Remote Australia Online

Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. METHODS: Baseline CT and NG laboratory data (2009-2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2-4 months (recommended) and 5-12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. RESULTS: There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2-4 months, 26.9% at 5-12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2-4-month (16.9% v. 11.5%, P<0.01) and 5-12-month (28.9% v. 23.5%, P=0.01) periods. Women aged 25-29 years had a significantly higher level of re-testing 5-12 months post-diagnosis than females aged 16-19 years (39.8% v. 25.4%, P<0.01). There was a total of 858 people re-tested at 2-12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P<0.01). CONCLUSIONS: Just under half the individuals diagnosed with CT or NG were re-tested at 2-12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2-4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.

This paper uses autoethnography and a narrative approach to examine trust-building that occurred between Indigenous people (Larrakia and Kunwinjku) in the Top End of Australia and the author. Trust was first established when an elder adopted the author to protect her from prosecution after she caught a snake. That trust was extended to visiting birdwatchers that Larrakia and their Kunwinjku relatives met at the author's home. Consequently Kunwinjku elders asked the author, a birdwatching guide, to help them establish a tourism project on their country. This paper investigates our use of tourism as a vehicle for further trust-building that resulted in the exchange of knowledge beneficial to both Bininj and the wider society, and aided Bininj growth of self-confidence. However it also exposes the limitations of the tourism industry and government institutions in building trusting relationships and explores the possibility of a business model built on the sharing economy.

Objective: To explore factors affecting recruitment and retention of pharmacists in rural/remote areas of New South Wales (NSW). Design: Qualitative semistructured in-depth interviews. Setting: Primary care – rural/remote community pharmacies. Participants: Purposive sample of 12 community pharmacists. Main outcome measures: Factors affecting recruitment and retention of pharmacists in rural/remote areas of NSW. Results: Respondents reported a variety of personal and professional reasons for taking up rural practice, including previous rural experience and a preference for working in rural over metropolitan areas. The main factor affecting retention in rural areas was the high level of professional satisfaction and interprofessional rapport. Perceived reasons for the current under-supply of pharmacists to rural/remote areas of NSW included changing demographics of the pharmacy undergraduate degree programs and pharmacy workforce, and negative perceptions of rural pharmacy practice and rural lifestyle. Conclusions: This study identified factors believed to affect recruitment and retention of pharmacists in rural/remote areas. There appears to be considerable overlap between the factors, with different weightings of importance for different individuals. The lack of consensus for a proposed method of resolving this problem highlights its complexity and the need for further studies in this area.

BACKGROUND: The Royal Flying Doctor Service (RFDS) provides aeromedical care to patients during fixed-wing transport over vast distances to healthcare unavailable in rural or remote communities. This study examined the relationship between changes in local accessibility to primary healthcare services and rates of aeromedical service use over time. METHODS: This was a 13-year interrupted time-series study (1999-2012) in Tennant Creek, Northern Territory. Quarterly aeromedical service use for primary care sensitive conditions were calculated and exposure to general practice (GP) services was characterised over time with events modelled as intervention variables: (a) GP service withdrawal (Nov-2004); and (b) GP service replacement (Dec-2006). Intervention effects were estimated using PROC ARIMA in SAS after examination of the time-series structure. RESULTS: GP withdrawal resulted in an immediate and sustained doubling in quarterly aeromedical service use (+11.8 services per quarter) and GP service replacement had no significant effect. DISCUSSION: Large and immediate increases in aeromedical service use result from the loss of local GPservices yet, in this case, replacement with a new GP service, 2-years hence, did not ameliorate that effect after six years. CONCLUSIONS: These findings demonstrate the immediate impact of GP-service loss on the rates ofaeromedical transfer of patients from this remote community and lend caution to expectations about thetimeline over which newly implemented primary health care services in such contexts can mitigate the impact of such a loss.

