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.

Experimental and modelling investigations of Opisthorchis viverrini miracidia transmission over time and across temperatures: implications for control

“…The relevance of this amended conceptual and methodological framework for an improved understanding of O. viverrini transmission dynamics aligns with recent propositions advocating the development of interdisciplinary research agendas and transdisciplinary actions for more sustainable disease control (Echaubard et al, 2015, 2016; Ziegler et al, 2016, Wilcox and Echaubard, in press).…”

The role of evolutionary biology in research and control of liver flukes in Southeast Asia

“…Cholangiocarcinoma incidence in Northeast Thailand is the world’s highest, ranging from 93.8 to 317.6/100,000 (Sithithaworn et al 2014). Although there is strong evidence indicating that Ov infection is a primary cause of CCA carcinogenesis (IARC, 1994, 2011, Miwa et al 2014, Sithithaworn et al 2014) other factors, including dietary, life style and genetic components (Miwa et al 2014, Sithithaworn et al 2014), are also likely to play a role calling for more integrative investigations (Ziegler et al 2016). …”

Untangling the proximate causes and underlying drivers of deforestation and forest degradation in Myanmar

“…Systems‐thinking and causal‐network analysis are tools that have a wide range of applications, including business (Sterman ), public health (Ziegler et al. ), and land‐use change (Geist & Lambin ).…”

“…Constructing causal networks-visual representations of the interconnections between underlying processes in a system-is a key component of the systems-thinking approach and is useful for identifying the key linkages that underpin a complex process. Systems-thinking and causal-network analysis are tools that have a wide range of applications, including business (Sterman 2000), public health (Ziegler et al 2016), and land-use change (Geist & Lambin 2002).…”