Aboriginal Eye Health #NDW2017 : Fact check: Has trachoma among Indigenous kids fallen from 20pc to 4pc ?

” On the final day of the Uluru convention on a referendum for Indigenous constitutional recognition, former prime minister Kevin Rudd spoke to the ABC about Indigenous disadvantage since his National Apology to the Stolen Generations in 2008.

Mr Rudd told Radio National on May 26: “One of the programs that we established back then was to eliminate trachoma amongst Indigenous young people. Twenty thousand kids were suffering from trachoma back then at about a 20, 25 per cent rate. We’re now down to about four per cent.”

Is Mr Rudd correct about the incidence and decline of trachoma among Indigenous young people? RMIT ABC Fact Check investigates

Originally Published HERE

NACCHO Declaration

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 ” The Roadmap to Close the Gap for Vision has played a part in prompting actions that contribute to this improvement. The Roadmap outlines a whole of system approach to improving Indigenous eye health, and achieving equity between Aboriginal and non-Aboriginal eye health outcomes.

There is however still work to be done on Closing the Gap for Vision. For example, half of Indigenous participants with diabetes had not had the recommended retinal examination.

NACCHO has been involved with the Roadmap from its inception, and had a long relationship with Indigenous Eye Health at the University of Melbourne, and with RANZCO. We’re pleased with the great work and good progress being made.”

 Ms Patricia Turner, Chief Executive Officer, of the National Aboriginal Community Controlled Health Organisation (NACCHO) launching  The 2016 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision November 2016

 

The verdict

Mr Rudd’s claim is overstated.

In saying that 20,000 kids were suffering from trachoma, Mr Rudd appears to have used data for the number of children living in communities judged to be at risk of having endemic trachoma. The number of children estimated to have trachoma in 2009 was about 3,000.

His rate of 20 to 25 per cent “back then” is supported by a prevalence figure of 21 per cent contained in a 2008 report. However, the rates for 2007 and 2009 were each 14 per cent, and the report for 2009 cautions about the reliability of the 2008 data.

Rates of trachoma among Indigenous children in at-risk communities have declined steadily since 2009. The claim that rates have fallen to about four per cent is supported by recent reliable data.

What is trachoma?

Trachoma is a contagious infection of the eye that, with repeated long-term infections, can result in the eyelashes turning inwards and scratching the cornea, leading to blindness.

Trachoma affects children and preschool-aged children in particular. It is commonly spread through nose and eye secretions, occurs in areas with poor community and personal hygiene, and is associated with overcrowding and reduced access to water.

Australia is the only developed country where trachoma is still endemic, and it occurs primarily in remote Aboriginal communities in Central Australia.

What program did the Rudd government establish?

Professor Hugh Taylor is the Harold Mitchell Professor of Indigenous Eye Health at Melbourne University and when Mr Rudd announced the policy in 2009 he was head of the National Trachoma Surveillance and Reporting Unit, which receives funding from the Federal Department of Health.

Professor Taylor told Fact Check that “after years of either inaction or ineffective action, in 2009 Kevin Rudd committed to eliminate trachoma in Australia by the year 2020”.

Australia adopted a trachoma eradication strategy in line with the World Health Organisation’s 1998 global strategy and based on its SAFE guidelines. SAFE stands for [S]urgery to repair inward eye lashes, [A]ntibiotics, promotion of [F]acial cleanliness, and [E]nvironmental improvements in hygiene and water access.

Mr Rudd’s office told Fact Check the policy he was referring to was a $58 million commitment made in February 2009 to “help tackle eye and ear diseases in Indigenous communities”, with a major focus on trachoma eradication.

The funding was to be allocated over four years, and according to a press release at the time, included “a major increase in services to address trachoma, which will enable at least 10 regional teams to treat and help prevent the disease in NT, WA, SA and other states where trachoma is identified”.

The 2009-10 federal budget papers spell out $58.4 million in funding over four years for “improving eye and ear health services for Indigenous Australians”.

According to the National Trachoma Surveillance and Reporting Unit, in 2009 the Government committed $16 million over four years towards eliminating trachoma in Australia, and in 2013 committed a further $16.5 million.

The source of the claim

When contacted by Fact Check, Mr Rudd’s spokeswoman said reports for 2008 and 2015 by the National Trachoma Surveillance and Reporting Unit were the source of his claim.

Fact Check was unable to find another consistent, national source of data on the prevalence of trachoma in Indigenous communities. Experts confirmed that there was not any other reliable source.

In the unit’s data collection process, communities are classified as being at risk or not at risk of trachoma and screening of the disease focuses on the at-risk communities.

Screening is administered by local health officials who report the data back to the surveillance and reporting unit for collation and analysis.

Coverage of trachoma screening of at-risk communities has increased over time, due to the increasing level of resourcing of the trachoma eradication program.