Background: An epidemic of end-stage renal disease (ESRD) is accompanying the rising rates of hypertension, type 2 diabetes and cardiovascular disease among Aborigines in the Northern Territory of Australia. Incidence rates are now 21 times those of nonAboriginal Australians and are doubling every four years. We describe the rates and associations of renal disease in one remote community, which has a current ESRD incidence of 2700 per million, and cardiovascular mortality among the highest in Australia. Methods: Between 1992 and 1995 a community-wide screening program was conducted, in which the urinary albumin/creatinine ratio (ACR) was used as the chief renal disease marker. More than 90% of the population ages five and older participated. Results: Albuminuria was evident in early childhood and increased dramatically with age; 26% of adults had microalbuminuria and 24% had overt albuminuria. All renal failure developed out of a background of overt albuminuria. ACR was significantly correlated with the presence of scabies at screening, with a history of poststreptococcal glomerulonephritis, which is epidemic and endemic in the community, with increasing body wt, blood pressure, glucose, insulin and lipid levels, and with evidence of heavy drinking. ACR was also significantly and inversely correlated with birth weight. As a result of its association with deteriorating hemodynamic and metabolic profiles, increasing ACR was also correlated with increasing cardiovascular risk score. Direct observations showed, and multivariate models predicted, progressive amplification of ACR when multiple risk factors were present simultaneously. Albuminuria also clustered in families. Conclusion: Renal disease in this population is multifactorial, with risk factors related to whole-of-life nutrition, metabolic and hemodynamic profiles, infections, health behaviors, and possibly a family predisposition. Its relationship to low birth weight, and its associations with deteriorating metabolic and hemodynamic profiles, suggest that renal disease is, in part, a component of Syndrome X, which explains the simultaneous increase in metabolic, cardiovascular and renal disease in Aboriginal people. The family clustering might have both environmental and genetic causes, and is under further investigation. Most of the identified risk factors arise out of poverty, disadvantage and accelerated lifestyle change, and the current epidemic can be explained by the confluence of many risk factors in the last few decades. The introduction of effective and sustained programs to address social, economic and educational inequities in all Aboriginal communities, and of screening and renal- and cardiovascular-protective treatment programs for those already afflicted are matters of great urgency.

Introduction We conducted a double-blind randomised controlled trial in a remote-living Australian Aboriginal group at high risk for chronic disease to assess whether pharmacological treatment with angiotensin converting enzyme inhibitor (ACEi) could delay the onset of albuminuria, hypertension or diabetes in people currently free of those conditions. Methods Eligibility criteria in 2008 were age ≥18yr, blood pressure ≤140/90 mm/Hg, urinary albumin creatinine ratio (ACR) < 3.4 mg/mmol, normal levels of glycosylated haemoglobin, and, in females, infertility. A 2011 amendment allowed enrolment of fertile females using long-term contraception. “Treatment” was the ACEi perindopril arginine, or placebo, and participant events were ACR ≥3.4 mg/mmol and/or blood pressure >140/90 mm Hg and/or haemoglobin A1c >6.5%, and/or cardiovascular events. Results were analysed in 125 randomised participants who commenced treatment. Results Recruitment was low, especially of women, and dropout rates high: there were finally 60 and 65 people in the ACEi and placebo groups respectively. In females, there were no events among 10 in the ACEi group, versus 5 events among 17 in the placebo group, and longitudinal ACR, HbA1c and blood pressure levels supported probable benefit of ACEi. There was no benefit of ACEi in males, but a probable benefit on diabetes/hypertension events. With the genders combined, there was probable reduction of diabetes (zero vs 4 events, p = 0.068), and of diabetes or hypertension (zero vs 5 events, p = 0.037). Discussion In this high-risk population, ACEi probably delays development of albuminuria, diabetes and hypertension in females, and of non-ACR events overall. Repeat investigation with a larger sample size is warranted.

