GIS-Based Spatial Statistical Analysis of Risk Areas for Liver Flukes in Surin Province of Thailand

Rujirakul, Ratana,Ueng-arporn, Naporn,Kaewpitoon, Soraya,Loyd, Ryan J,Kaewthani, Sarochinee,Kaewpitoon, Natthawut Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.6

It is urgently necessary to be aware of the distribution and risk areas of liver fluke, Opisthorchis viverrini, for proper allocation of prevention and control measures. This study aimed to investigate the human behavior, and environmental factors influencing the distribution in Surin Province of Thailand, and to build a model using stepwise multiple regression analysis with a geographic information system (GIS) on environment and climate data. The relationship between the human behavior, attitudes (<50%; $X_{111}$), environmental factors like population density ($148-169pop/km^2$; $X_{73}$), and land use as wetland ($X_{64}$), were correlated with the liver fluke disease distribution at 0.000, 0.034, and 0.006 levels, respectively. Multiple regression analysis, by equations OV= -0.599 + 0.005(population density ($148-169pop/km^2$); $X_{73}$) + 0.040 (human attitude (<50%); $X_{111}$) +0.022 (land used (wetland; X64), was used to predict the distribution of liver fluke. OV is the patients of liver fluke infection, R Square= 0.878, and, Adjust R Square= 0.849. By GIS analysis, we found Si Narong, Sangkha, Phanom Dong Rak, Mueang Surin, Non Narai, Samrong Thap, Chumphon Buri, and Rattanaburi to have the highest distributions in Surin province. In conclusion, the combination of GIS and statistical analysis can help simulate the spatial distribution and risk areas of liver fluke, and thus may be an important tool for future planning of prevention and control measures.

Spatial Distribution of the Population at Risk of Cholangiocarcinoma in Chum Phaung District, Nakhon Ratchasima Province of Thailand

Kaewpitoon, Soraya J,Rujirakul, Ratana,Loyd, Ryan A,Matrakool, Likit,Sangkudloa, Amnat,Kaewthani, Sarochinee,Khemplila, Kritsakorn,Eaksanti, Thawatchai,Phatisena, Tanida,Kujapun, Jirawoot,Norkaew, Jun Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.2

Background: Cholangiocarcinoma (CCA) is a serious health problem in Thailand, particularly in northeastern and northern regions, but epidemiological studies are scarce and the spatial distribution of CCA remains to be determined. A database for the population at risk is required for monitoring, surveillance and organization of home health care. This study aim was to geo-visually display the distribution of CCA in northeast Thailand, using a geographic information system and Google Earth. Materials and Methods: A cross-sectional survey was carried out in 9 sub-districts and 133 villages in Chum Phuang district, Nakhon Ratchasima province during June and October 2015. Data on demography, and the population at risk for CCA were combined with the points of villages, sub-district boundaries, district boundaries, and points of hospitals in districts, then fed into a geographical information system. After the conversion, all of the data were imported into Google Earth for geo-visualization. Results: A total of 11,960 from 83,096 population were included in this study. Females and male were 52.5%, and 47.8%, the age group 41-50 years old 33.3%. Individual risk for CCA was identifed and classified by using the Korat CCA verbal screening test as low (92.8%), followed by high risk (6.74%), and no (0.49%), respectively. Gender ($X^2$-test=1143.63, p-value= 0.001), age group ($X^2$-test==211.36, p-value=0.0001), and sub-district ($X^2$-test=1471.858, p-value=0.0001) were significantly associated with CCA risk. Spatial distribution of the population at risk for CCA in Chum Phuang district was viewed with Google Earth. Geo-visual display followed Layer 1: District, Layer 2: Sub-district, Layer 3: Number of low risk in village, Layer 4: Number of high risk in village, and Layer 5: Hospital in Chum Phuang District and their related catchment areas. Conclusions: We present the first risk geo-visual display of CCA in this rural community, which is important for spatial targeting of control efforts. Risk appears to be strongly associated with gender, age group, and sub-district. Therefor, spatial distribution is suitable for the use in the further monitoring, surveillance, and home health care for CCA.