20,000 kids with trachoma?

Mr Rudd’s February 2009 media release contains the sentence: “Approximately 20,000 Indigenous children suffer from trachoma in Australia.”

Mr Rudd’s office told Fact Check that “in 2009, it would appear the material provided by the Health Department to the Government referred to 20,000 kids suffering from trachoma”.

His spokeswoman pointed to a May 2009 media release from the then Indigenous affairs minister Jenny Macklin which contained the same sentence and a July 2009 speech by the then parliamentary secretary for social inclusion Ursula Stephens who said: “Trachoma affects approximately 20,000 Indigenous children — a stunning statistic and one that is confronting to government.”

However, a spokeswoman for the Department of Health told Fact Check that “the number of children screened and found to have active trachoma was 997 in 2008 and 575 in 2009”, and “we can confirm that the figure of 20,000 children relates to the number of children resident in potentially at-risk communities (population data), not those screened and found to have trachoma”.

The National Trachoma Surveillance and Reporting Unit’s report for 2009 says there were “20,155 children aged one to nine years resident in the 232 at-risk communities”.

Of these children, 4,116, or 20 per cent, were screened and 575 children had trachoma.

“If those 4,116 children screened were a representative sample of all 20,155 children resident in all at-risk communities, the additional number of children estimated to have trachoma across the three jurisdictions lies between 2,045 and 2,448,” the report said.

It appears that all three ministers were referring to statistics available at the time about the number of children at risk of contracting trachoma, not the number who were suffering from trachoma.

Professor Taylor told Fact Check that “the estimate in 2008 was that there were 20,000 kids in remote communities considered to be at risk of trachoma”.

“This is a rubbery figure because not all the communities had been examined,” he added.

The prevalence of trachoma in 2008

The executive summary of the National Trachoma Surveillance and Reporting Unit’s 2008 report says that “the prevalence of active trachoma in those communities from which data were reported was 21 per cent”.

Of 287 remote Aboriginal communities, 235 were identified as at risk of trachoma in 2008, and 121 were screened and reported data.

The 2008 report focused on the prevalence of trachoma in Indigenous children aged one to nine years old.

Fact Check notes that both the 2007 and 2009 reports show the trachoma prevalence in Aboriginal children aged one to nine years old in communities that reported data in those years to be 14 per cent.

The discussion section of the 2009 report says that “in 2008, there was an abrupt two-fold increase in trachoma prevalence in NT, and an equally abrupt seven-fold decrease in trachoma prevalence in SA, compared with past years. Both of these sudden changes were reversed in 2009”.

The report says the variation in the numbers “suggests that the data from 2008 might be problematic”.

Professor Taylor told Fact Check that “there is an inconsistency in the data and it’s appropriate to acknowledge it, but those are the data that we have, and those are the data that we must use”.

Carleigh Cowling, senior surveillance officer with the National Trachoma Surveillance and Reporting Unit, said the Northern Territory intervention had an impact on the collection of the data in 2008.

“During the intervention, the trachoma screening program was taken over by unusual bodies, whose training was questionable,” she said, adding that “data collected by those teams were not presented in the 2008 report, which does make the data presented problematic”.

The prevalence of trachoma today

The most recent report from the National Trachoma Surveillance and Reporting Unit, published in June 2016 and containing data for 2015, shows that 139 communities were identified as being at risk of trachoma, a decrease of 96 communities since 2008.

Of these 139 communities, 67 were screened and reported data.

The 2015 report focused on children aged five to nine, though reports prior to 2010 focused on children aged one to nine. “It’s an assumption that one to four-year-olds are similar,” Professor John Kaldor, the current head of the National Trachoma Surveillance and Reporting unit, now part of the Kirby Institute at the University of New South Wales, said.

Professor Taylor and Ms Cowling both told Fact Check that though the 2008 report focuses on children aged one to nine and the 2015 report on children aged five to nine, this will have little impact on the comparability of the data from those years.

The results, for children aged five to nine as against one to nine reported in 2008, reveal that the prevalence of trachoma in the communities that screened was 3.7 per cent. The prevalence “using the most recent data carried forward in all at-risk communities” was 4.6 per cent.

The 3.7 per cent is for at-risk communities that screened in 2015, and the 4.6 per cent is for all at-risk communities, meaning those that screened and those that didn’t screen that year but are considered at risk based on previous data.

Professor Kaldor said policy guidelines changed in 2014 so that if a community had high rates of trachoma several years in a row, resources were shifted towards treatment rather than screening.

He and Professor Taylor both agreed that the current prevalence of trachoma among children in affected communities was about 4 per cent.

Professor Kaldor said of hotspots that still exist in Central Australia: “While the drug azithromycin is a big part of combating the disease, there’s the whole issue of fulfilling the other parts of the SAFE strategy to sustainably improve facilities and living conditions.”