OBJECTIVE: This pilot study aimed to determine the feasibility of a novel, low-cost program to get remote schools started in gardening and nutrition activities, for a lower cost than existing models, and without on-the-ground horticultural support. METHODS: A multi-site, mixed methods case study was undertaken, in which four remote schools were shipped gardening materials and a nutrition and cooking resource, and provided with horticultural support by phone and email. A support register and teacher surveys were used for four months of evaluation. RESULTS: The study demonstrated that the program is feasible, and may be associated with an increase from baseline in student's time spent cooking, gardening and on related classroom activities. CONCLUSIONS: The program was delivered economically without the need for on-the-ground staff, in a manner that was acceptable to teachers. IMPLICATIONS: This model may have application in remote schools throughout Australia, where there is a need to alter health impacting behaviours in high-risk populations. Lengthier program evaluation times and further resource development may be worth investigating in the future.

ISSUE ADDRESSED: To assess the effect of anti-tobacco television advertising in comparison to other anti-tobacco interventions for Aboriginal people in remote communities in the Northern Territory. METHOD: This research was carried out as part of a large study evaluating the effect of multi-component, evidence-based tobacco interventions developed in three remote communities. Community surveys (assessing changes in smoking behaviour and exposure to tobacco interventions) were used to assess exposure to and effect of television advertising, relative to other interventions over the intervention year. RESULTS: 351 community members were interviewed. Exposure to anti-tobacco television advertising was high among both smokers and non-smokers (86% vs. 85%, p = 0.78). However, those who recalled seeing anti-tobacco advertising were no more likely to have quit than those who had not (11 exposed (6%) vs. 3 non-exposed (10%), Fisher's Exact Test p = 0.42). Logistic regression showed that exposure to individual tobacco interventions was not associated with an increased chance of cessation during the intervention year. CONCLUSION: Recall of anti-tobacco television advertising was high in these remote Aboriginal communities; more Aboriginal people recalled exposure to anti-tobacco television advertising than to any other cessation intervention. Although the overall cessation rate was low, a small number of smokers had given up as a result of seeing these television advertisements.

The objective of this study was to assess the potential for reducing the harm resulting from tobacco use through health promotion programmes run in community stores in remote Aboriginal communities. The Tobacco Project utilised data from 111 stakeholder interviews (72 at baseline and 71 at follow-up after 12 months) assessing presence of sales to minors, tobacco advertising, labelling and pricing. It also involved the assessment of observational data from community stores and comments obtained from 29 tobacco vendors derived from community surveys. Sales of tobacco to minors were not reported in community stores and all stores complied with requirements to display the legislated signage. However, tobacco was accessible to minors through a vending machine and through independent vendors. Only one store displayed tobacco advertising; all stores had displayed anti-tobacco health promotion posters or pamphlets. Pricing policies in two stores may have meant that food items effectively subsidised the cost of tobacco. All stores had unofficial no-smoking policies in accessible parts of the store. Remote community stores complied with existing legislation, aside from allowing access of minors to vending machines. There may still be potential for proactive tobacco education campaigns run through community stores and for a trial assessing the effect of changes in tobacco prices on tobacco consumption.

Indigenous peoples living in remote areas are often reliant on Governments for essential services and local economic development opportunities. Collaboration and partnership in resource planning and management is espoused as an approach that can provide multiple benefits for all stakeholders including more robust and long-lasting decisions, relationship-building and trust between government and community members as well as capacity building and empowerment of citizens. In Australia however, little evidence from the remote Indigenous community context is available to inform successful collaborations. This paper presents novel research using thematic analysis of practitioner interviews and document review to analyse the current situation of service-provider- remote community engagement and collaboration for sustainable water and energy management. An adapted typology of Indigenous engagement is applied as an analytical framework, categorising water and energy management initiatives according to four key types, each with varying levels of collaboration and implications for sustainable water and energy. Application of the typology shows that technocratic approaches to community engagement continue to dominate this space as collaborative processes are constrained by a range of institutional, governance, technical and cultural factors. The findings have implications for research, policy and practice, and point to a need for a systemic approach to address barriers and facilitate genuine collaboration.

