ATSI – Non-Pharmacological Management of Trachoma

KFP 2023.1 Case 10

Trachoma, a bacterial infection caused by Chlamydia trachomatis, can lead to blindness if not properly managed. In managing trachoma in an Aboriginal and Torres Strait Islander (ATSI) woman, a holistic approach encompassing non-pharmacological management, preventative public health measures, and culturally safe communication strategies is vital.

Non-Pharmacological Management of Trachoma:

  1. Hygiene and Sanitation: Emphasize the importance of facial cleanliness, especially washing the face and hands regularly. This can help to reduce the transmission of the bacteria.
  2. Environmental Improvements: Access to clean water and improved sanitation facilities can significantly reduce the risk of trachoma and its spread.
  3. Insect Control: Flies can transmit the bacteria from person to person. Measures to control fly populations, such as proper waste management and the use of fly screens, can be beneficial.
  4. Education: Providing education about the causes of trachoma, its transmission, and prevention methods is crucial. This includes information about maintaining personal and environmental hygiene.

Preventative Public Health Measures:

  1. Screening and Community Surveys: Regular community-wide screenings can help identify cases of trachoma early, especially in communities where trachoma is endemic.
  2. Contact Tracing and Treatment of Close Contacts: Identifying and managing individuals who are in close contact with the patient can prevent the spread of the infection.
  3. Community Engagement and Empowerment: Involving community leaders and members in awareness and prevention campaigns can lead to better outcomes.
  4. Health Promotion Activities: Implementing health promotion activities that focus on eye health and general hygiene can be effective in reducing the incidence of trachoma.

Culturally Safe Communication Strategies:

  1. Building Trust: Establishing a rapport and building trust with the patient and the community is essential for effective communication and management.
    1. Ask about the person and have a yarn before getting to the nuts and bolts
  2. Use of Language: Using Aboriginal Health Workers who speak the local Indigenous language can facilitate better understanding and trust.
  3. Understanding Cultural Sensitivities: Being aware of and respectful towards ATSI cultural norms, beliefs, and practices.
  4. Inclusive Communication: Engaging in two-way communication where the patient’s views and understandings are acknowledged and respected.
  5. Visual Aids and Storytelling: Using culturally appropriate visual aids and storytelling methods to convey information about trachoma and its management.
  6. Community Involvement: Involving community members in the planning and delivery of health messages ensures the appropriateness and effectiveness of the communication.
  7. Respectful Listening: Ensuring that the patient feels heard and her concerns are addressed respectfully.

By combining these approaches, the management of trachoma in ATSI communities can be effective and culturally sensitive, addressing both the medical and social aspects of health care.

WHO SAFE Strategy

Trachoma, a contagious bacterial infection caused by Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. The treatment of trachoma is multifaceted, focusing on both individual cases and public health strategies to prevent transmission. The primary approach to treatment involves the “SAFE” strategy, recommended by the World Health Organization (WHO):

  1. Surgery: For individuals with trichiasis, the inward turning of eyelashes that scrape the cornea, surgery is required to correct the eyelid deformity and prevent blindness.
  2. Antibiotics: The antibiotic Azithromycin is used to clear the infection. It’s typically given as a single oral dose, which is effective and has the advantage of being easy to administer. In cases where Azithromycin is not suitable (like in pregnant women or individuals allergic to it), alternative antibiotics like Tetracycline eye ointment can be used, applied twice daily for 6 weeks.
  3. Facial cleanliness: Improving facial hygiene, especially in children, helps to reduce transmission of bacteria. This involves education about and promotion of regular face washing to remove discharge from the eyes and nose.
  4. Environmental improvement: This includes measures to increase access to clean water and improve sanitation. Reducing overcrowding in living conditions also helps in reducing the transmission of the bacteria.

It’s important to treat not only the individual but also their close contacts, such as family members and neighbours, to prevent the spread of the infection. Trachoma is often a public health issue, so community-wide treatment campaigns can be undertaken in areas where the disease is endemic.

In addition to the SAFE strategy, ongoing monitoring and evaluation of the affected communities are crucial to ensure the success of control efforts and to prevent recurrence.