Age-Specific Prevalence of Trachoma in Remote Australian Communities

Trachoma is endemic in Australia, affecting remote Indigenous communities in northern, central and western Australia. The World Health Organization (WHO) defines a key requirement of elimination as a public health problem being the prevalence of active trachoma (characterised as trachomatis inflammation – follicular) below 5% in children aged 1–9 years. In Australia, screening is based in school settings and focuses on children aged 5–9 years. There is international evidence that active trachoma may be more common in children under five, meaning true Australian prevalence may be under-estimated.
In 2018, jurisdictions screened children aged 1–4 years in 64 at-risk communities in addition to usual screening of children aged 5–9 years. Active trachoma was assessed by trained graders according to WHO simplified grading criteria. Logistic regression using a mixed effect model was used to compare age groups.
In total, 2907 children were screened for trachoma, with observed active trachoma prevalence 7.2% and 6.9% in children aged 5–9 years and 1–4 years, respectively. No evidence of association between age group and trachoma prevalence was found overall [OR = 1.29 (95% CI: 0.93–1.79)] and when analyses were restricted by geographic location or to communities meeting screening coverage thresholds.
There was no evidence of higher active trachoma prevalence in children aged 1–4 years. These findings support the use of prevalence in children aged 5–9 years in assessing one of the key indicators of elimination of trachoma as a public health problem in the Australian context.