BACKGROUND: Otitis media, chronic suppurative otitis media, and skin infections are common in many Aboriginal communities. METHOD: Primary school students in a remote Aboriginal community were examined by blood testing. Audiometry was compared before and 6 months after children were provided with fresh fruit each school day, as were rates of skin infections, and the prescription of antibiotics for otitis media and skin infections. RESULTS: All 12 students who completed both points of hearing testing had slight or greater hearing loss at baseline. Five had improved hearing at 6 months and seven (58%) had no change. Mean antibiotic prescriptions decreased from seven to 1 per month. All 15 tested had low serum vitamin C concentrations and 11 had abnormal iron studies, suggesting their poor health might be caused by poor nutrition. DISCUSSION: Although many other factors may have contributed to the improvements, the results suggest nutrition as a possible factor for poor health outcomes in remote Aboriginal communities, which could be easily overcome. A randomised trial should be conducted.

OBJECTIVE: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. DESIGN: a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically. SETTING: the 'top end' of the Northern Territory of Australia. PARTICIPANTS: a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service. FINDINGS: the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth.

Background: In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians’ perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health system changes. Methods: Data were collected from semi-structured interviews with 25 clinicians providing or managing child health services in the two study sites. Thirty hours of participant observation was undertaken in the ‘baby-rooms’ at the two remote health centres between June and December 2012. The interview and observational data, as well as field notes were integrated and analysed thematically to explore clinicians’ perspectives of service delivery to infants in the remote health centres. Results: A range of factors affecting the quality of care, mostly identified before health system changes were instigated, persisted. These factors included ineffective service delivery, inadequate staffing and culturally unsafe practices. The six themes identified in the data: ‘very adhoc’, ‘swallowed by acute’, ‘going under’, ‘a flux’, ‘a huge barrier’ and ‘them and us’ illustrate how these factors continue, and when combined portray a ‘very chaotic system’. Conclusion: Service providers perceived service provision and quality to be inadequate, despite health system changes. Further work is urgently needed to improve the quality, cultural responsiveness and effectiveness of services to this population.

Water has been a critical resource for Anangu peoples across the remote inland for millennia, underpinning their ability to live in low rainfall environments. Anangu biocultural knowledge of kapi (water) developed in complex ways that enabled this resource to be found. Such biocultural knowledge included deep understandings of weather patterns and of species behavior. Kapi and its significance to desert-dwelling peoples can be seen in ancient mapping practices, whether embedded in stone as petroglyphs or in ceremonial song and dance practices associated with the Tjukurpa. While in the past the sustainability of kapi was facilitated by mobility that spread human dependence on this resource across multiple sites, since the 1940s Anangu have been coerced by the settler-colonial state to live a sedentary lifestyle in remote communities such as Haasts Bluff, Papunya and Yuendemu. In many of these communities the supply of kapi is becoming increasingly insecure in terms of viability of supply, cost, quality and threats from mining. This paper provides a brief insight into how kapi has become devalued in the context of contemporary remote communities with particular reference to my area of expertise – Aboriginal identity, well-being and Australian sports.

While a large proportion of Aboriginal Australians do not consume alcohol, those who do frequently show severe alcohol problems. In European-derived samples, heavy alcohol use is associated with relationship distress, conflict, and violence. Because Aboriginal groups commonly have very different family structures, values, and obligations to European-derived families, the association of family and alcohol problems in Aboriginal Australians may be different from European-derived families. This self-report study is the first known published empirical study of family and alcohol problems among Aboriginal Australians. It involved 99 people from a remote community in the far North of Australia. The aims were to explore the association of family conflict, family cohesion, family independence, alcohol problems, and alcohol-related expectancies. Compared to those without alcohol problems, people with alcohol problems reported more family conflict and women with alcohol problems reported high family independence. Expectancies of negative affect change mediated the association of alcohol problems and family conflict. Family cohesion was unrelated to alcohol or family problems. Implications for detection of and interventions for alcohol and family problems are discussed.

