Children are key to changing behavior to reduce infection

The school Yangyang was getting weaker every day. When his symptoms worsened with diarrhea and abdominal pain, his parents took him to the nearest hospital in Guangxi, southeast China, where a doctor examined him upon arrival and received treatment. To confirm his suspicion, the doctor ordered an examination of the fecal disease. The result confirmed that Yangyang contracted a parasitic liver infection that can be caused by eating raw fish – a traditional dietary practice that has developed into a growing public health problem in China.

“This practice of eating raw freshwater fish is passed down from generation to generation, especially among the class of workers who include farmers, manual workers and fishermen,“Said Dr. Men-Bao Qian, vice president of the Department of Soil Control and Food-Parasitic Diseases, National Institute of Parasitic Diseases, China Center for Disease Control and Prevention.

It is estimated that 10 million Chinese people suffer from clonorchiasis (a disease of the Chinese liver flake) caused by an infection with Clonorchis sinensis, This parasite is thought to be mainly prevalent in Guangdong, Guangxi and Heilongjiang provinces.

Behavioral trial

In addition to medical treatment, researchers believe that behavior can change among young people by providing accurate information to encourage change. A recent study of behavioral interventions in southeastern China found that clonorchiasis can be significantly controlled by informing and educating children about the harmfulness of eating raw or undercooked freshwater fish or shrimp.

According to Dr. Xiao-Nong Zhou, “Establishing the mechanism that drives the practice of eating fish with freshwater fish is crucial to devising a sustainable strategy to combat clonorelia“Adding that we” previously focused on adults because they are the main population suffering from this disease. We neglected to assess how they are developing this particular dietary practice. “

Persistent practices of eating raw fish, especially in adult males, result in frequent re-infection. Health education must discourage such practices by acknowledging the challenges of advocating for changes in eating practices in adult men. Field experiences show a relationship between these eating practices among family members.

Study findings

The study investigated the eating practices of raw and freshwater fish among families in the four main provinces of clonochiasis in eastern China. A total of 23,232 students from 15 counties were included as participants and provided data for themselves and their parents. The practice was found to be greater in families with boys than with girls.

Parental habits have had a strong impact. The adjusted ratio ratio in student feeding practice was 10.5 (95% confidential intervals (95% CI): 9.4–11.7) for those with father practice, 33.6 (95% CI: 26.3–42) , 9) in those with mothers «practice and 47.1 (95% CI: 42.0–52.8) in persons who have practice of both parents.

Interaction also existed among the spouses, with the influence of the husband on his wife being greater than that of the husband on the husband.

The belief that they will not eat freshwater fish in the future decreased with age and was lower in boys than in girls. This declining belief in children was related to the practice of eating raw material by parents; children who had previously eaten raw freshwater fish were less likely to believe they would not eat raw fish in the future.

These results suggest that individuals have become accustomed to consuming raw freshwater fish due to intergenerational assimilation by parents and marriage. These individuals pass the practice on to their children, resulting in constant practice and clonorchiasis infections in subsequent generations.

“The findings explain epidemiological profiles, namely the higher incidence of men and adults; persistence of clonorelia in East Asia, as well as difficulties in persuading adult males to give up eating raw food,“Said Dr. Bernadette Abela-Ridder, Team Leader, Veterinary Public Health, Vector Control and Environmental Protection, WHO Department for the Control of Neglected Tropical Diseases.”It also implies that early childhood education will be useful in the long-term control of clonorchiasis.“

Early behavioral intervention reduces the practice of eating freshwater fish in school children.

The researchers then conducted research under clusters in primary schools in southeast China to investigate the effectiveness of behavioral intervention aimed at schoolchildren. Basic research gathered knowledge about the transmission and symptoms of clonorchiasis, the practice of swallowing raw freshwater fish, and the belief that such a practice would be discontinued in the future. Comprehensive educational activities were conducted in one intervention school, and an evaluation survey was conducted after 6 and 12 months to record changes in knowledge, practice, and beliefs.

“The application of appropriate educational products and educational approaches is important,“Dr. Qian of the Chinese Centers for Disease Control and Prevention said.” We need to consider the different characteristics of children. “

The researchers also devised a cartoon, called “Changing the Life of a Liver Flake,” to present the story of Yangyang and the doctor who educated him and his comrades. Information on transmission, symptoms, prevention, and control is displayed sequentially, with actual images integrated into the cartoon to enhance student engagement. Comprehensive educational activities have been launched at the school, and billboards with information about the disease have been placed in public areas. The cartoon was shown to the students, each of whom received an educational brochure and was encouraged to participate in competitions for drawing and writing essays on the control and prevention of clonorelia.

In the school where the survey took place, the percentage of students with knowledge of the route of transmission, early symptoms, complications and carcinogenicity increased from 15.0% to 78.5%, from 6.5% to 36.8%, from 4.0% to 93.9% and from 4.5% to 49.4% after 12 months.

Of the 247 students (6.5%), 16 ate raw freshwater fish during the year immediately prior to the initial study; 12 months later, that number dropped to 3 (1.2%). The percentage of students who were convinced that they should stop eating raw freshwater fish in the future was 70.9% and 97.2% 12 months later.

“Similar studies are needed for other food-borne trematodiases,” Dr. Abela-Ridder said. “Further solid evidence will promote the control of food-borne trematodiases and the benefits of populations in endemic areas.“

Other trematode infections in food, which also result in a high disease burden, are caused by other human livers opisthorchis viverrini and O. felineus, which have biological and epidemiological characteristics similar C. sinensis.

Further reading

Qian MB, Jiang ZH, Zhou CH, Ge T, Wang X, Zhou XN. Family assimilation in transmitting the practice of eating fish with freshwater fresh water leading to clonorchiasis. PLOS Negl says too much. 2020 14 (4): e0008263. doi: 10.1371 / journal.pntd.0008263. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008263

Qian MB, Gan XQ, Zhao JG, Zheng WJ, Li W, Jiang ZH, et al. The effectiveness of health education in improving the knowledge, practices and beliefs associated with clonorchiasis in children. Acta Too. 2020 207: 105436. doi: 10.1016 / j.actatropica.2020.105436. https://www.sciencedirect.com/science/article/abs/pii/S0001706X20300668?via%3Dihub