“If these are not addressed, the impact of treatment may be short-lived.”

Professor Taylor told Fact Check that “since 2008 we’ve made considerable progress”.

“If you look at closing the gap, it’s actually one area where you can say we’ve made considerable progress,” he said.

Sources

NACCHO Aboriginal Eye Health : A game changer for #eye care for #diabetes

eyes

” Diabetes is also a leading cause of vision loss and blindness in Indigenous people and causes 12% of vision loss cases and 9% of blindness cases — rates that are 14 times higher than those in the non-Indigenous population.4

There are many reasons why Indigenous people with diabetes do not receive the appropriate care they need; the Roadmap to close the gap for vision lists 35 individual problems that need to be dealt with to provide this care.7,8

Professor Hugh Taylor

As published MJA : Non-mydriatic photography may be the key to accessible eye care for references

The Roadmap to Close the Gap for Vision has played a part in prompting actions that contribute to this improvement. The Roadmap outlines a whole of system approach to improving Indigenous eye health, and achieving equity between Aboriginal and non-Aboriginal eye health outcomes.

There is however still work to be done on Closing the Gap for Vision. For example, half of Indigenous participants with diabetes had not had the recommended retinal examination.

NACCHO has been involved with the Roadmap from its inception, and had a long relationship with Indigenous Eye Health at the University of Melbourne, and with RANZCO. We’re pleased with the great work and good progress being made.”

 Ms Patricia Turner, Chief Executive Officer, of the National Aboriginal Community Controlled Health Organisation (NACCHO) launching  The 2016 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision November 2016

Download a copy cover

2016-annualupdate

Every patient with diabetes is at risk of losing vision, but up to 98% of the cases of severe vision loss could be prevented.1 At any given time, about a third of patients with diabetes will have diabetic retinopathy, and one in ten will experience sight-threatening retinopathy requiring prompt treatment.2

The National Health and Medical Research Council (NHMRC) guidelines recommend an eye examination every 2 years for non-Indigenous Australians with diabetes, and annual examinations for Indigenous people with diabetes.3

However, approximately only half of non-Indigenous patients with diabetes and only one in five of Indigenous Australians with diabetes receive the recommended eye examinations.4

Although the prevalence rates of diabetes have increased dramatically in Australia over recent years, they have increased even more so among Indigenous people. In the 1970s, the prevalence of diabetes among Indigenous people was one-tenth that of non-Indigenous people,5 and now it is about five times higher.6

For patients with diabetes, maintaining good vision is an essential goal. Not only is good vision important in its own right but, without it, patients cannot manage their diabetes, look after medications, check blood sugars, check their feet and attend clinic appointments unassisted, let alone manage home dialysis.

Diabetes is also a leading cause of vision loss and blindness in Indigenous people and causes 12% of vision loss cases and 9% of blindness cases — rates that are 14 times higher than those in the non-Indigenous population.

4 There are many reasons why Indigenous people with diabetes do not receive the appropriate care they need; the Roadmap to close the gap for vision lists 35 individual problems that need to be dealt with to provide this care.7,8

Consistent with the Roadmap is an important announcement in the May 2016 federal Budget of the new Medicare items for non-mydriatic photography (listed in November 2016), which will enable easy and affordable eye screening within the primary care setting for patients with diabetes.9 This is a very important development and a game changer for both non-Indigenous and Indigenous people with diabetes.

The new item numbers cover a test of visual acuity and a retinal photograph.9 Patients with abnormalities in the eye will need to be referred to a specialist for further assessment and treatment. Patients with a normal eye examination will be reviewed again according to the NHMRC recommendations.

Non-mydriatic cameras are now readily available, and most are at least semi-automatic, making them easier to use by clinic staff. Moreover, non-mydriatic cameras do not require the use of dilating drops, which facilitates patient assessment.

The patient does not need to wait and there is no discomfort of blurry vision for several hours as the drops wear off. Testing visual acuity and taking a retinal photograph in the primary care setting means that a separate specialist appointment is not required, and the eye examination can be easily incorporated into the care plan.

If the vision is found to be impaired or a photograph cannot be obtained, then the patient requires a comprehensive eye examination and should be referred to a specialist, as in the case of visible signs of retinopathy.

This method provides real benefits to patients because the eye examination becomes an integral part of their normal care, avoiding in many cases the need for an additional eye examination and allowing timely treatment, if required. There is a real advantage for the clinic as well, since they can be sure that their patients are receiving the necessary eye examinations.

Moreover, there are also advantages for optometrists and ophthalmologists, because people with diabetes who particularly need their care — those with retinopathy and vision loss — will be referred, rather than them seeing people for widespread screening.

Of course, it is expected that the overall number of people with diabetes being screened will increase significantly, and that changes in the eye will be found much earlier and severe retinopathy will be avoided.