The rapid development of new information and communications technologies, an increase in affordable, small mobile technologies and the penetration of the internet and mobile telephony over the past decade account for an explosion in new modes and channels for communication and multimedia production. Internationally, such developments have led to substantial ethnographic inquiry into youth and the emergence of new social practices surrounding new media. Some researchers posit that digital technologies are enabling new kinds of agency and engagement in learning and others suggest that new thinking about language and literacy has been catalysed. In Australia, accounts of remote Indigenous youth culture in public or policy discourse tend not to portray their agentive participation in new forms of learning, multimodal practice and production or online communication. Additionally, relatively little ethnographic information is available on how Indigenous youth are shaping the creative, cultural and communicative uses of new media, and how and why these practices are taking hold in remote contexts. This paper looks at the uptake of new media technologies in remote Indigenous contexts and the implications for youth learning and cultural practice by tracing the way in which social relations and communication styles have altered across the generations. Data gathered through ethnographic research indicate that where young people have access to new media technologies, expertise is acquired with ease, often leading to the rapid development of new communication practices and new forms of cultural production and public participation. Through participating in collaborative research young people are also reflecting on their changing cultural practice and giving voice to these reflections.

Objective: To compare supervised vs unsupervised oral iron treatment in anaemic Aboriginal children living in a remote community with a 40% prevalence of iron deficiency anaemia. Methodology: A randomised unblinded clinical trial in children < 6 years presenting to a remote Health Centre with anaemia. Oral iron prescribed as a daily unsupervised dose (group A) was compared to twice weekly supervised administration (group B) over 12 weeks. Parenteral iron (group C) was reserved for failure of oral treatment. Results: Only 3 of 25 children in group A responded to treatment compared to 23 of 26 children in group B (odds ratio = 7.7, 95% confidence interval 2.6–25.0). After six weeks of treatment, the mean haemoglobin rise was 0.96 g/L in group A compared to 10.9 g/L in group B and 12.4 g/L in group C. On entry to the study, 29.4% of subjects were underweight, 33.3% stunted and 35.3% microcephalic. The mean catch-up in weight/height on iron treatment over the study was only 0.28 (0.08, 0.48) Z-scores. Conclusions: Oral iron as directly observed twice weekly treatment is superior to unsupervised therapy. In view of the poor compliance with unsupervised treatment and the high prevalence of iron deficiency anaemia (along with stunting and microcephaly) in Aboriginal children in northern Australia, we propose to undertake in partnership with communities a nutritional intervention program with a high energy weaning food fortified with micronutrients (iron, vitamin A, zinc, folate) as the most effective strategy to address these nutritional problems in the weaning period.

OBJECTIVE: To assess the accuracy of grading diabetic retinopathy (DR) using single-field digital fundus photography compared with clinical grading from a dilated slit-lamp fundus examination in Indigenous Australians living in Central Australia. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study comparing DR grades in participants with diabetes mellitus presenting for examination at remote community clinics from 1 July 2005 to 30 June 2008. MAIN OUTCOME MEASURES: Sensitivity and specificity of grading using digital photography compared with the clinical gold standard of slit-lamp fundus examination. RESULTS: Of the 1884 participants recruited for the study, 1040 had self-reported diabetes mellitus and, of those, 360 had fundus photographs available (706 eyes) that were able to be graded. On clinical grading, 163 eyes had any DR and 51 eyes had vision-threatening DR (VTDR). The sensitivity and specificity for detecting any DR were 74% (95% CI, 67%-80%) and 92% (95% CI, 90%-94%), respectively. The sensitivity and specificity for detecting VTDR were 86% (95% CI, 77%-96%) and 95% (95% CI, 93%-97%), respectively. CONCLUSION: Single-field digital fundus photography is a valid screening tool for DR in remote communities of central Australia and may be used to provide eye care services to this region with acceptable accuracy.

