile of trachoma in indigenous communities in Brazil. METHODS: We analyzed data from two databases collected during trachoma screening activities among the population of indigenous settlements in Brazil between 2000 and 2008. Trachoma cases were detected by ocular examination in accordance with the World Health Organization simplified trachoma grading system. RESULTS: According to the surveillance database, a total of 9582 individuals in six different states were examined. Among children aged 1-9 years, the prevalence of follicular trachomatous inflammation (TF) was 35.2%. In individuals aged ≥15 years, the prevalence of trachomatous trichiasis (TT) was 1.2% in individuals and the sex-specific prevalence was 0.8% in males and 1.6% in females (p = 0.02). In a survey of two states, 2301 indigenous schoolchildren were examined. In the age bracket 5-9 years, the prevalence of TF was 4.9 (95% confidence interval 3.8-6.0%). CONCLUSION: In Brazil, trachoma appears to be a serious public health problem in indigenous settlements, which should therefore be given priority in programs aimed at the elimination of trachoma in the country.
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Indígenas Sudamericanos/estadística & datos numéricos , Tracoma/etnología , Tracoma/epidemiología , Adolescente , Distribución por Edad , Brasil/epidemiología , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Vigilancia de la Población , Prevalencia , Caracteres SexualesRESUMEN
Chlamydia trachomatis causes sexually transmitted infections and the blinding disease trachoma. Current data on C. trachomatis phylogeny show that there is only a single trachoma-causing clade, which is distinct from the lineages causing urogenital tract (UGT) and lymphogranuloma venerum diseases. Here we report the whole-genome sequences of ocular C. trachomatis isolates obtained from young children with clinical signs of trachoma in a trachoma endemic region of northern Australia. The isolates form two lineages that fall outside the classical trachoma lineage, instead being placed within UGT clades of the C. trachomatis phylogenetic tree. The Australian trachoma isolates appear to be recombinants with UGT C. trachomatis genome backbones, in which loci that encode immunodominant surface proteins (ompA and pmpEFGH) have been replaced by those characteristic of classical ocular isolates. This suggests that ocular tropism and association with trachoma are functionally associated with some sequence variants of ompA and pmpEFGH.
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Proteínas de la Membrana Bacteriana Externa/genética , Chlamydia trachomatis/genética , Genoma Bacteriano/genética , Filogenia , Tracoma/microbiología , Adulto , Australia/epidemiología , Niño , Código de Barras del ADN Taxonómico , Enfermedades Endémicas , Humanos , Nativos de Hawái y Otras Islas del Pacífico , Serotipificación , Tracoma/etnologíaRESUMEN
OBJECTIVES: Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease. METHODS: A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined. RESULTS: Having a clean face was found to be protective for trachoma, but face-washing education programs have produced no significant benefits. Sanitation infrastructure in a community was the key determinant of facial cleanliness. Installation of swimming pools in remote Indigenous communities has been demonstrated to reduce the prevalence of several common childhood infections. However, minimal research has explored the impact of pools on trachoma rates. CONCLUSIONS: The locally supported construction of pools in remote Indigenous communities may contribute to a decline in trachoma. A prospective, controlled trial is needed to test this hypothesis in endemic communities. IMPLICATIONS: If validated by a well-designed study, pool construction may provide a much sought-after practical government strategy to combat trachoma in remote Indigenous communities.
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Nativos de Hawái y Otras Islas del Pacífico , Salud Pública , Población Rural , Tracoma , Australia/epidemiología , Humanos , Salud Rural , Vigilancia de Guardia , Tracoma/etnología , Tracoma/prevención & controlRESUMEN
Australia remains the only developed country to have endemic levels of trachoma (a prevalence of 5% or greater among children) in some regions. Endemic trachoma in Australia is found predominantly in remote and very remote Aboriginal communities. The Australian Government funds a National Trachoma Surveillance and Reporting Unit to collate, analyse and report trachoma prevalence data and document trachoma control strategies in Australia through an annual surveillance report. This report presents data collected in 2012. Data are collected from Aboriginal and Torres Strait communities designated as at-risk for endemic trachoma in the Northern Territory, Queensland, South Australia and Western Australia. The World Health Organization grading criteria were used to diagnose cases of trachoma in Aboriginal children with jurisdictions focusing screening activities on the 5-9 years age group; however, some children in the 1-4 and 10-14 years age groups were also screened. The prevalence of trachoma within a community was used to guide treatment strategies as a public health response. Aboriginal adults aged 40 years or older were screened for trichiasis. Community screening coverage of the designated at-risk communities was 96%. Screening coverage of the estimated population of children aged 5-9 years and adults aged 40 years or older in at-risk communities was 71% and 31%, respectively. Trachoma prevalence among children aged 5-9 years who were screened was 4%. Of communities screened, 63% were found to have no cases of active trachoma and 25% were found to have endemic levels of trachoma. Treatment was required in 87 at-risk communities screened. Treatment coverage of active cases and their contacts varied from 79%-97% between jurisdictions. Trichiasis prevalence was 2% within the screened communities.