Community-Based Cross-Sectional Study of Carcinogenic Human Liver Fluke in Elderly from Surin Province, Thailand

Kaewpitoon, Soraya J.,Rujirakul, Ratana,Ueng-Arporn, Naporn,Matrakool, Likit,Namwichaisirikul, Niwatchai,Churproong, Seekaow,Wongkaewpothong, Patcharaporn,Nimkuntod, Porntip,Sripa, Banchob,Kaewpitoon, Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.9

Background: Opisthorchis viverrini infection is a serious public-health problem in Southeast Asia. It is associated with a number of hepatobiliary diseases and the evidence strongly indicates that liver fluke infection is the etiology of cholangiocarcinoma. Objectives: This study aimed to determine Opisthorchis viverrini infection in elderly people in Surin province, Northeastern Thailand. Methods: A community-based cross-sectional survey was conducted among 333 elderly in 17 districts of Surin province, during one year period from January to December 2011. O. viverrini infection was determined using Kato's Thick Smear technique and socio-demographic were collected using predesigned semi-structured questionnaires, respectively. Results: A total of 333 elderly including 116 males and 217 females were selected from different study sites. Overall intestinal parasitic infection was 16.2%, predominantly in O. viverrini (9.91%) and followed by Strongyloides stercolaris (4.80%) and hookworm (1.50%), respectively. The O. viverrini infection was found higher in males (13.8%) than females (7.83%), and frequently in elderly 60-70 year old with 14.2%. Chi-square testing indicated that education and occupation were significantly associated with O. viverrini infection (P value = 0.02). The distribution of O. viverrini infection was found in 11 districts which was covered 64.7% of the studies areas. The highest prevalence was found in Thatum with 39.1%, and followed by Sangkha (24.0%), Buachet (21.1%), Samrong Thap (19.1%), Si Narong (15.0%), and Ratanaburi (13.3%) districts. Conclusion: This findings stress that O viverrini is still a problem in Thailand. We confirmed, for the first time, the high endemicity of human O. viverrini infections in elderly in Surin province of Thailand, underlying the fact that mass treatment and health education are urgently required.

Detection of the Carcinogenic Liver Fluke Opisthorchis viverrini Using a Mini Parasep SF Faecal Parasite Concentrator

Kaewpitoon, Soraya J,Rujirakul, Ratana,Tongtawee, Taweesak,Matrakul, Likit,Panpimanmas, Sukij,Wakkuwattapong, Parichart,Loyd, Ryan A,Kaewpitoon, Natthawut Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.1

The Mini Parasep SF fecal parasite concentrator (MPSFC) is a new modification of the closed concentration system, which can easily be adopted in any routine clinical pathology laboratory. Here we describe our experience with the system in diagnosing Opisthorchis viverrini. A total of 199 fecal samples was submitted for routine examination in the clinical pathology laboratory of Suranaree University of Technology hospital, Nakhon Ratchasima province, Thailand, during August to October 2015. Out of all samples examined, 10 (5.03%) were positive with intestinal parasites including O. viverrini (2.01%), followed by Strongyloided stercoralis (1.51%), Hookworm (0.5%), Taenia spp. (0.5%), and Entamoeba coli (0.5%). Regarding the distribution of intestinal parasites in relation to the methods used, and found that 4 samples (2.01%) were positive using the direct wet smear method while 10 (5.03%) were positive with the Mini Parasep SF method; the difference was statistically significant ($X^2$-test = 116.506, p-value =0.001). Mean time for processing using the Parasep system was 6.03 min/sample, the conventional direct wet smear method at 0.3 min/sample. Cost per test, conventional direct wet smear method costing less than the Parasep method at USD 0.74/sample versus USD 1.47/sample. This first report of O. viverrini detection using MPSFC indicates that Parasep concentration test is useful in the routine laboratory, increasing the yield of parasites as compared to direct microscopy, but with greater processing time and cost. Further comparisons between the Parasep concentration test and common methods for O. viverrini detection are required, particularly concerning use in epidemiological surveys.

