Infection with Opisthorchis viverrini and Use of Praziquantel among a Working-age Population in Northeast Thailand

Infection with Opisthorchis viverrini (OV) due to eating certain traditional freshwater fish dishes is the principal risk factor for cholangiocarcinoma in Northeast Thailand where the infection is endemic and the incidence of this form of primary liver cancer has been the highest in the world. This paper is the second report of a prospective research project to monitor the impacts of a national liver fluke control programme in a rural community of Northeast Thailand. A sample of 684 villagers aged 20-65 years completed an interview questionnaire and were tested for infection using the Kato thick smear technique. The questionnaire was designed for the exploration of associations between OV infection, previous treatment with praziquantel, and knowledge and beliefs about the drug. The data were analysed using descriptive statistics and multiple logistic regression. The overall prevalence of OV infection was 37.2% and was highest in the 20-35 year age group, in those with a university degree and in those employed in the government sector. As many as 91.8% reported eating fish dishes known to place them at risk of infection. In the multiple regression analysis, previous use of praziquantel and lack of knowledge about whether or not the drug has a protective effect against re-infection were the only factors related to OV infection ($OR_{adj}$= 2.31, 95%CI =1.40-3.79 and $OR_{adj}$= 1.95, 95%CI= 1.24-3.05). The findings were discussed in terms of the possibly unwise dependency on praziquantel as a primary element in a control programme.