The Integrated Opisthorchiasis Control Program, commonly known as the "Lawa Project", located in Khon Kaen Province,

Thailand Thailand ( ), historically known as Siam () and officially the Kingdom of Thailand, is a country in Southeast Asia, located at the centre of the Indochinese Peninsula, spanning , with a population of almost 70 million. The country is bo ...

, is an effort to reduce chronic infection by the Southeast Asian

liver fluke Liver fluke is a collective name of a polyphyletic group of parasitic trematodes under the phylum Platyhelminthes. They are principally parasites of the liver of various mammals, including humans. Capable of moving along the blood circulation, t ...

(''

Opisthorchis viverrini ''Opisthorchis viverrini'', common name Southeast Asian liver fluke, is a food-borne trematode parasite from the family Opisthorchiidae that infects the bile duct. People are infected after eating raw or undercooked fish. Infection with the par ...

'') among the native peoples of

Isan Northeast Thailand or Isan (Isan/ th, อีสาน, ; lo, ອີສານ; also written as Isaan, Isarn, Issarn, Issan, Esan, or Esarn; from Pali ''īsānna'' or Sanskrit ईशान्य ''īśānya'' "northeast") consists of 20 provin ...

( th, อีสาน; ), the northeast region of Thailand. The project operates under the aegis of the Tropical Disease Research Laboratory, Department of Pathology, Faculty of Medicine,

Khon Kaen University Khon Kaen University ( th, มหาวิทยาลัยขอนแก่น) or KKU (มข.) is a public research university, and it is one of the most prestigious universities in Thailand. The university was the first institution of highe ...

. It is directed by Banchob Sripa. Its aim is to eliminate the practice of consuming raw or undercooked fish, the major cause of liver fluke infection and

bile duct cancer Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Light colored stool ...

in the region. The project is unique in that it follows the principles of

EcoHealth Health ecology (also known as eco-health) is an emerging field that studies the impact of ecosystems on human health. It examines alterations in the biological, physical, social, and economic environment to understand how these changes impact ...

, a

One Health One Health is an approach calling for "the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals and our environment", as defined by the One Health Initiative Task For ...

approach to improving human and animal health. The project has been the subject of newspaper and TV reports by BBC, ''The New York Times'', and ''The Guardian''.

The area and population

The project area consists of several villages around the ''Kaeng Lawa'' (Thai: แก่งละว้า), a lake and wetlands about 25 kilometers south of the city of Khon Kaen. The people's primary occupations are rice farming and fishing. The lake is a source of the

cyprinid Cyprinidae is a family of freshwater fish commonly called the carp or minnow family. It includes the carps, the true minnows, and relatives like the barbs and barbels. Cyprinidae is the largest and most diverse fish family and the largest verte ...

fish that the locals consume raw in dishes known as ''

koi pla ''Koi'' ( lo, ກ້ອຍ; th, ก้อย, ) is a "salad" dish of the Lao people living in modern-day Laos and Isan, Thailand, consisting of raw meat denatured by acidity, usually from lime juice. Common varieties include ''koi kung'' ( th, � ...

'' and ''pla som'', which are often infested with the cysts or

metacercariae Trematodes are parasitic flatworms of the class ''Trematoda'', specifically parasitic flukes with two suckers: one ventral and the other oral. Trematodes are covered by a tegument, that protects the organism from the environment by providing secr ...

of the liver fluke. Cats and dogs also ingest the fish, making them hosts for the fluke. Northeast Thailand still has the highest incidence of bile duct cancer in the world, and the prevalence of ''O. viverrini'' infection in some villages in Khon Kaen Province has reached 100 percent. VillagehealthvolunteersfromLAWAproject

Lawa model

The first attempts at opisthorchiasis control in Thailand began in the 1950s and included education on liver fluke infection and safe cooking, but these efforts had limited success since the consumption of raw fish dishes is an ingrained part of the rice-fish culture of the indigenous people. With the introduction of

praziquantel Praziquantel (PZQ), sold under the brandname Biltricide among others, is a medication used to treat a number of types of helminthiasis, parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is us ...

in the 1980s, treatment became a part of the program. The prevalence of infection was reduced, but after funding reductions during the

economic crises A financial crisis is any of a broad variety of situations in which some financial assets suddenly lose a large part of their nominal value. In the 19th and early 20th centuries, many financial crises were associated with banking panics, and man ...

in the 1990s, prevalence rates rose again to as high as 85 percent in some areas of the northeast by 2009. In 2007, researchers at Khon Kaen University, led by Banchob Sripa, decided to take a more multidisciplinary approach, incorporating EcoHealth principles, which involve the collaboration of human and animal health specialists toward improving the health of people, animals and the environment as well as achieving greater understanding of how the ecosystem affects human and animal health. The "Lawa model" as it became known, involves community participation as a key element. Village health volunteers, staff of local sub-district hospitals, teachers, and others maintain a campaign of continuous education, teaching in the community and the schools about liver fluke disease and discouraging the consumption of raw or undercooked fish. The campaigns often involve "edutainment" activities (songwriting, dancing, and music) to attract public attention.

Benefits

After implementation of the Lawa model, the prevalence of infection declined from 67 percent to 16 percent over three years in Lawa village with little reinfection after treatment, a common reason for failure in the past. An intensive program in nine schools in the village reduced infection to undetectable levels. In 2012, the schools were certified as liver fluke free. Infection typically begins in childhood, leading to the lifelong chronic infection that often results in cancer. An analysis conducted by the university on the

social return on investment Social return on investment (SROI) is a principles-based method for measuring extra-financial value (such as environmental or social value not currently reflected or involved in conventional financial accounts). It can be used by any entity to e ...

estimates a return of 3.47 relative to resources invested, with the primary benefit going to villagers and especially the children of the students who should avoid a lifetime of chronic infection and its possible consequences. Such projects are hard to assess solely on the basis of an economic analysis.

References

{{DEFAULTSORT:Integrated Opisthorchiasis Control Program, or Lawa Project in northeast Thailand Healthcare in Thailand Helminthiases Infectious causes of cancer IARC Group 1 carcinogens Foodborne illnesses Tropical diseases