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Chlamydia trachomatis/aislamiento & purificación , Monitoreo Epidemiológico , Tracoma/etnología , Tracoma/epidemiología , Triquiasis/epidemiología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Australia/epidemiología , Azitromicina/uso terapéutico , Niño , Preescolar , Chlamydia trachomatis/efectos de los fármacos , Femenino , Humanos , Lactante , Masculino , Nativos de Hawái y Otras Islas del Pacífico , Prevalencia , Tracoma/tratamiento farmacológico , Tracoma/microbiologíaAsunto(s)
Ceguera/etnología , Ambiente , Servicios de Salud del Indígena/estadística & datos numéricos , Nativos de Hawái y Otras Islas del Pacífico/etnología , Determinantes Sociales de la Salud/etnología , Tracoma/etnología , Australia/epidemiología , Femenino , Humanos , Masculino , Factores de Riesgo , Factores SocioeconómicosRESUMEN
This essay examines the period between 1897 and 1910, when trachoma, a contagious eye disease, became an "Oriental" problem that justified exclusionary immigration policy against Asians entering the United States. It also investigates the ways in which the public fear and alleged threat of the eye disease destabilized and undermined the rights of Asian immigrants. Many scholars have explored the link between trachoma and southern and eastern European newcomers, in particular Jews, but they have not paid much attention to Chinese or Japanese immigrants, for whose exclusion trachoma played a significant role. This is primarily because the number of Asian immigrants was much smaller than that of their European counterparts and because the Chinese Exclusion Acts, which had already been in place, functioned as a stronger and more lasting deterrent to Asian immigration than exclusion or deportation through medical inspection. Moreover, into the 1910s, medical and scientific innovations for detecting parasitic diseases (e.g. hookworm) helped American authorities exclude Asians in larger numbers. Still, the analysis of the discourses surrounding trachoma and immigration from Asia, though short-lived, demonstrates the role of medical inspection in controlling and regulating Asian immigrants, in particular Chinese and Japanese, into the United States and in constructing their legal and political rights. In 1906, the fear of trachoma justified an order to segregate Japanese students from white children in San Francisco even at the cost of compromising their rights as citizens. Along with fierce criticisms against immigration officials by the American public, the 1910 investigation of the San Francisco Immigration Office problematized the admission of trachoma-afflicted Asian immigrants. Those critical of the Immigration Office and its implementation of American immigration policy called for exclusionary measures to limit the privileges of exempt classes and domiciled aliens and hinder the exertion of their rights to leave and reenter their adopted country. The two examples show that trachoma was a convenient excuse to condemn inefficient immigration policy and regulate allegedly diseased Asian bodies. In 1910, the federal government made a decision to relegate to steamship companies full responsibility for medical inspection at Asian ports. Since they had to pay a fine for every immigrant excluded at American borders for medical reasons, including trachoma, steamship companies carried out more rigorous examinations. With medical advancements and growing interest in parasitic diseases, trachoma soon lost its appeal to immigration authorities. However, the association of immigration, race, and disease has continued to provide a rationale for immigration control beyond American borders.
