Effectiveness of Community Intervention to Prevent and Control Small Liver Flukes in People After 2 Years of Intervention

The study has tested the research questionnaire when participating in answering the questions in the questionnaire before the intervention and after the intervention, the original questionnaire was used again to evaluate, the interviewees can know how to answer and answer better than before. The problem of the questionnaire used before and after the intervention does not affect the research results because the content in the questionnaire coincides with the content of the TTGDSK in the intervention program of the study. Third is the influence of maturity, changes in time, as well as human development can affect the results of the intervention program. The impact of maturity does not affect this study because the intervention research subjects of the study are people aged 15 and over and the intervention content is health communication and education to improve people's knowledge, attitudes, and practices on preventing and controlling SLGN. Fourth, the behavior measured through the questionnaire is self-reported by the people and because of the desire to please the questioner, people can answer in the direction of good behavior. In addition to the above limitations, the implementation of the intervention also encountered some difficulties because some local people work at sea and are rarely at home, so the communication staff had to arrange a reasonable time to visit the household to advise people on measures to prevent and control SLGN. The questionnaire lacked a variable on the history of treatment/deworming within the past 6 months for subjects who did not detect SLGN eggs in the stool, this is a limitation of the study.

4.4.3. Lessons learned from research

During the program implementation, we also learned valuable lessons to help change behaviors to prevent SLGN more effectively, such as:

(1) It is necessary to pay attention to the personal interests of the subject; (2) Discuss as specifically as possible with the subject about the benefits that will be achieved and the risks that will be reduced when implementing new health-beneficial behaviors, behaviors related to SLGN prevention such as not eating raw fish, undercooked fish; not raising free-range livestock; not feeding dogs and cats raw fish; not using fresh manure for production and breeding; using hygienic toilets; not urinating or defecating indiscriminately in ponds, lakes, rivers and streams; not sharing utensils for processing raw food and cooked food for immediate consumption, etc.; (3) Instruct people to practice beneficial behaviors that are easy to implement or

(4) Clearly indicate to the research subjects that beneficial behaviors such as not eating raw fish or undercooked fish; not raising free-range livestock; not feeding dogs and cats raw fish; not using fresh manure for production and animal husbandry; using hygienic toilets; not urinating or defecating in ponds, lakes, rivers, streams; not sharing utensils for preparing raw food and cooked food for immediate consumption; etc. are behaviors that are accepted and supported by the community and society; many people have successfully implemented them; (5) Provide specific instructions and advice on how to practice the above beneficial behaviors and how to overcome obstacles when encountering them; (6) Special attention should be paid to those who do not support behavioral change, focusing on persuading these people to set an example for others; (7) Use specific “examples” to show people how to practice beneficial behaviors as well as the effects and benefits that come from practicing beneficial behaviors.

The lessons learned from this study can be applied to localities with the habit of eating raw fish, undercooked fish and having similar SLGN infection rates as in Rang Dong town, Nghia Hung district, Nam Dinh province.

CONCLUDE

From the results of the research project on community intervention to prevent and control small liver flukes for people in Rang Dong town, Nghia Hung district, Nam Dinh province, we draw some conclusions as follows:

1. Rate of infection with small liver flukes in humans

- The rate of SLGN infection in people aged 1 year and older is 15.8%, no SLGN infection has been detected in people aged 14 years and younger, the rate of SLGN infection in people aged 15 years and older is 18.5%.

- The SLGN species parasitizing humans in Rang Dong town is Clonorchis sinensis .

- 6/7 freshwater fish species are infected with SLGN larvae, including crucian carp 30.0%; silver carp 14.0%; common carp 10.0%; snakehead fish 10.0%; bighead carp 6.0%; tilapia 4.0%.

2. Current status of knowledge, attitude, practice of prevention and control of small liver fluke infection and some factors related to small liver fluke infection among people

- People's knowledge, attitude and practice of preventing and controlling liver fluke infection before intervention were still low.

+ 28.2% of people have correct knowledge about disease transmission, 32.9% think that SLGN is dangerous, knowledge depends on education level (OR=16.7)

+ 58.5% have eaten raw fish or undercooked fish; 42.4% have used the same utensils to prepare raw and cooked food, and 73.8% have used fresh human or animal manure to fertilize fields or raise fish.

