Epidemiology and determinants of Clonorchis sinensis infection in Binyang County, Guangxi in 2022

doi:10.12140/j.issn.1000-7423.2024.06.003

Abstract

Abstract:

Objective To investigate the epidemiological characteristics of, and knowledge, attitude, and practice towards Clonorchis sinensis infections in humans in Binyang County, Guangxi in 2022, for providing insights into formulation of targeted control measures. Methods Binyang County in Guangxi was geographically divided into five regions (eastern, western, southern, northern, and central) in 2022, and one township was sampled from each geographical region, followed by one administrative village (community) sampled from each township. Two hundred residents at ages of over 3 years were sampled from each administrative village (community) using a cluster sampling method, and participants’ stool specimens were sampled for detection of C. sinensis eggs using a modified Kato-Katz thick smear method (two smears from one stool sample). One questionnaire survey was performed in each household, and 40 residents were sampled from each village for individual questionnaire surveys on knowledge, attitude, and practice towards clonorchiasis control. The differences in the awareness of clonorchiasis control knowledge, practice towards consumption of raw freshwater fish, and attitude to consume raw freshwater fish were compared among different participants with Chi-square test or Fisher’s exact test. In addition, univariate and multivariate logistic regression models were employed to identify factors affecting the prevalence of C. sinensis infections in humans, practice of consuming raw freshwater fish, and attitude towards consumption of raw freshwater fish in future among participants. Results A total of 1 007 residents received stool examinations, and 372 household questionnaire surveys and 202 individual questionnaire surveys were completed, including 175 individuals completing both stool examinations and questionnaire surveys. The overall prevalence of C. sinensis infections was 15.49% [95% confidential interval (CI): (13.25%, 17.73%)] among participants, with the highest prevalence in Silong Township [22.00%; 95% CI: (15.84%, 27.38%)] (P < 0.05), and the prevalence was higher in males [26.32%; 95% CI: (22.27%, 30.06%)] than females [5.07%; 95% CI: (3.16%, 6.97%)] (P < 0.05). The prevalence of C. sinensis infections in humans raised and then decreased following the increase of ages, with a peak at ages of 45 to 59 years [24.31%; 95% CI: (19.01%, 29.61%)] (P < 0.05), and the highest prevalence was found among participants with an educational level of junior high school [23.77%; 95% CI: (19.89%, 27.64%)] (P < 0.05). Among the 372 households surveyed, the proportions of households preparing raw freshwater fish less than once, once to 10 times, 11 to 50 times and more than 50 times annually were 4.03% (15/372), 21.77% (81/372), 15.06% (56/372) and 8.60% (32/372), respectively. Notably, Binzhou Township recorded the highest proportion of households preparing raw freshwater fish once to 10 times annually (83.64%, 46/55), and Xinxu Township recorded the highest proportion of households preparing raw freshwater fish 11 to 50 times annually (50.47%, 54/107) and more than 50 times annually (29.91%, 32/107), respectively (P < 0.05). The highest proportion of households that had purchased raw freshwater fish from outside was found in Silong Township (35.09%, 20/57) (P < 0.05), and the highest proportion of households that had presented raw freshwater fish to their neighbors was seen in Binzhou Township (51.81%, 43/55) (P < 0.05), while both the highest proportion of households that had received raw freshwater fish from neighbors (99.07%, 106/107) and did not separate raw and cooked chopping boards in daily life (98.08%, 102/104) was found in Xinxu Township (P < 