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Emigrantes e Inmigrantes/historia , Emigración e Inmigración/historia , Tracoma/historia , Emigrantes e Inmigrantes/legislación & jurisprudencia , Emigración e Inmigración/legislación & jurisprudencia , Asia Oriental/etnología , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Tracoma/etnología , Tracoma/prevención & control , Estados UnidosRESUMEN
This essay examines the period between 1897 and 1910, when trachoma, a contagious eye disease, became an "Oriental" problem that justified exclusionary immigration policy against Asians entering the United States. It also investigates the ways in which the public fear and alleged threat of the eye disease destabilized and undermined the rights of Asian immigrants. Many scholars have explored the link between trachoma and southern and eastern European newcomers, in particular Jews, but they have not paid much attention to Chinese or Japanese immigrants, for whose exclusion trachoma played a significant role. This is primarily because the number of Asian immigrants was much smaller than that of their European counterparts and because the Chinese Exclusion Acts, which had already been in place, functioned as a stronger and more lasting deterrent to Asian immigration than exclusion or deportation through medical inspection. Moreover, into the 1910s, medical and scientific innovations for detecting parasitic diseases (e.g. hookworm) helped American authorities exclude Asians in larger numbers. Still, the analysis of the discourses surrounding trachoma and immigration from Asia, though short-lived, demonstrates the role of medical inspection in controlling and regulating Asian immigrants, in particular Chinese and Japanese, into the United States and in constructing their legal and political rights. In 1906, the fear of trachoma justified an order to segregate Japanese students from white children in San Francisco even at the cost of compromising their rights as citizens. Along with fierce criticisms against immigration officials by the American public, the 1910 investigation of the San Francisco Immigration Office problematized the admission of trachoma-afflicted Asian immigrants. Those critical of the Immigration Office and its implementation of American immigration policy called for exclusionary measures to limit the privileges of exempt classes and domiciled aliens and hinder the exertion of their rights to leave and reenter their adopted country. The two examples show that trachoma was a convenient excuse to condemn inefficient immigration policy and regulate allegedly diseased Asian bodies. In 1910, the federal government made a decision to relegate to steamship companies full responsibility for medical inspection at Asian ports. Since they had to pay a fine for every immigrant excluded at American borders for medical reasons, including trachoma, steamship companies carried out more rigorous examinations. With medical advancements and growing interest in parasitic diseases, trachoma soon lost its appeal to immigration authorities. However, the association of immigration, race, and disease has continued to provide a rationale for immigration control beyond American borders.
Asunto(s)
Humanos , Emigrantes e Inmigrantes/historia , Emigración e Inmigración/historia , Asia Oriental/etnología , Historia del Siglo XIX , Historia del Siglo XX , Tracoma/etnología , Estados UnidosAsunto(s)
Nativos de Hawái y Otras Islas del Pacífico/etnología , Pautas de la Práctica en Medicina , Práctica de Salud Pública/normas , Tracoma/etnología , Adolescente , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Niño , Femenino , Política de Salud , Promoción de la Salud , Humanos , Masculino , Programas Nacionales de Salud/normas , Pautas de la Práctica en Medicina/normas , Queensland/epidemiología , Tracoma/tratamiento farmacológicoRESUMEN
BACKGROUND: To estimate the incidence and causes of visual impairment for the purposes of service provision among the indigenous Australian population within central Australia from its most common causes, namely cataract, diabetic retinopathy and trachoma. DESIGN: Clinic-based cohort study. PARTICIPANTS: One thousand eight hundred eighty four individuals aged ≥20 years living in one of 30 remote communities within the statistical local area of 'Central Australia'. METHODS: From those initially recruited, 608 (32%) participants were reviewed again between 6 months and 3 years (median 2 years). Patients underwent Snellen visual acuity testing and subjective refraction. Following this, an assessment of their anterior and posterior segments was made. Baseline results were compared with those who were reviewed. MAIN OUTCOME MEASURES: The annual incidence rates and causes of visual impairment (vision worse than Snellen visual acuity 6/12 in at least one eye). RESULTS: The incidence of visual impairment in at least one eye was 6.6%, 1.2% and 0.7% per year for cataract, diabetic retinopathy and trachoma, respectively (7.9%, 1.5% and 0.7% per year for those aged ≥40 years). Advancing age was the main risk factor common to all three. CONCLUSION: It is important to be mindful not only of the prevalence of disease in a community but also of the rate at which new cases are occurring when allocating resources to address the ocular health needs of this region. Compared with historical data, diabetic retinopathy is emerging as a new and increasing threat to vision in this population.