The incidence of cryptosporidiosis is highest in children <5 years, yet little is known about disease patterns across urban and rural areas of Australia. In this study, we examine whether the risk of reported cryptosporidiosis in children <5 years varies across an urban-rural gradient, after controlling for season and gender. Using Australian data on reported cryptosporidiosis from 2001 to 2012, we spatially linked disease data to an index of geographic remoteness to examine the geographic variation in cryptosporidiosis risk using negative binomial regression. The Incidence Risk Ratio (IRR) of reported cryptosporidiosis was higher in inner regional (IRR 1.4 95% CI 1.2–1.7, p < 0.001), and outer regional areas (IRR 2.4 95% CI 2.2–2.9, p < 0.001), and in remote (IRR 5.2 95% CI 4.3–6.2, p < 0.001) and very remote (IRR 8.2 95% CI 6.9–9.8, p < 0.001) areas, compared to major cities. A linear test for trend showed a statistically significant trend with increasing remoteness. Remote communities need to be a priority for future targeted health promotion and disease prevention interventions to reduce cryptosporidiosis in children <5 years.

While associations between salivary characteristics and dental caries have been well studied, we are not aware of this being assessed in a remote Indigenous child population, where lifestyles may be different from urban children. Our aim was to assess associations between caries experience and putative biomarkers in saliva, accounting for oral hygiene and dietary habits. As with studies in other populations, childhood salivary counts of MS and LB were significantly associated with greater caries experience in this remote Indigenous community. To address the serious burden of oral disease, we are researching ways to promote a healthy oral environment by encouraging good dietary habits, and emphasising the importance of daily tooth brushing with a fluoridated toothpaste. Our ongoing longitudinal studies will indicate the success of measures employed to reduce the counts of bacteria closely associated with cariogenesis and their impact on caries increment.

PURPOSE: To determine the prevalence and associations of diabetic retinopathy (DR) within the indigenous Australian population living in central Australia. METHODS: 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of 'central Australia' were recruited for this study. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Participants were recruited as they presented to the eye clinic at each remote community. Following dilated slit-lamp fundoscopy, the amount of DR in participants with diabetes mellitus (DM) was quantified using the Early Treatment of Diabetic Retinopathy Study criteria. The presence of any DR and vision-threatening DR (clinically significant macular oedema and/or proliferative DR) in one or both eyes was presented. RESULTS: Of those with diabetes, 22.2% (25.4% of those aged 40 years or older) had any DR and 7.0% (8.4% of those aged 40 years or older) had vision-threatening DR. Both the presence of any DR and vision-threatening DR were associated with advancing age and HbA1c level, but neither subcategory was associated with sex or self-reported hypertension. CONCLUSION: Our study has shown similar prevalence rates for DR in indigenous Australians compared with non-indigenous Australians. However, as DM is far more prevalent among indigenous Australians, the proportion of those affected by DR across the population should be considerably higher when compared with non-indigenous Australians.

PURPOSE: To determine the prevalence and associations of blinding trachoma within the indigenous Australian population living in central Australia. METHODS: A total of 1884 individuals aged 20 years or older, living among 30 remote communities within the statistical local area of 'Central Australia', were recruited for this study. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Participants were recruited as they presented to the eye clinic at each remote community. Anterior segment examination was performed and the rates of trachomatous trichiasis (TT) and trachomatous corneal opacification (CO) were documented. The prevalence of TT and CO in one or both eyes was presented. RESULTS: There were 6.1% (95% CI 5.0-7.2) (8.3% of those aged 40 years or older) who had TT and 3.3% (95% CI 2.5-4.1) (4.4% of those aged 40 years or older) who had CO. Both TT and CO were associated with advancing age and female sex. Prevalence varied widely between communities, from 0% to 33% for TT and 0% to 27% for CO. CONCLUSION: Our study has shown that blinding trachoma remains endemic among indigenous Australians in central Australia. However, compared with previous estimates, the prevalence of TT and CO appears to be decreasing.