0.05). The awareness of hearing of clonorchiasis, knowing the transmission route of clonorchiasis and knowing the harm of clonorchiasis was 54.46% (110/202), 50.00% (101/202) and 38.12% (77/202) among all participants, with 63.00% (63/100), 59.00% (59/100), and 46.00% (46/100) in males and 46.08% (47/102), 41.18% (42/102), and 30.39% (31/102) in females, respectively (P < 0.05), and the awareness was higher in Gula Township (92.50%, 37/40; 92.50%, 37/40; 90.00%, 36/40), among the elderly at ages of 60 years and older (71.43%, 45/63; 63.49%, 40/63; 50.79%, 32/63), Han ethnic group (58.29%, 102/175; 54.29%, 95/175; 41.14%, 72/175), and participants with an educational level of senior high school and above (87.50%, 14/16; 81.25%, 13/16; 62.50%, 10/16) (P < 0.05). There were 26.73% (54/202) of respondents reporting ingestion of raw freshwater fish, with a higher percentage in Silong Township (45.00%, 18/40) (P < 0.05). The percentage of consuming raw freshwater fish was higher in males (45.00%, 45/100) than females (8.82%, 9/102) (P < 0.05), and the highest proportion of consuming raw freshwater fish was seen among participants at ages of 30 to 44 years (42.31%, 11/26) (P < 0.05). There were 80.69% (163/202) of respondents that were willing to stop consuming raw freshwater fish in future, with a higher proportion in females (97.06%, 99/102) than males (64.00%, 64/100) (P < 0.05). Univariate logistic regression analysis showed that C. sinensis infection was associated with gender, age, awareness of clonorchiasis, frequency of preparing and consuming raw freshwater fish and way of acquiring raw freshwater fish (P < 0.05), and the practice of consuming raw freshwater fish was associated with gender, awareness of clonorchiasis, understanding routes of C. sinensis infection, having experiences of preparing raw freshwater fish, having experiences of purchasing raw freshwater fish from outside, and having experiences of presenting or receiving raw freshwater fish (P < 0.05), while factors affecting the attitude towards consumption of raw freshwater fish in future included gender, age, positive fecal test, frequency of consuming raw freshwater fish, and having experiences of receiving raw freshwater fish from neighbors (P < 0.05). Multivariate logistic regression analysis revealed that the prevalence of C. sinensis infections was 30.01 [95% CI: (7.56, 152.04)] times among respondents consuming raw freshwater fish once to 5 times annually and 81.40 [95% CI: (7.78, 287.37)] times than among those consuming raw freshwater fish more than 5 times annually relative to individuals without ingestion of raw freshwater fish, and the prevalence was 15.18 [95% CI: (2.15, 123.25)] times higher among respondents that had received raw freshwater fish from their neighbors than among those who had not. The proportion of consuming raw freshwater fish was 17.58 [95% CI: (6.21, 61.88)] times in males than females, and the proportion of consuming raw freshwater fish was 15.75 [95% CI: (1.40, 185.99)] times among respondents that knew clonorchiasis than among those who did not, while the percentages of continuing to consume raw freshwater fish were 3.66 [95% CI: (1.85, 4.32)] times among respondents with consumption of raw freshwater fish once to five times annually and 3.55 [95% CI: (1.17, 3.03)] times among those with consumption of raw freshwater fish more than five times annually than among individuals without consumption of raw freshwater fish. Conclusion The prevalence of C. sinensis infection is high in Binyang County, Guangxi, notably among adult males, and the special dietary habit of consuming raw freshwater fish is the major cause of C. sinensis infections among human. Intensified health education and changes of the behavior of consuming raw freshwater fish are required to achieve sustainable clonorchiasis control.