Prevalence of Opisthorchis viverrini Infection in Nakhon Ratchasima Province, Northeast Thailand

Kaewpitoon, Soraya J.,Rujirakul, Ratana,Kaewpitoon, Natthawut Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.10

Background: Opisthorchis viverrini infection is a serious public-health problem in Southeast Asia especially in Lao PDR and Thailand. It is associated with a number of hepatobiliary diseases and the evidence strongly indicates that liver fluke infection is the major etiology of cholangiocarcinoma. Objectives: This study aimed to determine actual levels of Opisthorchis viverrini infection in Nakhon Ratchasima province, Northeast Thailand. Methods: A cross-sectional survey was conducted during a one year period from October 2010 to September 2011. O. viverrini infection was determined using a modified Kato's thick smear technique and socio-demographic data were collected using predesigned semi-structured questionnaires. Results: A total of 1,168 stool samples were obtained from 516 males and 652 females, aged 5-90 years. Stool examination showed that 2.48% were infected with O. viverrini. Males were slightly more likely to be infected than females, but the different was not statistically significant. O. viverrini infection was most frequent in the 51-60 year age group and was found to be positively associated with education and occupation. Positive results were evident in 16 of 32 districts, the highest prevalence being found in Non Daeng with 16.7%, followed by Pra Thai with 11.1%, Kaeng Sanam Nang with 8.33%, and Lam Ta Men Chai (8.33%) districts. Conclusion: This study indicates that O viverrini is still a problem in some areas of Nakhon Ratchasima, the patients in this study bing suitable for the purpose of monitoring projects.

Distribution of the Population at Risk of Cholangiocarcinoma in Bua Yai District, Nakhon Ratchasima of Thailand Using Google Map

Kaewpitoon, Soraya J,Rujirakul, Ratana,Sangkudloa, Amnat,Kaewthani, Sarochinee,Khemplila, Kritsakorn,Cherdjirapong, Karuna,Kujapun, Jirawoot,Norkaew, Jun,Chavengkun, Wasugree,Ponphimai, Sukanya,Polsri Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: Cholangiocarcinoma (CCA), a major problem of health in Thailand, particularly in Northeastern and Northern regions, is generally incurable and rapidly lethal because of presentation in stage 3 or 4. Early diagnosis of stage 1 and 2 could allow better survival. Therefore, this study aimed to provide a distribution map of populations at risk for CCA in BuaYai district of Nakhon Ratchasima province, Northeast Thailand. Materials and Methods: A cross-sectional survey was carried out in 10 sub-districts and 122 villages, during June and November 2015. The populations at risk for CCA were screened using the Korat CCA verbal screening test (KCVST) and then risk areas were displayed by using Google map (GM). Results: A total of 11,435 individuals from a 26,198 population completed the KCVST. The majority had a low score of risk for CCA (1-4 points; 93.3%). High scores with 6, 7 and 8 points accounted for 1.20%, 0.13% and 0.02%. The population at risk was found frequently in sub-district municipalities, followed by sub-district administrative organization and town municipalities, (F=396.220, P-value=0.000). Distribution mapping comprised 11 layers: 1, district; 2, local administrative organization; 3, hospital; 4, KCVST opisthorchiasis; 5, KCVST praziquantel used; 6, KCVST cholelithiasis; 7, KCVST raw fish consumption; 8, KCVST alcohol consumption; 9, KCVST pesticide used; 10, KCVST relative family with CCA; and 11, KCVST naive northeastern people. Geovisual display is now available online. Conclusions: This study indicated that the population at high risk of CCA in Bua Yai district is low, therefore setting a zero model project is possible. Key success factors for disease prevention and control need further study. GM production is suitable for further CCA surveillance and monitoring of the population with a high risk score in this area.

