Abstract
A liver fluke, Opisthorchis viverrrini (OV), is the major cause of the high incidence of cholangiocarcinoma in North-eastern Thailand. The prevalence of OV infection remains high in various parts of the country, especially in wetland rural areas where a large proportion of the community work in agriculture and continue the traditional practice of eating raw or uncooked cyprinoid fish products. The national control program seems to have had little impact in many of these areas, and it has been difficult to make precise assessments of the overall effectiveness of the program. Therefore there is a need for a community-based approach to prevent infection with the parasite, ideally involving as many players as possible. Here we document an attempt to assess the best means to prevention on the basis of a community intervention in three villages in north-east Thailand, with participation of representatives of Health Promotion Hospitals of the Ministry of Public Health with dedicated staff, but also school teachers, independent government sponsored village health volunteers, and housewives responsible for cooking and diet selection. An action plan was followed, allowing detailed discussions of practical proposals, their introduction and then repeated reflection and further proposals at the individual village level.
Highlights
The liver fluke, Opisthorchis viverrini (OV), continues to be a serious public health problem in north and northeast Thailand, associated with a very high incidence of cholangiocellular carcinoma (Shin et al, 2010)
High variability has been reported between the different districts within a province; for example, the age and gender adjusted proportion of the population infected in the 20 districts of Khon Kaen Province varied between 10.0% and 70.9% (Sriamporn et al 2004)
1981-2001 a variety of different surveys indicated that the national prevalence of Opisthorchis viverrrini (OV) infection had fallen from 63.6% to 9.6%, but the most recent a data indicate the prevalence rate in the Northeast region remains high at 16.6% and had not decreased over the previous decade (Sithithaworn et al, 2012)
Summary
The liver fluke, Opisthorchis viverrini (OV), continues to be a serious public health problem in north and northeast Thailand, associated with a very high incidence of cholangiocellular carcinoma (Shin et al, 2010). Over six million Thai people are estimated to be infected, and the highest prevalence rates are found in Issan and to a lesser extent in the North. The geographic pattern of OV infection rates in Thailand is very uneven, but high rates are more likely in rural than urban environments, especially in wetlands and agricultural areas (Wattanayingcharoenchai et al, 2011) where there are rivers, lakes, man-made watercourses for irrigation, ponds for aquaculture and rice-fields and where the food-culture of the local people includes the consumption of raw or undercooked fish (Grundy-Warr et al, 2012).
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