Key words: Clonorchiasis, Knowledge, Practice, Attitude, Determinant

CLC Number:

R532.23

ZHU Yuying, ZHAO Jiaguang, ZHOU Changhai, ZHU Tingjun, HUANG Jilei, MENG Jun, JIANG Zhihua, ZHOU Xiaonong, LI Shizhu, QIAN Menbao. Epidemiology and determinants of Clonorchis sinensis infection in Binyang County, Guangxi in 2022[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2024, 42(6): 701-714.

Figures/Tables 8

Table 1

Fig. 1

Table 2

Fig. 2

Fig. 3

Table 3

Univariate and multivariate logistic regression analyses of factors affecting Clonorchis sinensis infections among different populations in Binyang County, Guangxi, 2022 (n = 175)

变量 Variable	调查人数 No. Surveyed	粪检阳性例数（占比） No. case with C. sinensis infection (ratio/%)	粗OR（95% CI） Crude OR (95% CI)		P		调整后OR（95% CI）^a Adjusted OR (95% CI)^a	P
乡镇 Villages					> 0.05
宾州镇 Binzhou	29	11 (37.93)	-
古辣镇 Gula	38	3 (7.89)	0.14 (0.02~0.64)		< 0.05
黎塘镇 Litang	40	6 (15.00)	0.29 (0.08~1.04)		> 0.05
思陇镇 Silong	33	12 (36.36)	0.94 (0.29~2.98)		> 0.05
新圩镇 Xinxu	35	7 (20.00)	0.42 (0.11~1.43)		> 0.05
性别 Gender					< 0.05
女性 Female	89	7 (7.87)	-
男性 Male	86	32 (37.21)	9.85 (3.90~30.26)
年龄/岁 Age/Year					< 0.05
≤ 29	54	3 (5.56)	-
30~44	24	9 (37.50)	10.12 (2.67~50.58)		< 0.05
45~59	42	11 (26.19)	6.03 (1.73~28.23)		< 0.05
≥ 60	55	16 (29.09)	6.97 (2.14~31.51)		< 0.05
民族 Ethnicity					> 0.05
汉族 Han	151	32 (21.19)	-
壮族 Zhuang	24	7 (29.17)	1.58 (0.57~4.03)
文化程度^bEducation level^b					> 0.05
文盲或半文盲 Illiteracy or semi-illiteracy	3	0 (0)	-
小学 Primary school	79	13 (16.46)	-
初中 Junior high school	79	24 (30.38)	2.22 (1.03~4.76)		< 0.05
高中及以上 Senior high school and above	14	2 (14.29)	0.85 (0.17~4.26)		> 0.05
知晓华支睾吸虫病 Hearing of clonorchiasis					< 0.05
否 No	79	11 (13.92)	-
是 Yes	96	28 (29.17)	3.21 (1.45~7.68)
了解感染途径 Knowing transmission route					< 0.05
否 No	85	14 (16.47)	-
是 Yes	90	25 (27.78)	2.35 (1.11~5.22)
了解疾病危害 Knowing the harm of disease					> 0.05
否 No	105	21 (20.00)	-
是 Yes	70	18 (25.71)	1.60 (0.77~3.36)
食“鱼生”频次 Frequency on cunsuming raw freshwater fish					< 0.05			< 0.05
无 Never	136	9 (6.62)	-				-
1~5次/年 1-5 times/year	33	25 (75.76)	46.12 (16.03~151.80)		< 0.05		30.01 (7.56~152.04)	< 0.05
> 5次/年 > 5 times/year	11	10 (90.91)	158.14 (24.99~341.38)		< 0.05		81.40 (7.78~287.37)	< 0.05
制作“鱼生”频次 Frequency of making raw freshwater fish					< 0.05
无 Never	92	14 (15.22)	-
< 1次/年 < 1 times/year	9	1 (11.11)	0.70 (0.04~4.25)		> 0.05
1~10次/年 1-10 times/year	48	18 (37.50)		3.34 (1.49~7.68)	< 0.05
11~50次/年 11-50 times/year	22	5 (22.73)		1.64 (0.48~4.96)	> 0.05
> 50次/年 > 50 times/year	4	1 (25.00)		1.86 (0.09~15.73)	> 0.05
从外面买过“鱼生” Purchased raw freshwater fish from outside					< 0.05
否 No	145	28 (19.31)		-
是 Yes	30	11 (36.67)		3.07 (1.25~7.36)
向邻居赠送“鱼生” Gave raw freshwater fish to neighbors					< 0.05
否 No	118	19 (16.10)		-
是 Yes	57	20 (35.09)		2.63 (1.24~5.60)
接受过赠送的“鱼生” Received raw freshwater fish as a gift					< 0.05			< 0.05
否 No	104	12 (11.54)		-		-
是 Yes	71	27 (38.03)		4.62 (2.16~10.39)		15.18 (2.15~123.25)
生熟砧板分开使用 Use separate cutting boards for raw and cooked foods					> 0.05
否 No	32	6 (18.75)		0.77 (0.29~2.03)
是 Yes	143	33 (23.08)		-

