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In recent decades, vaccination has been very successful in eliminating or substantially reducing the rates of many Vaccine-Preventable Diseases (VPDs), such as diphtheria, polio, tetanus, hepatitis B, measles, mumps and rubella, in all Australians, and has made a substantial contribution to improvements in Aboriginal and Torres Strait Islander child mortality.
For some VPDs, control is suboptimal in the general population despite high vaccination coverage (e.g. pertussis). For others, such as invasive pneumococcal disease, greater burdens of illness still occur in Aboriginal people than in non-Indigenous people, largely due to the greater prevalence in Aboriginal people of serotypes for which vaccines do not provide protection, and high exposure levels associated with environmental issues.
Timeliness of immunisation can also be a factor to low Immunisation coverage as well as limited access in some areas to culturally safe health care.
In recognition of the higher rates of disease in the Aboriginal and Torres Strait Islander population, some vaccines are specifically recommended for use in Aboriginal and Torres Strait Islander people, or for administration to a broader age range than is recommended for non-Indigenous persons .Currently there are different vaccine recommendations for Aboriginal and Torres Strait Islander people in some parts of Australia. For children, these are Bacille Calmette-Guérin (BCG), Haemophilus influenzae type b, hepatitis A, influenza and pneumococcal vaccines. For adults, these are hepatitis B, influenza and pneumococcal polysaccharide vaccines.
To learn more about Immunisation schedules for Aboriginal and Torres Strait Islander people click here.
Although there has been an increase in national childhood vaccination coverage from 54% in the early 1990s to over 90% in 2012, Aboriginal childhood immunisation statistics remain much lower. South Australia has the lowest Aboriginal childhood Immunisation coverage in the nation.
The Aboriginal Health Council of SA offers support to its member services to improve Immunisation coverage. Currently all Aboriginal Health Workers enrolled in the course for Primary Health care clinical certification receive Immunisation education during their training. AHCSA also supports the concept of Aboriginal Health Practitioners as independent Immunisation providers, ensuring more access to culturally appropriate service delivery. This is potentially a positive way forward to improving immunisation coverage for Aboriginal people in South Australia.
All Aboriginal Community Controlled Health organisations offer Immunisations services; if you are unsure if you or your children are up to date with your Immunisation schedules please ask your local Aboriginal Health team to assist you.
Alternatively if you have any queries regarding Immunisation issues please feel free to contact Mary –Anne Williams at AHCSA on 08 8273 7200.
If you would like to view the current South Australian Immunisation schedule dated October 2014, please click here.
The AHCSA TS and Healthy Lifestyle team has a Puyu Blaster healthy lifestyle and anti-smoking campaign that promotes local role models. In sharing knowledge about healthy lifestyles, our ambassadors inspire and encourage all of us to eat healthily, exercise regularly or make a quit attempt.
The healthy hero Puyu Blaster attends events with the team to spread healthy messages about not smoking, exercising and eating healthy food.
If you are looking for some inspiration for cooking healthy meals have a look at the 20 Healthy Feeds Cookbook, which is made up of recipes from members of our Aboriginal communities around South Australia.
For more information on smoking, exercise and healthy eating visit the Keep It Corka Facebook page.
Disease occurrence and public health significance
Trachoma is the leading cause of preventable infectious blindness in the world. Endemic in 53 countries, trachoma is responsible for visual impairment in about 2.2 million people worldwide, of which 1.2 million people are irreversibly blind. The prevalence of blindness in Aboriginal and Torres Strait Islander people is 6 times higher than non-Aboriginal people, and Trachoma accounts for 9% of this blindness.
Australia is the only developed nation in the world to still have endemic trachoma. Although Trachoma was eliminated from most parts of Australia by the 1930s, it continues to be a significant public health problem in Aboriginal and Torres Strait Islander communities in many rural and remote areas of the Northern Territory, South Australia and Western Australia.
The National Indigenous Eye Health Survey in 2008 detected cases in other jurisdictions and this mapping is ongoing. In Australia, the prevalence of Trichiasis (turned-in eye lashes) is approximately 1.4% in Aboriginal and Torres Strait Islanders.
In line with its Vision 2020 initiative, the World Health Organisation (WHO) has adopted a resolution to eliminate blinding Trachoma by 2020. Australia is a signatory to this resolution, the Global Elimination of Trachoma (GET 2020).
The SAFE Strategy
The SAFE Strategy is an innovative public health approach designed to treat and prevent Trachoma. Endorsed by the World Health Organisation, the components of SAFE are:
The acronym SAFE covers four public health components, and in order of public health priority are:
The ‘E’ component ‘environmental health’ covers a very broad category of potential activities.
Safe access to clean and functioning water supplies, adequate sanitation including clean linen and aired mattresses, improved housing, reducing overcrowding and attempts to minimise fly density are all potentially important factors for Trachoma control.
Environmental improvements should focus on reducing the barriers to children washing their hands and faces and look to achieving facial cleanliness. Time and effort should be spent on checking household and community washing facilities to ensure they are functional and safe for children. Leaky or broken plumbing should be repaired, with bathrooms and laundries properly maintained. The installation of mirrors so children can actually see whether their faces are clean or dirty is another way to help reinforce the message and promote clean faces.