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Catarata/etnología , Retinopatía Diabética/etnología , Nativos de Hawái y Otras Islas del Pacífico/etnología , Tracoma/etnología , Trastornos de la Visión/etnología , Personas con Daño Visual/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Necesidades y Demandas de Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Northern Territory/epidemiología , Refracción Ocular/fisiología , Población Rural , Trastornos de la Visión/etiología , Agudeza Visual/fisiología , Adulto JovenRESUMEN
BACKGROUND: To determine the change in the prevalence in active trachoma in children in a remote Aboriginal community over a 32-year period. DESIGN: Data used from two cross-sectional studies repeated in the same community 32 years apart. PARTICIPANTS OR SAMPLES: Children aged 5-13 years living in the community. METHODS: Thirty-five mm photographs of the everted upper lid taken in 1975 and digital photographs taken in 2007 were graded using a fine trachoma-grading scheme. MAIN OUTCOME MEASURE: The age-specific prevalence and severity of trachoma was compared at the two time points. RESULTS: Images were available from 82 children in 1975 and from 92 children in 2007. The overall prevalence of active trachoma (trachomatous inflammation follicular and or trachomatous inflammation intense) was 59% in 1975 and in 2007 was significantly lower at 23% (P<0.001). The overall severity grades of active trachoma had also decreased significantly for each sign from 1975 to 2007 (all P values from the rank-sum test were less than 0.001). However, in 2007, there were still some children with severe active trachoma and severe scarring still occurred. CONCLUSION: Although the prevalence and severity of active trachoma in children have decreased significantly over the last 30 years in this community, trachoma still remains a significant public health problem. One third of the children have active trachoma, a figure in excess of the threshold set as a public health problem by the World Health Organization.
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Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Tracoma/etnología , Adolescente , Distribución por Edad , Australia/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Población Rural/estadística & datos numéricos , Distribución por Sexo , Tracoma/clasificaciónRESUMEN
PURPOSE: Eight million people have trachomatous trichiasis (TT). The World Health Organization (WHO) recommends entropion surgery for TT regardless of severity. However, epilation is widely practiced for treating minor TT (1-5 lashes touching the globe). We report the frequency and effectiveness of patient-initiated epilation and its relationship to corneal opacity. DESIGN: Cross-sectional baseline data of individuals recruited to 2 randomized, clinical trials. PARTICIPANTS: We included 2556 individuals (4310 eyes) with previously unoperated TT in ≥ 1 eye. METHODS: A single ophthalmologist examined all participants for signs of trachoma using WHO grading systems with additional assessment of entropion grading, location and number of trichiatic lashes, and evidence of epilation. A questionnaire enquired about epilation practices. MAIN OUTCOME MEASURES: The association between epilation and degree of corneal opacity. Epilation practices of TT patients. RESULTS: Central corneal scarring was present in 1436 (33%) eyes. Entropion was absent/mild in 2328 (54%) eyes, moderate in 1259 (29.2%), and severe in 723 (16.8%). The median number of lashes touching the eye was 2 (interquartile range, 1-5; range, 0-133). There was clinical evidence of epilation in 3018 (70%) eyes, of which 738 (24%) were successfully epilated (no lashes touching globe). Epilation was performed frequently (at least monthly in 3311 [76.8%] eyes), by someone other than the patient (92.8%), and using locally made forceps (88.9%). Controlling for age and degree of entropion, successful epilation was associated with less corneal opacity (odds ratio [OR], 0.61; 95% confidence interval [CI]. 0.43-0.88; P = 0.007). The association was only significant in patients with severe entropion (OR, 0.07; 95% CI, 0.02-0.25; P<0.005). CONCLUSIONS: We found an association between successful epilation and less central corneal opacity. This indicates the importance of preventing eyelashes from touching the cornea, particularly in individuals with severe entropion. This is a cross-sectional study; therefore, a causative relationship cannot be concluded. However, the results suggest that among patients who decline or are unable to access surgery, and perhaps in minor TT where the management remains controversial, the provision of high-quality forceps and epilation training may be beneficial. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Opacidad de la Córnea/prevención & control , Remoción del Cabello , Tracoma/terapia , Triquiasis/terapia , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Estudios Transversales , Pestañas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Medición de Riesgo , Encuestas y Cuestionarios , Tracoma/diagnóstico , Tracoma/etnología , Resultado del Tratamiento , Triquiasis/diagnóstico , Triquiasis/etnologíaRESUMEN
Within the context of the endemic trachoma that affected different regions of Spain until the 1960s, this paper analyses the epidemiological determinants of child trachoma and its treatment, based on a preventive care model which incorporated the concept of community health that took shape during the interwar period. Early detection of cases, together with preventive measures, education, therapy and inspections, such as those carried out by visiting nurses, all helped to control the disease. Our results reaffirm the validity of the horizontal intervention strategies used for improving the sanitary conditions and environmental factors responsible for this prevalence of trachoma.