Table 3

Table 4

Univariate and multivariate logistic regression analyses of factors affecting consuming raw freshwater fish (n = 175)

变量 Variable	调查人数 No. surveyed	食“鱼生”人数（占比/%）No. with consuming raw freshwater fish (ratio/%)	粗OR（95% CI） Crude OR (95% CI)	P	调整后OR（95% CI）^aAdjusted OR (95% CI)^a	P
乡镇 Villages				> 0.05
宾州镇 Binzhou	29	12 (41.38)	-
古辣镇 Gula	38	5 (13.16)	0.22 (0.05~0.81)	< 0.05
黎塘镇 Litang	40	6 (15.00)	0.26 (0.07~0.89)	< 0.05
思陇镇 Silong	33	14 (42.42)	1.04 (0.34~3.24)	> 0.05
新圩镇 Xinxu	35	7 (20.00)	0.36 (0.10~1.22)	> 0.05
性别 Gender				< 0.05		< 0.05
女性 Female	89	6 (6.74)	-		-
男性 Male	86	38 (44.19)	10.88 (4.56~30.41)		17.58 (6.21~61.88)
年龄/岁^bAge/Year^b				> 0.05
≤ 14	48	0 (0)	-
15~29	6	0 (0)	-
30~44	24	10 (41.67)	1.35 (0.44~4.01)	> 0.05
45~59	42	15 (35.71)	1.05 (0.42~2.64)	> 0.05
≥ 60	55	19 (34.55)	-
民族 Ethnicity				> 0.05
汉族 Han	151	38 (25.17)	1.01 (0.35~3.34)
壮族 Zhuang	24	6 (25.00)	-
文化程度^cEducation level^c				> 0.05
文盲或半文盲 Illiteracy or semi-illiteracy	3	0 (0)	-
小学 Primary school	79	19 (24.06)	3.48 (0.42~28.76)	> 0.05
初中 Junior high school	79	24 (30.38)	5.18 (0.63~42.43)	> 0.05
高中及以上 Senior high school and above	14	1 (7.14)	-
知晓华支睾吸虫病 Hearing of clonorchiasis				< 0.05		< 0.05
否 No	79	12 (15.19)	-		-
是 Yes	96	32 (33.33)	2.80 (1.35~6.12)		15.75 (1.40~185.99)
了解感染途径 Knowing transmission route				< 0.05
否 No	85	15 (17.65)	-
是 Yes	90	29 (32.22)	2.23 (1.11~4.66)
了解疾病危害 Knowing the harm of disease				> 0.05
否 No	105	24 (22.85)	-
是 Yes	70	20 (28.57)	1.38 (0.69~2.77)
制作过“鱼生” Made raw freshwater fish				< 0.05
否 No	92	14 (15.22)	-
是 Yes	83	30 (36.14)	3.32 (1.63~7.06)
从外面买过“鱼生” Purchased raw freshwater fish from outside				< 0.05
否 No	145	30 (20.69)	-
是 Yes	30	14 (46.67)	4.02 (1.71~9.58)
向邻居赠送“鱼生”Gave raw freshwater fish to neighbors				< 0.05
否 No	118	20 (16.95)	-
是 Yes	57	24 (42.11)	3.97 (1.94~8.29)
接受过赠送“鱼生”Received raw freshwater fish as a gift				< 0.05
否 No	104	15 (14.42)	-
是 Yes	71	29 (40.85)	4.60 (2.24~9.77)

Table 4

Table 5

Univariate and multivariate logistic regression analyses of factors affecting consumption of raw fresh water fish in future (n = 169)

