Primary Care Intervention to Prevent and Control Cholangiocarcinoma: Lesson from Nakhon Ratchasima, Thailand
Soraya J. Kaewpitoon MD*,**,***, Ryan A. Loyd MD*, Ratana Rujirakul MEd**, Parichart Wakkuwattapong PhD**, Taweesak Tongtawee MD***,****, Likit Matrakool MD***,****, Sukij Panpimanmas MD***,****, Pontip Kompor MSc*****, Jun Norkaew MSc*****, Jirawoot Kujapun MPH*****, Wasugree Chavengkun MSc*****, Sukanya Ponphimai BSc*****, Mali Pothipim PhD*****, Tanida Phatisena PhD******, Thawatchai Eksanti MSc******, Poowadol Polsripradist PhD*******, Natnapa Padchasuwan MPH********, Fuangfa Benjaoran MD**, Niwatchai Namvichaisirikul MD**, Pattanapong Kuebkuntod BNS***, Natthawut Kaewpitoon PhD**,***,*****
Affiliation : * Parasitic Disease Research Unit, Suranaree University of Technology, Nakhon Ratchasima, Thailand ** School of Family Medicine and Community Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand *** Suranaree University of Technology Hospital, Nakhon Ratchasima, Thailand **** School of Surgery, Suranaree University of Technology, Nakhon Ratchasima, Thailand ***** Faculty of Public Health, Vongchavalitkul University, Nakhon Ratchasima, Thailand ****** Faculty of Public Health, Nakhon Ratchasima Rajabhat University, Nakhon Ratchasima, Thailand ******* Provincial Public Health Office of Nakhon Ratchasima, Nakhon Ratchasima, Thailand ******** Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
Background : Cholangiocarcinoma (CCA) is a bile duct cancer. It includes intra-and extra-hepatic bile duct. It is most
commonly found in Thailand particularly in the northeast and north region. Those regions have been reported as the highest
of incident of the world.
Objective : Primary car interven in the risk areas of CCA among population in Nakhon Ratchasima province,Thailand.
Material and Method: A community-based study was conducted among three districts of Nakhon Ratchasima province,
Thailand including Bua Yai, Chum Phuang, and Mueang Yang district between July and December 2015. Mix method was
used in this study that included cross-sectional survey, action research, and application of Geographic Information System.
The study was composed of five steps, develop Korat CCA network, CCA screening by using Korat CCA verbal screening test,
detection of liver fluke and CCA in the population at risk by using Kato Katz thick smear technique and ultrasonography,
health behavior modification, and development of Geographic Information System for CCA database.
Results : Three hundred fifty five participants were tested for liver fluke infection and the infection rate was found to be 2.25%.
Eight cases from 88 participants at risk had a dilated bile duct. Populations at risk in each district were selected for health
modification briefing that used the social engagement model. Seven community rules were agreed, cooked fish consumption,
stop under-cooked fish, hygienic defecation, CCA campaign, food safety club, annual health check, an ongoing monitoring by
village health volunteer and local public health officer.
Conclusion : Infection in Nakhon Ratchasima is high. A community briefing and rules were agreed. A geovisual display of the
population at risk for CCA is now available.
Keywords : Primary care intervention, Cholangiocarcinoma, Nakhon Ratchasima, Thailand
