Sustainable Prevention of Cholangiocarcinoma Through Community Participation in a High-incidence Area in Thailand.

Opisthorchiasis and cholangiocarcinoma (CCA) are major public health problems in Northeast Thailand, especially in Ubon Ratchathani, which are the alluvial plains. Those with poor food habits are mostly at risk of having diseases. This study was a participatory action research (PAR) aimed to define the models/plans for CCA prevention. The samples consisted of 40 community representatives. The data were collected by the PAR method. Qualitative data were analyzed by content analysis. The samples coordinately analyzed and prioritized the problems and presented information to the community. The plans consisted of (1) cultivating the right values and behaviors of eating food safe from CCA in children, (2) supervising the shops not to sell foods that are the main risk factors for CCA, (3) supporting the community leaders to act as good role models to the people, (4) assigning every housewife to cook clean and safe food from CCA, and (5) encouraging the villagers to have knowledge and awareness, which can protect them from CCA. After the community designed these plans, responsible persons were assigned to implement them. Two years later, researchers evaluated the outcome. The average scores on knowledge and attitude toward CCA were significantly higher than before implementation. For the impact of projects, prevalence of opisthorchiasis in 2016 was significantly lower than that in 2014. CCA prevention by community participation employed a combination of quantitative and qualitative studies. This study has been successful and sustainable since the community has human resources, budget, and appropriate management of the project.

Behavior-related risk factors for opisthorchiasis-associated cholangiocarcinoma among rural people living along the mekong river in five greater mekong subregion countries.

Opisthorchiasis-associated cholangiocarcinoma (OV-CCA) is a major public health problem in Greater Mekong Subregion (GMS) Countries, the poorest region in Asia. People in this region have similar traditions or respect the same religion. There is no difference in lifestyle and food culture. Excluding Thailand, publications on risk factors for OV-CCA from the GMS Countries are few, especially data on behavioral risk factors for OV-CCA. Therefore, this study aimed to assess the behavior-related risk factors and to compare the risk of OV-CCA among rural people living along the Mekong River in five GMS countries. It was a cross-sectional analytic study during June and October 2017. All participants with informed consent completed the questionnaires. Descriptive statistics were used to describe the prevalence of risk factors. Odds ratio with 95% confidence intervals were used to compare the risk of OV-CCA. It was found that there were more drinkers than non-drinkers in all areas, except in Vietnam. The highest history of liver fluke infection was found in Cambodia. Praziquantel use and consumption of raw freshwater fish dishes were mostly found in Lao PDR. The highest consumption of nitrosamine-contaminated foodstuffs was found in Ubon Ratchathani, Thailand. The spatial comparison of OV-CCA risk showed that Lao PDR and Ubon Ratchathani were two risk areas when compared to Tachileik, Myanmar (a reference area). This study provided the behavior-related risk factors for OV-CCA among people in five GMS Countries which would be a major jigsaw puzzle leading to proactive surveillance for OV-CCA prevention in the future.

Trematode infections: liver and lung flukes.

Food-borne trematodiases are an emerging public health problem in Southeast Asia and Latin America and of growing importance for travel clinics in Europe and North America. The disease is caused by chronic infections with liver, lung, and intestinal flukes. This article focuses on the most important liver and lung flukes that parasitize man, namely Clonorchis sinensis, Fasciola gigantica, Fasciola hepatica, Opisthorchis felineus, Opisthorchis viverrini, and Paragonimus spp. The article describes the epidemiology of major liver and lung fluke infections, including current distribution, burden, life cycle, clinical signs and symptoms, diagnostic approaches, and current tools for prevention, treatment, and control.

Raw attitudes, wetland cultures, life-cycles: socio-cultural dynamics relating to Opisthorchis viverrini in the Mekong Basin.

Opisthorchis viverrini is one of the most common and medically important food-borne parasites in the Lower Mekong area of Southeast Asia. As we learn more about its ecology, pathology and epidemiology we see the need to consider more deeply the socio-cultural dynamics with which food-borne species complexes are associated. This paper argues that the Mekong region is characterized by strong livelihoods and life-style associations within wetland ecosystems, which are inseparable from human eating habits ("raw attitudes"). Within the fish-rice economies of the region there are many long-cherished food cultures based on eating raw, semi-cooked and fermented fish dishes, which are known to lead to opisthorchiasis, and potentially cholangiocarcinoma. This paper examines evidence from northeast Thailand showing that dedicated health outreach campaigns do help to reduce prevalence of opisthorchiasis over time. For disease prevention and health education approaches to be most effective, they must be sensitive to culture, livelihood economics, gender, and age. Further integrative, inter-disciplinary and international research must incorporate the complex dynamics of parasite ecology, human behavior, socio-economics, and public health awareness.