- Risk of infection with small liver flukes in Rang Dong related to gender, education, occupation, knowledge and practice of preventing small liver flukes

Men were 5.3 times more likely to have SLGN (OR = 5.3; p < 0.01) than women. People with low education had 2.7 times more likely to have SLGN (OR = 2.7; p < 0.05) than people with high education.

People who did not understand the transmission route of SLGN were 3.2 times more likely to be infected with SLGN (OR = 3.2; p < 0.05) than those who understood the transmission route of SLGN correctly. People who thought SLGN was not a dangerous disease were 4.1 times more likely to be infected with SLGN (OR = 4.1; p < 0.01) than those who thought SLGN was a dangerous disease.

People who ate raw fish, raw fish, or undercooked fish had a 66.3 times higher risk of SLGN infection (OR = 66.3; p < 0.01) than those who did not eat raw fish, raw fish, or undercooked fish.

People who use fresh human or animal manure to fertilize fields or raise fish have a 6.5 times higher risk of SLGN infection (OR = 6.5; p < 0.01) than those who do not.

3. Effectiveness of community intervention to prevent and control small liver flukes in people after 2 years of intervention

The proportion of people who know about the transmission of SLGN increased (28.2% compared to 98.2%). CSHQ was 248.2%; The proportion of people who believe that SLGN can be prevented increased (31.5% compared to 98.5%). CSHQ was 212.7%.

The percentage of people agreeing that SLGN infection is dangerous increased (32.9% compared to 97.9%). CSHQ was 197.6%; The percentage of people supporting SLGN prevention increased (17.9% compared to 98.2%). CSHQ was 450.3%.

The proportion of people eating raw fish and undercooked fish decreased (58.5% compared to 0.9%). The CSHQ was 98.5%; The proportion of people using the same utensils to prepare raw food and cooked food for immediate consumption decreased (42.4% compared to 1.8%). The CSHQ was 95.8%; The proportion of people using fresh human and livestock manure to fertilize fields and raise fish decreased (73.8% compared to 0.3%). The CSHQ was 99.6%.

The rate of SLGN egg clearance after 24 months of intervention was 100.0%; The rate of egg reduction after 6 months and 12 months was 75.8%; 100.0%, respectively; The rate of reinfection after 6 months was 3.2%; after 12 months was 1.6% and after 24 months was 0.0%. The rate of new infection after 24 months was 0.0%.

RECOMMENDATION

1. Local authorities need to pay attention and direct health stations and local departments, branches and organizations to continue maintaining activities to prevent and control SLGN.

2. The town's interdisciplinary steering committee for food safety and hygiene annually needs to build SLGN prevention and control content into the local food safety implementation plan.

3. The health station is the focal unit advising the Town People's Committee to strengthen inter-sectoral coordination and socialization of HIV/AIDS prevention and control work. Every year, plans are developed and implemented to integrate HIV/AIDS prevention and control content into regular meetings of the health station and local departments, branches and organizations.

4. Mass organizations (Farmers' Association, Women's Association, Elderly Association, Ho Chi Minh Communist Youth Union) continue to integrate the content of preventing and combating HIV/AIDS into regular meetings of mass organizations in the area.

5. It is necessary to continue researching and proposing solutions to control SLGN infection in freshwater fish species.

LIST OF PUBLISHED WORKS OF THE AUTHOR RELATED TO THE THESIS TOPIC

1. Luong Thi Phuong Lan, Nguyen Van De (2012), “Using morphological and molecular biological methods to identify food-borne parasites in Nam Dinh”, Journal of Practical Medicine , No. 842, pp. 268-272.

2. Luong Thi Phuong Lan , Nguyen Van De (2012), “Status of SLGN infection and treatment effectiveness with praziquantel dose of 75mg/kg/24 hours at a location in the Northern Delta”, Journal of Practical Medicine , No. 842, pp. 275-278.

3. Luong Thi Phuong Lan , Nguyen Van De, Nguyen Dinh Dung (2015), " Identifying SLGN pathogen contamination that transmits disease to humans in some fish species raised in Rang Dong town, Nghia Hung district, Nam Dinh province" (2014), Preventive Medicine Journal, volume XXV, No. 5 (165), 2015, pages 446-450 (Presented at the 2015 Preventive Medicine Conference).

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