title: Untangling the Complexity of Liver Fluke Infection and Cholangiocarcinoma in NE Thailand Through Transdisciplinary Learning.
abstract: This study demonstrates how a transdisciplinary learning approach provided new insights for explaining persistent Opisthorchis viverrini infection in northern Thailand, as well as elucidating problems of focusing solely on the parasite as a means of addressing high prevalence of cholangiocarcinoma. Researchers from diverse backgrounds collaborated to design an investigative homestay program for 72 Singaporean and Thai university students in five northeast Thai villages. The students explored how liver fluke infection and potential cholangiocarcinoma development are influenced by local landscape dynamics, aquatic ecology, livelihoods, food culture and health education. Qualitative fieldwork was guided daily by the researchers in a collaborative, co-learning process that led to viewing this health issue as a complex system, influenced by interlinked multidimensional factors. Our transdisciplinary experience has led us to believe that an incomplete understanding of these linkages may reduce the efficacy of interventions. Further, viewing liver fluke infection and cholangiocarcinoma as the same issue is inadvisable. Although O. viverrini infection is an established risk factor for the development of cholangiocarcinoma, multiple factors are known to influence the likelihood of acquiring either. Understanding the importance of the current livelihood transition, landscape modification and the resulting mismatch between local cultures and new socio-ecological settings on cholangiocarcinoma initiation and liver fluke transmission is of critical importance as it may help readjust our view of the respective role of O. viverrini and other socioeconomic risk factors in cholangiocarcinoma etiology and refine intervention strategies. As demonstrated in this study, transdisciplinary approaches have the potential to yield more nuanced perspectives to complex diseases than research that focuses on specific aspects of their epidemiology. They may therefore be valuable when designing effective solutions to context-sensitive diseases such as liver fluke infection and cholangiocarcinoma.
authors.affiliation: Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore. geoadz@nus.edu.sg.
authors.forename: A D
authors.initials: AD
authors.lastname: Ziegler
authors.affiliation: Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.|Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand.|Department of Biology, Laurentian University, Sudbury, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Echaubard
authors.affiliation: Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
authors.forename: Y T
authors.initials: YT
authors.lastname: Lee
authors.affiliation: Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
authors.forename: C J
authors.initials: CJ
authors.lastname: Chuah
authors.affiliation: Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
authors.forename: B A
authors.initials: BA
authors.lastname: Wilcox
authors.affiliation: Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
authors.forename: C
authors.initials: C
authors.lastname: Grundy-Warr
authors.affiliation: Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.|Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.|Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Sithithaworn
authors.affiliation: Department of Ecology and Parasitology, Karlsruhe Institute of Technology, Kornblumenstrasse 13, Karlsruhe, Germany.|Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: T N
authors.initials: TN
authors.lastname: Petney
authors.affiliation: Office of Prevention and Control 8, Udonthani Province, Thailand.
authors.forename: L
authors.initials: L
authors.lastname: Laithevewat
authors.affiliation: Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
authors.forename: X
authors.initials: X
authors.lastname: Ong
authors.affiliation: Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.|Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.|Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: R H
authors.initials: RH
authors.lastname: Andrews
authors.affiliation: Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
authors.forename: T
authors.initials: T
authors.lastname: Ismail
authors.affiliation: Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: B
authors.initials: B
authors.lastname: Sripa
authors.affiliation: Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: N
authors.initials: N
authors.lastname: Khuntikeo
authors.affiliation: Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Poonpon
authors.affiliation: Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Tungtang
authors.affiliation: Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Tuamsuk
mesh_terms: D000818:Animals; D001650:Bile Duct Neoplasms / Q000469:parasitology*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000469:parasitology*; D005210:Fasciola hepatica / Q000472:pathogenicity*; D006801:Humans; D009889:Opisthorchiasis / Q000150:complications*; D009891:Opisthorchis; D012307:Risk Factors; D013785:Thailand
keywords: Bithynia snails; Isaan–Lao culture; Opisthorchis viverrini sensu lato; cholangiocarcinoma; cyprinid fish; food safety; health education; livelihood change; raw or uncooked fish
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