The ‘F’ component ‘facial cleanliness’ is seen as the key preventive measure that can be taken to prevent infection. Facial cleanliness is the absence of nasal and ocular discharge and it requires the proper maintenance of housing, especially washing facilities and bathrooms, and the development of household and personal hygiene skills and behaviours.
Facial cleanliness in children should be promoted by including regular face washing a part of a holistic personal hygiene program that may also include tooth brushing, hand washing and general hygiene. Clean faces in children should be promoted as normality with children, families and communities being empowered to make the physical and behavioural changes. The program aims for facial cleanliness for all children at all times with the target for at least 85% of children in a community at any one time to have a clean face.
The benefits of amended hygiene and environmental improvements include reduced morbidity from other diseases, such as scabies, otitis media, rheumatic fever and gastrointestinal infections, which share similar risk factors.
The ‘A’ component ‘antibiotic distribution’ of the strategy has an important role in the prevention by reducing the duration of infection (both symptomatic and asymptomatic), and therefore reducing disease transmission.
In endemic areas with established, coordinated Trachoma control programs, health services should not promote opportunistic screening of individuals or households, as it is the communities and regions that should be the focus of the public health action.
In areas where trachoma is not known to be endemic, symptomatic individuals should be examined for Trachoma and if it is diagnosed, the patient should be treated, along with their household contacts and this treatment well documented. The local public health unit should also be notified of the case as wider community screening may be indicated.
The “S” component ‘surgery’ of the strategy involves the detection, referral and surgical management of Entropion (in-turned eye lid margin) and Trichiasis (in-turned eye lashes) to prevent further corneal abrasion and the development of corneal scarring and blindness.
A lot of the time, children with active trachoma will look normal and will not tell you they have trouble with their eyes. They are frequently asymptomatic and sore, red, sticky eyes are often regarded as normal. These children may have dirty faces with ocular and nasal discharge or their faces may look clean.
The presence of active trachoma is characterised by redness of the tarsal conjunctiva, discharge, follicles and swelling of the tarsal conjunctivae. Sometimes, especially with secondary bacterial infection, they may have lots of pus discharging from their eyes.
Repeated episodes of infection from Chlamydia Trachomatis leads to long-term inflammation, scarring of the tarsal conjunctivae and distortion of the upper eyelid with the in-turning of eyelashes that abrade the surface of the globe. This constant abrasion can cause irreversible corneal opacity and blindness.
Older adults with Trichiasis often present with irritated watery eyes and if not recognised, referred and operated on, the Trichiasis will lead to corneal scarring and blindness.
For further information please contact Desley Culpin, Manager, Trachoma Elimination Program.
Statewide Aboriginal Dental Scheme
AHCSA receives funding from the Commonwealth Department of Health for the Aboriginal Dental Program that is provided to the South Australian Dental Service (SADS) that assists in the provision of oral health programs for Aboriginal and Torres Strait Islander children and eligible adults.
An adult is eligible for government funded dental services if they are a holder or adult dependent of a holder of a current Centrelink Pensioner Concession Card or Health Care Card. AHCSA provides the funding with an emphasis on the provision of oral health programs as part of a whole-of-health primary health care approach for Aboriginal and Torres Strait Islander people.
The Aboriginal Dental Program provides general emergency and course of care that can include extractions, restorative work, dentures and other services. The areas covered are Balaklava, Barossa Valley, Ceduna, Coober Pedy, Fleurieu, Leigh Creek, Meningie, Murray Bridge, Port Augusta, Port Lincoln, Port Pirie, Riverland, South East, Streaky Bay, Whyalla and Yorke Peninsula.
AHCSA and SADS have had a strong partnership since 2008 and meet biannually. There is strong representation from both parties on the Aboriginal Oral Health Advisory Group hosted by AHCSA.
For more information, please email Amanda Mitchell or phone 08 8273 7200.
The SA Dental Service provides dental support through the Aboriginal Oral Health Program.
For further information phone (08) 8222 8222 or visit
SA Dental Service
180 Flinders St
The AHCSA Rising Spirits Community Resilience Resources program explores what grief is within the Aboriginal community, the emotional feelings and behaviours that are associated to it, physical feelings and spiritual aspects of grief.
The program helps the Aboriginal community to check if someone is okay, help them cope with grief and loss for all members of the community including carers and children.
The program also aims to provide the appropriate resources where Aboriginal individuals can receive help, investigate funeral insurance funds and the steps involved in organising a funeral.
Below are a list of services around the state which provide grief and loss support.
Ceduna Koonibba Yalata
Hills-MurrayLands, Fleurieu, Riverland
Throughout the website the term Aboriginal is used in this context to include people who identify as Aboriginal, people who identify as Torres Strait Islander Peoples and people who identify as both Aboriginal and Torres Strait Islander. It is also used interchangeably with the term Aboriginal and Torres Strait Islander.