Project Lead(s): Frank Mallory
Food-borne trematodiases (liver flukes) are one major group of neglected tropical diseases worldwide, with more than 40 million people infected and 750 million (>10% of the world’s population) at risk.
Over 100 species of food-borne trematodes are known to infect humans. These infections usually occur focally and are still endemic in many parts of the world, particularly Southeast Asia.
Projects using integrated, bottom-up approaches (sometimes called ecosystem approaches to health) are beginning to prove effective toward addressing neglected tropical diseases in low- and middle-income countries, by integrating the biomedical, environmental and social determinants of health.
The primary purpose of this project was to expand an integrated, bottom-up approach to tackle liver flukes in Northeastern Thailand.
Three years ago, the team initiated a pilot project to target the villages around Lawa Lake with praziqantel treatment and an intensive education curriculum (IEC).
As a result, the prevalence of liver infection declined from 67% to 16% in the third year, with minimal re-infection.
An intensive Liver Fluke-free School program was added in schools around Lawa Lake, which included stool examination, treatment, health education, exhibitions and curriculum focusing on liver fluke infection and liver cancer (Grades 4 to 6).
The new project involved several components:
· Treatment and IEC – this included a tailored treatment program with intensive education in different age groups
· A school-based IEC and science curriculum
· Technical training for liver fluke control – community hospital staff and community volunteer training programs were developed and extended to all villages in the Lawa Lake area
· Manual of liver fluke control strategy – a manual was developed describing methods for establishing and sustaining community-based liver fluke control
· Disease surveillance and environmental monitoring – liver fluke prevalence was measured in treated human populations and host wildlife populations (snails and fish).
Results showed the effectiveness of an integrated, bottom-up approach of an intensive Liver Fluke-free School program that included stool examination, treatment, health education, exhibitions and curriculum focusing on liver fluke infection and liver cancer.
Baseline infection prevalence in nine schools (which was 9.2%) has now been reduced to zero.
Development of the Liver Fluke Manual and DVDs, and provision of DVD players, has been completed and distributed to the schools in the project. The life history of human liver flukes has been incorporated into the science curriculum in each school.
Knowledge about the project has been disseminated in conferences, including The 39th Congress on Science and Technology of Thailand and the annual meeting of the Gastroenterological Society of Thailand. More recent research has shown that domestic cats are a major carrier and host to this human liver fluke parasite.