Abstract
In contrast to northern and northeastern Thailand, central Thailand was believed not to be endemic for Opisthorchis viverrini (OV). Fieldwork conducted in a rural area of central Thailand revealed that the prevalence and incidence were relatively high compared with regional average data. We hypothesized that the behavioural-psycho-social background of the study population might play an important role in the high burden of the infection. As a result, a qualitative study was conducted to highlight potential social determinants of the infection dynamics to gain greater understanding of the risk behaviours and their contexts. A qualitative study using focus group discussion and in-depth interviews was conducted in Na-ngam Village, Chachoengsao Province from 2012–14. Framework analysis was used to explore associations between infection and thematic content. Social influence showed a strong impact on infection dynamics of OV infection. Our results revealed that Koi pla (chopped raw fish salad) remains a popular dish in the community, as the dish itself represents northeastern culture. The cultural norm had been transferred from ancestors to their descendants. Some elders complained that discontinuing the consumption of Koi pla went against old traditions with respect to cultural norms and socialization. In contrast, modern education teaches about hygiene including OV infection risks, and accordingly teenagers and young adults were reported to modify their lifestyles including their eating habits. Children are a potential key to pass knowledge to their parents and school-based education programs can serve as a practical hub for knowledge dissemination. However, health education alone might not lead to behavioural change in other age groups. Therefore, more efforts are needed to support the transformation.
Highlights
Opisthorchis viverrini (OV), a human liver fluke, is a pathologically and economically important food-borne trematode. [1,2,3] OV infection is endemic in Southeast Asia along the Mekong Basin [4,5,6,7] including Thailand, Lao PDR and Cambodia, where an estimated nine million people are infected [8,9,10]
Attitudes and perceptions regarding liver fluke infections have been evaluated in rural areas of northeastern Thai and neighboring Lao provinces. [25,27] The results showed that improving health education together with treatment could result in better knowledge and behavioral change concerning liver fluke infections[27]
Social influence plays an important role in shaping the dynamics of OV infection
Summary
Opisthorchis viverrini (OV), a human liver fluke, is a pathologically and economically important food-borne trematode. [1,2,3] OV infection is endemic in Southeast Asia along the Mekong Basin [4,5,6,7] including Thailand, Lao PDR and Cambodia, where an estimated nine million people are infected [8,9,10]. OV survives in the bile duct in the absence of treatment [13,14,15]. Many studies have demonstrated that chronic infection is strongly related to a bile duct cancer, cholangiocarcinoma (CCA) [16,17,18,19]. The International Agency for Research on Cancer has declared that OV is a group 1 agent, carcinogenic to humans [8]. Thailand has the highest CCA incidence in the world, with estimates ranging from 93.8 to 317.6 /100,000 person-years [13,18,20,21,22]. OV infection is acknowledged as a neglected and underestimated disease globally [9,10,23]
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