Determinants of Clonorchis sinensis infection and subsequent treatment: a qualitative study in Guangxi, China

Clonorchiasis is caused by the ingestion of raw freshwater fish containing the metacercariae of Clonorchis sinensis. High burden is exerted by clonorchiasis in East Asia, especially in China. Treatment is compulsory to control the morbidity, while mass drug administration and selective drug administration are recommended in high endemic areas. Few qualitative studies have been implemented to explore the knowledge, attitudes, and practices (KAP) towards clonorchiasis as well as the treatment. In 2024, a qualitative cross-sectional study was conducted in two clonorchiasis-endemic villages of Binyang county, Guangxi, China. A total of ten focus group discussions (FGDs) were carried out, involving 52 participants (10 village leaders, 2 village doctors and 40 villagers). Interview focused on the knowledge on harm, transmission, treatment and prevention of clonorchiasis, and attitudes and practices to ingesting raw freshwater fish ("yusheng") and treatment. Recorded data were transcribed and analyzed manually by using thematic analysis. About half of the participants (25/52) reported the practice of consuming "yusheng", with a higher percentage in males (84.00 %, 21/25) than in females (16.00 %, 4/25), which is relevant to the differences in dietary predilection and social roles. Especially, a dinner party at festivals is an important contributor in male's ingestion of "yusheng". Although 76.92 % of the participants (40/52) acknowledged the potential health risks associated with the ingestion of "yusheng", most were unaware of the severe morbidities caused by C. sinensis. Furthermore, some people hold a misconception on the additional nutritional value of "yusheng". Most of the participants (88.46 %, 46/52) had not undergone treatment for clonorchiasis. The participants tended to take medicine while a definite diagnosis of infection was made, and especially low compliance was demonstrated in the individuals without the practice of ingesting "yusheng". Additionally, the price of the drug and delivery approach also impacted their choices. Village leaders and doctors believed the importance to implement control for clonorchiasis, and health education was suggested to increase the compliance in treatment. In the studied areas, the endemicity of clonorchiasis is driven by the cultural identification, inadequate knowledge, as well as misconception, which demonstrate significant difference in different populations. The choice of treatment is highly impacted by the definite diagnosis and individual's dietary habit, which may hinder the adoption of drug administration at population level. To control and prevent clonorchiasis, health education is suggested to increase the knowledge including the harm and importance of subsequent drug administration.