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Servicios de Salud del Niño , Protección a la Infancia , Epidemiología , Bienestar del Lactante , Enfermería en Salud Pública , Servicios de Salud Escolar , Tracoma , Niño , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/historia , Servicios de Salud del Niño/legislación & jurisprudencia , Protección a la Infancia/economía , Protección a la Infancia/etnología , Protección a la Infancia/historia , Protección a la Infancia/legislación & jurisprudencia , Preescolar , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/historia , Servicios de Salud Comunitaria/legislación & jurisprudencia , Epidemiología/educación , Epidemiología/historia , Historia del Siglo XX , Humanos , Lactante , Bienestar del Lactante/economía , Bienestar del Lactante/etnología , Bienestar del Lactante/historia , Bienestar del Lactante/legislación & jurisprudencia , Recién Nacido , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Enfermería en Salud Pública/economía , Enfermería en Salud Pública/educación , Enfermería en Salud Pública/historia , Enfermería en Salud Pública/legislación & jurisprudencia , Servicios de Salud Escolar/historia , Responsabilidad Social , España/etnología , Tracoma/etnología , Tracoma/historiaRESUMEN
Purpose: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis.There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from thecontacts of children with trachoma.Design: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national averagein 2003. The sample was stratified according to population size. Participants: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. Methods: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. Main Outcome Measures: Prevalence and grade of trachoma, age, gender, race, and municipality location. Results: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%6.0%) compared with urban areas (3.9%; 95% CI, 2.9%4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9 2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.110.5). Conclusions: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence...
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Masculino , Femenino , Humanos , Chlamydia trachomatis , Tracoma , Tracoma/etnología , Tracoma/prevención & controlRESUMEN
PURPOSE: To assess the contribution of trachoma, cataract and refractive error to visual morbidity among Indigenous adults living in two remote communities of the Northern Territory. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey of all adults aged 40 and over within a desert and coastal community. MAIN OUTCOME MEASURES: Visual acuity, clinical signs of trachoma using the simplified WHO grading system and assessment of cataract through a non-dilated pupil. RESULTS: Two hundred and sixty individuals over the age of 40 years participated in the study. The prevalence of visual impairment (<6/12) was 17%. The prevalence of blindness (<3/60) was 2%, 40-fold higher than seen in an urban Australian population when adjusted for age. In total, 78% of adults who grew up in a desert community had trachomatous scarring compared with 26% of those who grew up in a coastal community (P < or = 0.001). In the desert community the prevalence of trachomatous trichiasis was 10% and corneal opacity was 6%. No trachomatous trichiasis or corneal opacity was seen in the coastal community. CONCLUSIONS: Trachoma, cataract and uncorrected refractive error remain significant contributors to visual morbidity in at least two remote indigenous communities. A wider survey is required to determine if these findings represent a more widespread pattern and existing eye care services may need to be re-assessed to determine the cause of this unmet need.
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Ceguera/etnología , Catarata/etnología , Nativos de Hawái y Otras Islas del Pacífico/etnología , Errores de Refracción/etnología , Tracoma/etnología , Baja Visión/etnología , Personas con Daño Visual/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Northern Territory/epidemiología , Prevalencia , Tracoma/diagnóstico , Agudeza VisualRESUMEN
AIMS: The aim of the study was to determine the rates of trachoma in Aboriginal communities and to compare clinical assessment with photographic assessment for the presence of signs of trachoma. METHODS: Five Aboriginal communities in the Katherine region of the Northern Territory, Australia, were assessed for the presence of trachoma. Trachoma was diagnosed by clinical eye examination using a fine grading based on the World Health Organization (WHO) simplified grading system. Photographs were taken of the left eye of every person and graded using the fine grading system. The clinical assessment was compared with the photographic assessment for each person using the fine grading system. RESULTS: A total of 1316 people out of 1545 (85.2%) were screened for trachoma from five communities, with 1254 photographs being compared with clinical assessment scores. The overall prevalence of active trachoma was greater than 10% across the five communities, and greater than 20% in two communities. CONCLUSION: Active trachoma in young people and scarring in older people remain as problems in Aboriginal communities. Photographic assessment is a useful technique, but in comparison with clinical assessment it can result in overestimation of scoring for trachoma for inflammation.