变量 Variable	调查人数 No. surveyed		坚持食“鱼生”人数 No. with persisting in consuming raw freshwater fish (ratio/%)		粗OR（95% CI） Crude OR (95% CI)		P		调整后OR（95% CI）^a Adjusted OR (95% CI)^a	P
乡镇 Villages							> 0.05
宾州镇 Binzhou	27		5 (18.52)		0.77 (0.17~3.13)		> 0.05
古辣镇 Gula	35		5 (14.29)		0.57 (0.13~2.25)		> 0.05
黎塘镇 Litang	40		7 (17.50)		0.72 (0.19~2.60)		> 0.05
思陇镇 Silong	32		8 (25.00)		1.12 (0.31~4.04)		> 0.05
新圩镇 Xinxu	35		8 (22.86)		-
性别 Gender							< 0.05
女性 Female	85		4 (4.71)		-
男性 Male	84		29 (34.52)		10.68 (3.93~37.51)
年龄/岁 Age/Year							< 0.05
≤ 14	48		2 (4.17)		-
15~29	24		7 (29.17)		9.47 (2.06~67.96)		< 0.05
30~44	42		11 (26.19)		8.16 (2.16~55.14)		< 0.05
45~59	55		13 (23.64)		7.12 (1.83~47.25)		< 0.05
民族 Ethnicity
汉族 Han	145		118 (81.38)		1.46 (0.53~4.02)		> 0.05
壮族 Zhuang	24		18 (75.00)		-
文化程度^bEducation level^b							> 0.05
文盲或半文盲 Illiteracy or semi-illiteracy	3		0 (0)		-
小学 Primary school	79		12 (15.19)		-
初中 Junior high school	75		19 (25.33)		1.89 (0.14~4.66)		> 0.05
高中及以上 Senior high school and above	12		2 (16.67)		1.12 (0.11~6.29)		> 0.05
粪检阳性 C. sinensis infection							< 0.05
否 No	132		11 (8.33)		-
是 Yes	37		22 (59.46)		16.13 (6.73~41.23)
知晓华支睾吸虫病 Hearing of clonorchiasis							> 0.05
否 No	76		10 (13.16)		-
是 Yes	93		23 (24.73)		2.18 (0.96~4.90)
了解感染途径 Knowing transmission route							> 0.05
否 No	82		11 (13.41)		-
是 Yes	87		22 (25.29)		2.19 (0.98~4.85)
了解疾病危害 Knowing the harm of disease							> 0.05
否 No	102		19 (18.63)		-
是 Yes	67		14 (20.90)		1.15 (0.53~2.50)
食“鱼生”频次 Frequency of ingesting raw freshwater fish							< 0.05			< 0.05
无 Never	130		5 (3.85)		-				-
1~5次/年 1-5 times/year	29		21 (72.41)		65.63 (21.16~244.24)		< 0.05		3.66 (1.85~4.32)	< 0.05
> 5次/年 > 5 times/year	10		7 (70.00)		58.33 (12.61~346.73)		< 0.05		3.55 (1.17~3.03)	< 0.05
制作“鱼生”频次 Frequency of making raw freshwater fish							> 0.05
无 Never	90		14 (15.56)		-
< 1次/年 < 1 time/year	8		3 (37.50)		3.26 (0.61~14.89)		> 0.05
1~10次/年 1-10 times/year	45		8 (17.78)		1.17 (0.43~3.00)		> 0.05
11~50次/年 11-50 times/year	22		7 (31.82)		2.53 (0.84~7.24)		> 0.05
> 50次/年 > 50 times/year	4		1 (25.00)		1.81 (0.09~15.33)		> 0.05
从外面买过“鱼生” Purchased raw fish from outside								> 0.05
否 No		142		25 (17.61)		-
是 Yes		27		8 (29.63)		1.97 (0.74~4.89)
向邻居赠送“鱼生” Gave raw fish to neighbors								> 0.05
否 No		116		21 (18.10)		-
是 Yes		53		12 (22.64)		1.32 (0.58~2.91)
接受过赠送“鱼生” Received raw fishas a gift								< 0.05
否 No		103		15 (14.56)		-
是 Yes		66		18 (27.27)		2.20 (1.02~4.81)