Re-Examination of Opisthorchis viverrini in Nakhon Ratchasima Province, Northeastern Thailand, Indicates Continued Needs for Health Intervention

Kaewpitoon, Soraya J,Rujirakul, Ratana,Loyd, Ryan A,Panpimanmas, Sukij,Matrakool, Likit,Tongtawee, Taweesak,Kompor, Porntip,Norkaew, Jun,Chavengkun, Wasugree,Kujapan, Jirawoot,Polphimai, Sukanya,Phati Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.1

Opisthorchis viverrini infection is associated with cholangiocarcinoma particularly in the cases of chronic or re-infection. This presents a serious health problem in northeastern and northern Thailand. A community base approach is required for surveillance. Therefore, in a pilot project, re-examination of O. viverrini infection was conducted in the 3 districts of Nakhon Ratchasima province, Thailand, during June and October 2015. A total of 355 participants from a 194,152 population, was selected through multi-stage sampling. O. viverrini infection was determined using modified Kato Katz thick smear technique. Participants were 229 males and 126 females, and aged ${\geq}30$ years old. Prevalence of O. viverrini infection was 2.25% (8/355 participants). O. viverrini infection was slightly higher in females (3.17%), and age group between 41-50 years (4.49%). Mueang Yang district had a highest of O. viverrini infection rate (2.82%), and followed by Bua Yai (2.48%), and Chum Phuang (1.84%), respectively. O. viverrini infection rate was increased from year 2012 to 2015 particularly in Bua Yai and Mueang Yang. These re-examinion results indicate that opisthorchiasis is still problem in community of Nakhon Ratchasima province, therefore, the provincial-wide scale is need required. Furthermore health education is need intervened in the infected group, and screening of cholangiocarcinoma is urgently concerned.

People Participation Towards Opisthorchis viverrini Prevention and Control in Chaiyaphum Province, Northeastern Thailand

Phongsiripapat, Rutjirapat,Chimplee, Kanokporn,Rujirakul, Ratana,Kaewpitoon, Soraya,Keawpitoon, Natthawut Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.1

This cross-sectional descriptive and qualitative study was aimed to study the people participation and their approaches toward the human carcinogenic liver fluke, Opisthorchis viverrini, prevention and control in Ban Chaun sub-district administrative organization (BCSAO) and Bamnet Narong sub-district municipality (BNSM), Bamnet Narong district, Chaiyaphum Province, Thailand between June 2013 and February 2014. Participants were purposive selected, included chiefs of sub-district administrative organizations, sub-district municipalities, sub-district health promotion hospitals (SHPHs), heads of village, and a further sample was selected with a multi-stage random sampling for public health volunteers, and villagers. The pre-designed questionnaire contained items for individualized status and the participatory steps of sharing ideas, decision-making, and planning, procession, evaluation, and mutual benefit, for the project O. viverrini prevention and control (POPC). In-depth interviews were used for collection of need approaches to POPC. With 375 participants who completed the questionnaire, it was found that people had a high level regarding to participate in the POPC, particularly in the process stage ($\bar{X}=3.78$, S.D. = 0.56), but the lowest level was found in sharing ideas, decision making, and planning step ($\bar{X}=3.65$, S.D. = 0.63). By comparison, participant status and organization did not significantly differ with people participation. In each step, Ban Chaun sub-district had a high level of participation in the step of sharing ideas, decision making, and planning toward POPC, more than Bamnet Narong sub-district municipality (t=2.20, p=0.028). Approaches for POPC in Ban Chaun sub-district and Bamnet Narong sub-district municipality included requirements for budget support, annual campaigns for liver fluke prevention and control, campaign promotion, risk group observation, home visiting, community rules regarding reducing raw fish consumption in their communities, and a professional public health officer for working in their communities, BCSAO, BNSM, and SHPH, for O. viverrini prevention and control. This study indicates that people realize that eradication of the liver fluke needs a continuous people participation for O. viverrini prevention and control in their communities.

