การศึกษาประสิทธิภาพของการบันทึกพฤติกรรมการบริโภคปลาดิบอย่างต่อเนื่องด้วยตนเองเพื่อป้องกันการติดเชื้อพยาธิใบไม้ในตับ ณ บ้านทุ่งเหียง ต. ท่ากระดาน อ. สนามชัยเขต จ. ฉะเชิงเทรา

Abstract

Background: Opisthorchiasis caused by Opisthorchis viverrini remains a major public health problem in Thailand. Although a long decade use of public health prevention and control program for opisthorchiasis were well established the results of these interventions have not been fully satisfied. The persitting high prevalence of opisthorchiasis insome areas especially the North and the Northeast of Thailand represent that people still continue consuming  uncooked fresh-water fish.The behavioral change theory named Preceed Model conceptualized that the sustainablebehavioral  change needs 3 components which are predisposing reinforcing and enabling factors. The failure of opisthorchiasis  control program might be due to lack of reinforcing and enabling factors. Thus we added the on-goinguncooked fish consuming self report to fulfill the opisthorchiasis control. Objectives: To evaluate the effectivenessof  on-going uncooked fish consuming self-report for opisthorchiasis prevention. Study Design: ExperimentalStudy Materials and Methods: Community Trial was performed at Baan. Tunghaeng Village. Chachoengsao. Theenrolled  participants were persons who were negative for opisthorchiasis from stool examination  during the baselinesurvey  on October 2006 and signed informed consents. The population was divided into 2 groups the control groupwhich  obtained only health education for opisthorchiasis prevention and the intervention group which obtained bothhealth  education and on-going uncooked fish consuming self-report. When consumed uncooked  or raw fish villagersneed  to record in the self-report calendar. Then the indepth-information for that consumption  was done by usingthe weekly consuming self-report. After 1 year follow- up risk factors were determined by using standardized questionnaires. Opisthorchiasis case detection was performed using double blind stool examination  by modified Katothick technique and formalin ethyl acetate concentration technique. Moreover Geographic  Information System(GIS) had  been applied to study the relationship between spatial risk and incidence of opisthochiasis. Results: Therewere  318 enrolled participants in this study (response rate = 72.93%). There were 203  subjects in the control group 42 Royal Thai Army Medical Journal Vol. 62 No. 1 January-March 2009 วรรณวิภา มาลัยทอง และคณะand  114 subjects in the intervention group (response rate = 69.8% and 77.9% respectively). The results revealed thatthere were not statistically different in gender age group educational level and occupation between these two groups. The incidence rates of the former and the latter were 11.11 and 5.84 person-months respectively. The control groupwas  2.07 times at greater risk to acquire the opisthorchis infection than the intervention group after adjusted by genderand age groups (p=0.041;95%CI 1.02-4.22). Geographic information system (GIS.)  revealed that households that obtainedonly health education were 2.54 times more likely to increase in infected members than those who obtained both  healtheducation and on-going self-report (p <0.001; 95%CI 1.57-4.11).We also found the risk factors for opisthorchiasisincluding.  Chopped raw fish salad or Koi-pla consumption male gender and older age groups. Conclusion: Inaddition to predisposing, reinforcing and enabling factors are necessary for opisthorchiasis  control. Opisthorchiasiscontrol strategies were fulfilled by adding the on-going uncooked fish consuming  self-report to health education based on Preceed Model and will lead to sustainable opisthorchiasis prevention.