An evaluation of a SAFE-style trachoma control program in Central Australia.
OBJECTIVE
To evaluate the effectiveness of a trachoma control program in a remote community before and after major environmental health improvements.


METHODS
Before-and-after cross-sectional design. The control program was in three rounds - each consisting of community census, screening of children < 13 years, health promotion activities and antibiotic treatment. There were two housing and infrastructure surveys.


METHODS
Treatment of affected children and their households with azithromycin at baseline, 7 and 21 months, and health promotions. Housing and sewerage infrastructure improvements were completed at 12 months.


METHODS
Large, remote Central Australian Aboriginal community, 1998-2000.


METHODS
All community residents.


METHODS
Prevalence of active trachoma among children under 13 years; community population changes; and adequacy of housing facilities for healthy living practices.


RESULTS
The prevalence of trachoma among children was 40% (95% CI, 32%-46%) at baseline, 33% (95% CI, 26%-40%) at 7 months' follow-up and 37% (95% CI, 29%-46%) at 21 months. These proportions were neither clinically nor statistically significantly different. There was a high degree of population mobility over the study period, with only 32% of residents appearing in all three censuses. The proportion of houses with completely adequate facilities increased from 0 to 16%.


CONCLUSIONS
Population mobility (both within and between communities), inadequate housing and continued crowding (despite improvements), as well as uncertainty about compliance with antibiotic treatment, are the likely factors contributing to the lack of effect of this trachoma control program. Because of high population mobility, a region-wide approach is needed for effective trachoma control.
Ewald
Dan P
DP
Centre for Remote Health, Flinders University, PO Box 4066, Alice Springs, NT 0871, Australia. dan.ewald@flinders.edu.au
Hall
Gillian V
GV
Franks
Christine C
CC
D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D006920:Hygiene / Q000592:standards; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods; D011159:Population Surveillance; D015995:Prevalence; D015397:Program Evaluation; D012008:Recurrence; D014141:Trachoma / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
D017963:Azithromycin