Opisthorchis viverrini Infection Among People in the Border Areas of Three Provinces, Northeast of Thailand

Kaewpitoon, Soraya J,Rujirakul, Ratana,Wakkuwattapong, Parichart,Matrakool, Likit,Tongtawee, Taweesak,Panpimanmas, Sukij,Pengsaa, Prasit,Jomkoa, Darawan,Joosiri, Apinya,Kaewpitoon, Natthawut Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.6

Opisthorchis viverrini is still a serious problem in Northeastern and Northern Thailand. Active surveillance is required to determine updated data for further prevention and control planning. Therefore, this study aimed to examine the prevalence and risk factors for O. viverrini in three provinces, Northeastern Thailand. A cross-sectional survey was conducted during October 2015 to March 2016 at Kaeng Sanam Nang district of Nakhon Ratchasima province, Waeng Noi district of Khon Kaen province, and Khon Sawan district of Chaiyaphum province, Thailand. Stool samples were examined by using a modified Kato-Katz Thick smear technique. From a total of 978 participants screened, O. viverrini infection was found in 1.74%, the majority opf positive cases being male (6.62%), age group 51-60 years old (4.21%), educated at primary school (8.43%), occupied with agriculture (9.62%),having an income <4,000 baht per month (4.82%), and living in Khon Sawan district (8.43%). Participants had a high knowledge level (42.43%), good attitude level (34.76%), and fair level (38.04%). The present study indicates the O. viverrini infection rate is low, but elderly males with primary school education involved in agriculture are still frequently effected particularly in Khon Sawan district. Therefore, this risk group requires behavior modification and continued monitoring.

Overweight Relation to Liver Fluke Infection among Rural Participants from 4 Districts of Nakhon Ratchasima Province, Thailand

Kaewpitoon, Soraya J,Rujirakul, Ratana,Wakkuwattapong, Parichart,Matrakool, Likit,Tongtawee, Taweesak,Panpimanmas, Sukij,Kujapun, Jirawoot,Norkaew, Jun,Photipim, Mali,Ponphimai, Sukanya,Chavengkun, Wa Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.5

A cross-sectional survey was conducted among 730 participants from 4 rural districts of Nakhon Ratchasima province, Thailand, with a reported high incidence of liver fluke infection. This study was aimed to examine and evaluate the nutritional status in relation to Opisthorchis viverrini infection. Participants were purposive selected from Chum Phuang, Mueang Yang, Bua Yai, and Kaeng Sanam Nang districts. Stool samples were prepared by Kato Katz technique and then assessed by microscopy. Anthropometry was evaluated according to the body mass index from weight and height. Descriptive statistics and Spearman rank correlation coefficients were used to evaluate the association between the nutritional status and O. viverrini infection. Of 1.64% infected with O. viverrini the highest proportions were found in age groups ${\geq}61$ and 41-50 years old, Mueang Yang district. The majorities of participants had normal weight (32.2%), followed by class II obesity (28.1 %), class I obesity (21.8%), underweight (10.3%), and class III obesity (8.63%). Nutritional status with class II obesity (rS=0.639, p<0.01) and class I obesity (rS=0.582, p<0.05), had moderately statistical significant correlations with O. viverrini infection. Meanwhile, normal weight (rS=0.437, p<0.05) and class III obesity (rS=0.384, p<0.05) demonstrated lower statistical significance. These findings raise the possibility that infection with O. viverrini may contribute to fat deposition and thereby have long-term consequences on human health. Further studies are needed to better understand whether O. viverrini contributes directly to fat deposition and possible mechanisms.