title: Trachoma in remote Indigenous Australia: a review and public health perspective.
abstract: OBJECTIVE
  Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease.
  
  
  METHODS
  A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined.
  
  
  RESULTS
  Having a clean face was found to be protective for trachoma, but face-washing education programs have produced no significant benefits. Sanitation infrastructure in a community was the key determinant of facial cleanliness. Installation of swimming pools in remote Indigenous communities has been demonstrated to reduce the prevalence of several common childhood infections. However, minimal research has explored the impact of pools on trachoma rates.
  
  
  CONCLUSIONS
  The locally supported construction of pools in remote Indigenous communities may contribute to a decline in trachoma. A prospective, controlled trial is needed to test this hypothesis in endemic communities.
  
  
  CONCLUSIONS
  If validated by a well-designed study, pool construction may provide a much sought-after practical government strategy to combat trachoma in remote Indigenous communities.
authors.affiliation: Royal Adelaide Hospital, South Australia.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Warren
authors.affiliation: Queen Elizabeth Hospital, South Australia.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Birrell
mesh_terms: D001315:Australia / Q000453:epidemiology; D006801:Humans; D011634:Public Health; D012423:Rural Health; D012424:Rural Population; D018571:Sentinel Surveillance; D014141:Trachoma / Q000208:ethnology / Q000517:prevention & control
keywords: social determinants; swimming pools; trachoma