Specialist Viewpoint – or cholangiocarcinoma as they see it …

Prof Paiboon2Article 6

Cholangiocarcinoma in Thailand

by Professor Paiboon Sithithaworn
Department of Parasitology and the
Liver Fluke  and Cholangiocarcinoma Research Center
Faculty of Medicine
Khon Kaen University
Thailand

 

Fighting the liver fluke and cholangiocarcinoma (CCA) through school health education

Khon Kaen Faculty of Medicine symbolI have been working as a lecturer in Parasitology at the Faculty of Medicine, Khon Kaen University since 1979 and joined the Liver Fluke and Cholangiocarcinoma Research Center (LFCRC) in 2002. The research center was established by the University in order to combat the liver fluke and cholangiocarcinoma through research and education.

Cholangiocarcinoma (CCA) is one of the top five causes of death in Thailand, killing approximately 20,000 people per year. Unlike the risk of CCA in UK and the Western World, the unique risk factor in Thailand is human infection by the liver fluke, Opisthorchis viverrini, infection by which occurs through eating undercooked freshwater fish. A similar type of the liver fluke known as Clornorchis sinensis also occurs in Asia mainly in China and Korea. Based on epidemiological and experimental evidence, these Asian liver flukes are now recognized as carcinogenic agents by the International Agency for Research on Cancer, WHO.

Similar to CCA worldwide, this is a devastating disease that causes a high death rate and with no early diagnosis being available. Although there are cases of sporadic CCA in Bangkok and in the north near the Burma border, the vast majority of CCA cases in Thailand are liver fluke related, and the highest incidence of these is found in the north-east of the country. The risk of CCA is at least 14 times higher in people infected by the liver fluke compared with uninfected individuals.

In Thailand the primary means for preventing and controlling CCA is through preventing liver fluke infection. The campaign against liver fluke, particularly against the raw fish consumption, has to date met with little success, although the fluke itself was discovered over a century ago. This is the case even though drug treatment with Praziquantel is effective and has been available for more than 30 years. It is believed that multiple means of disrupting the liver fluke life cycle are necessary to achieve control of the parasite, but health education is always thought to be the best strategy.

In rural areas, river fish are caught and eaten raw with herbs

In rural areas, river fish are caught and eaten raw with herbs

Selling fish in Khon Kaen market

Selling fish in Khon Kaen market

 

 

 

 

 

 

We are now targeting the younger generation, particularly primary school children, with a school-based health education programme. The ultimate aim of the programme is to educate these children so they are aware of the problem of the liver fluke infection, thus lowering the subsequent risk of CCA 20-30 years later in life. The key element used to push this school-based health education programme is a systematic training programme for school teachers. In addition to local public health workers, the teachers can play critical roles in transferring the health message to the children, their parents at home and also the communities.

This primary prevention approach may have a longer term benefit and cost less than sophisticated medical intervention which hardly reaches the poor rural people in affected areas in Asia.

My ultimate hope is to see the new and healthy generation of northeastern Thai people who not only are liver fluke- free but also have great awareness on the problems of the liver fluke and CCA. Although there are still a lot to do, we are all looking forward to witness the success of the E-san (northeast) agenda “eradicate the liver fluke to reduce CCA” in the near future.   

Professor Paiboon Sithithaworn
Department of Parasitology and the
Liver Fluke  and Cholangiocarcinoma Research Center
Faculty of Medicine
Khon Kaen University
Thailand

May 2014

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