Community engagement for effective control of opisthorchiasis: A three-year mixed-methods study in rural Thailand

Abstract

Background Opisthorchiasis posed a significant risk of bile duct cancer and was a critical health issue in Southeast Asia, particularly in Thailand. This study aimed to assess the effectiveness of rural participation in preventing and controlling O. viverrini infections in endemic areas. Methods A mixed-methods approach and One Health innovations were implemented over three years, involving 3,600 enrolled participants in 2020. The research integrated epidemiological data collection and risk factor analysis to comprehend the influence of community engagement on disease transmission. The evaluation of innovations was conducted by assessing the incidence of O. viverrini reinfection among participants from 2020 to 2023. Results The prevalence assessment revealed that 218 cases were infected with O. viverrini (6.0%) in the first year, with notable risk factors including proximity to water sources and raw fish consumption. Significant variables contributing to infection risk among participants (P < 0.001) included education level, participation in traditional ceremonies, inadequate sanitation, absence of ducks in nearby water sources, self-medication for parasitic conditions, and multiple infections within a household. Dogs, cats, and cyprinoid fish exhibited prevalence rates of 5.4%, 6.3%, and 11.5%, respectively. Geographic information analysis highlighted concentrations of infected households around water sources. One Health innovations, including in-depth interviews, focus group discussions, parasitic treatment, health education, and biological control using local free-range ducks, were implemented to reduce O. viverrini-infected cases over three years. In the second year, no human reinfections occurred, signifying positive impacts from interventions. In the third year, only nine participants (0.3%) were reinfected, with significantly lower egg intensity. Additionally, a reduction in metacercaria in fish was noted. Conclusions This research provided insights into dynamic changes in infection prevalence, offering a valuable contribution to effective disease control and community health promotion.