AIM: To determine the prevalence and causes of visual impairment and blindness among indigenous Australians living in central Australia. METHODS: 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of "Central Australia", were recruited for this study, from which 1883 were assessable. This equated to 36% of those > or =20 years old and 67% of those > or =40 years old within this district. Participants were recruited as they presented to the eye clinic at each remote community. Patients underwent Snellen visual acuity testing and subjective refraction. After this, an assessment of their anterior and posterior segments was made. Rates and causes of bilateral visual impairment (vision worse than Snellen visual acuity 6/12 in the better eye) and bilateral blindness (Snellen visual acuity worse than 6/60 in the better eye) were presented. RESULTS: 19.4% (365/1883) had bilateral visual impairment (25.1% of those > or =40 years old) and 2.8% (53/1883) had bilateral blindness (3.6% of those > or =40 years old). Refractive error followed by cataract were the main causes for bilateral visual impairment and blindness. Following these, diabetic eye disease and trachomatous corneal opacification were the main causes of bilateral visual impairment and bilateral blindness, respectively. CONCLUSION: This study indicates that bilateral visual impairment and blindness are, respectively, 25.1% and 3.6% among indigenous Australians, four to seven times higher than among the non-indigenous Australian population. Trachoma is the leading cause of bilateral blindness after refractive error and cataract.

PURPOSE: To describe the design and demographic characteristics of a study to determine the prevalence of ocular morbidity among indigenous Australians living within remote central Australia. METHODS: 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of 'central Australia' were recruited for this study. Participants were recruited as they presented to the eye clinic at each remote community. Patients underwent visual acuity testing and subjective refraction. Following this they had a comprehensive ocular assessment. A baseline description of the participants is presented. RESULTS: 1884 participants were recruited including 689 (36.6%) males and 1195 (63.4%) females. This equates to 36% of those aged 20 years or older and 67% of those aged 40 years or older living in central Australia. 55% of participants were diabetic and 20% of participants were symptomatic of an eye condition, but the majority of these only had presbyopia. Combined, those who presented due to diabetes (regardless of symptoms), due to presbyopia, or without any symptoms made up 95% of the sample. CONCLUSION: Despite being recruited through clinics, the majority of participants presented for a 'check-up' because the clinic was available and not due to symptoms. Therefore, the data we collected may be used to establish the current prevalence of ocular morbidity within the indigenous community living in remote central Australia with particular reference to those aged 40 years or older. As such, this can help to determine the current and future needs of this population.

Purpose: To determine the prevalence and associations of refractive error within the indigenous Australian population living in central Australia. Methods: 1884 individuals aged 20 years or older, living in one of 30 remote communities within the statistical local area of ‘central Australia’ were recruited for this study. This equated to 36% of those aged 20 years or older and 67% of those aged 40 years or older within this district. Participants were recruited as they presented to the eye clinic at each remote community. Participants underwent subjective refraction to determine spherical equivalent and then had a slit-lamp anterior segment examination. Participants were only included if they were phakic and only the right eye was considered. The prevalence of hypermetropia worse than +1.0 dioptres (D), myopia worse than −0.5 D and astigmatism worse than 1.0 D is presented. Results: From those recruited, 15.2% were hypermetropic; 11.1% were myopic; and 6.2% had astigmatism. Participants became progressively more hypermetropic with increasing age until the age of 70 years, after which time they become more myopic. Furthermore, there was an increasing likelihood of myopia and a decreasing likelihood of hypermetropia with increasing nuclear opalescent cataract. Conclusion: Our study has shown that indigenous Australians are less likely to be ametropic compared with non-indigenous groups. Variations with age and nuclear opalescent cataract seen in other previous work have also been observed in our sample.