There is also a tangible advantage to the community through cost savings in the identification and care of retinopathy, which will prevent unnecessary blindness and vision loss.10

The impact will be particularly noted among Indigenous people with diabetes, who represent three-quarters of the Indigenous adults who need an eye examination each year.7,

8 In addition to diabetic retinopathy, people with diabetes have an increased risk of cataract and may also need a change in glasses.

To provide adequate eye care to people with diabetes, a referral process for the treatment of retinopathy needs to be established, along with a process of specialist referral for appropriate further investigation and treatment — including post-operative follow-up when required — for those who need cataract surgery or refraction. Those who do not have diabetes will also use these pathways.

The focus on eye care for Indigenous people with diabetes will therefore deal with over 70% of the eye care needs in the community, and it will also assist with providing care for Indigenous patients who do not have diabetes. Again, it is a real game changer.

There are a number of resources to assist with the uptake and promotion of these new services. There are online modules aimed at helping clinic staff learn more about the eye care required for people with diabetes,11,12 for conducting eye examinations and for grading diabetic retinopathy.

In addition, culturally appropriate health promotion material has been specifically developed with close community involvement, which aims to alert and inform patients and the community about the need for regular eye examinations.13

It is said that “what is not measured is not done” and that “what is not monitored cannot be managed”. It is very important that appropriate monitoring and evaluation processes to track performance are put in place at the clinic, regional, jurisdictional and national levels. The diabetic eye screening rate should be a key performance indicator for primary care and diabetes clinics.

The new Medicare item number for non-mydriatic diabetic retinopathy screening is a major advance in closing the gap for vision.

NACCHO Aboriginal Eye Health : Annual update -The Roadmap to Indigenous eye health is closing the gap

pt-vision

 ” Eye health and good vision is an important issue for everyone, but particularly for Aboriginal and Torres Strait Islander people.

It accounts for a significant proportion of the health gap between Indigenous and non-Indigenous people. I’m pleased to report that progress is being made.

The National Eye Health Survey, released on World Sight Day this year, also tells an important story. Rates of blindness amongst Aboriginal and Torres Strait Islander people have improved from 6 times to 3 times as much compared with non-Indigenous people.

And the prevalence of active trachoma among children in at-risk communities fell from 21% in 2008 to 4.6% in 2015.

The Roadmap to Close the Gap for Vision has played a part in prompting actions that contribute to this improvement. The Roadmap outlines a whole of system approach to improving Indigenous eye health, and achieving equity between Aboriginal and non-Aboriginal eye health outcomes.

There is however still work to be done on Closing the Gap for Vision. For example, half of Indigenous participants with diabetes had not had the recommended retinal examination.

NACCHO has been involved with the Roadmap from its inception, and had a long relationship with Indigenous Eye Health at the University of Melbourne, and with RANZCO. We’re pleased with the great work and good progress being made.”

 Ms Patricia Turner, Chief Executive Officer, of the National Aboriginal Community Controlled Health Organisation (NACCHO) launching  The 2016 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision

Pat Turner pictured above with Mark Daniell President, RANZCO,  and Prof Hugh Taylor at the launch.

vision-crowd

The gap in blindness in Indigenous communities has been halved since 2008 through collective implementation of the sector-supported Roadmap to Close the Gap for Vision, according to a report launched yesterday

Speaking at the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Annual Scientific Congress in Melbourne, Laureate Professor Hugh R Taylor AC, Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne said that progress is being made on every single recommendation in the Roadmap to Close the Gap for Vision, which was developed by Indigenous Eye Health at the University of Melbourne.

cover

Download copy of the Report 2016-annualupdate

Eleven of the 42 recommendations have now been fully implemented, with almost two thirds of all activities completed.

“In terms of regional implementation of the Roadmap, there has been positive engagement. We are working with 18 regions across the country covering almost half of the nation’s Indigenous population,” Professor Taylor said.

“We can report that at the beginning of this project, we found rates of blindness and impaired vision were up to six times higher than for non-Indigenous populations. This has now been halved,” he said.

“While the rate stands at three times more than the national average, this is still a very encouraging improvement. With on-going national support, we are determined to reach eye health parity with the rest of the Australian population.”

In his role as Chair of Indigenous Eye Health, Professor Taylor is also working with Indigenous leaders, partners and members of the community in a mission to eliminate trachoma in Australia.

“We are the only developed nation with endemic disease and only in Indigenous communities. Many Indigenous communities are now trachoma free and we can turn our attention to other main causes of blindness and poor vision in Indigenous communities: cataract, refractive error and diabetes,” Professor Taylor said.

Since 2008 rates of trachoma in children in outback communities has fallen from 21% to 4.6%. “We are really seeing some striking progress but we still need to focus on the hot spots.”

“The 2016 Roadmap update shows we are making great progress and are on track to close the gap for Indigenous vision completely in the next four years.”

 

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