Table 5

References 24

[1]	Qian MB, Utzinger J, Keiser J, et al. Clonorchiasis[J]. The Lancet, 2016, 387(10020): 800-810.
[2]	Hong ST, Fang YY. Clonorchis sinensis and clonorchiasis, an update[J]. Parasitol Int, 2012, 61(1): 17-24.
[3]	Qiao T, Ma RH, Luo XB, et al. Cholecystolithiasis is associated with Clonorchis sinensis infection[J]. PLoS One, 2012, 7(8): e42471.
[4]	Qian MB, Chen YD, Liang S, et al. The global epidemiology of clonorchiasis and its relation with cholangiocarcinoma[J]. Infect Dis Poverty, 2012, 1: 4.
[5]	Bouvard V, Baan R, Straif K, et al. A review of human carcinogens: Part B: biological agents[J]. Lancet Oncol, 2009, 10(4): 321-322.
[6]	Chen YD, Zhou CH, Zhu HH, et al. National survey on the current status of important human parasitic diseases in China in 2015[J]. Chin J Parasitol Parasit Dis, 2020, 38(1): 5-16. (in Chinese)
	(陈颖丹, 周长海, 朱慧慧, 等. 2015年全国人体重点寄生虫病现状调查分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(1): 5-16.) doi: 10.12140/j.issn.1000-7423.2020.01.002
[7]	Lü GL, Wan XL, Liu J, et al. Analysis on clonorchiasis surveillance in Guangxi Zhuang Autonomous Region from 2016 to 2020[J]. J Trop Dis Parasitol, 2021, 19(3): 121-126. (in Chinese)
	(吕国丽, 万孝玲, 刘健, 等. 2016—2020年广西壮族自治区华支睾吸虫病监测结果分析[J]. 热带病与寄生虫学, 2021, 19(3): 121-126.)
[8]	Qian MB, Zhou XN. Clonorchis sinensis[J]. Trends Parasitol, 2021, 37(11): 1014-1015.
[9]	Olsson U. Confidence intervals for the mean of a log-normal distribution[J]. J Stat Educ, 2005, 13(1): 1-9.
[10]	Jiang ZH, Wan XL, Lv GL, et al. High prevalence of Clonorchis sinensis infection in Guangxi, Southern China[J]. Trop Med Health, 2021, 49(1): 6.
[11]	Lu X. Discussion on raw fish culture of Hengxian County and its sustainable development[J]. J Nanning Polytech, 2019, 27(5): 20-23. (in Chinese)
	(鲁煊. 广西横县鱼生文化与可持续发展探讨[J]. 南宁职业技术学院学报, 2019, 27(5): 20-23.)
[12]	Yang JX, Yang XG, Wan XL, et al. Status of Clonorchis sinensis in the minority area of northern Guangxi, 2017[J]. China Trop Med, 2019, 19(6): 571-573. (in Chinese)
	(杨进新, 杨杏爱, 万孝玲, 等. 广西桂北少数民族地区2017年华支睾吸虫感染调查[J]. 中国热带医学, 2019, 19(6): 571-573.)
[13]	Shen HG, Zhou ZZ, He QB, et al. Infection status of freshwater fishes with metacercariae of Clonorchis sinensis in Liujiang River of Guangxi[J]. Chin J Parasitol Parasit Dis, 2010, 28(2): 157-159. (in Chinese)
	(申海光, 周振座, 何曲波, 等. 广西柳江河鱼类华支睾吸虫囊蚴感染情况[J]. 中国寄生虫学与寄生虫病杂志, 2010, 28(2): 157-159.)
[14]	Xie YH, Kanankege KST, Jiang ZH, et al. Epidemiological characterization of Clonorchis sinensis infection in humans and freshwater fish in Guangxi, China[J]. BMC Infect Dis, 2022, 22(1): 263.
[15]	World Health Organization. Preventive chemotherapy in human helminthiasis: coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers[M]. Genava: World Health Organization, 2006: 1-23.
[16]	Chen Z, Ye B, Jiang WS, et al. Survey on the knowledge, attitude and practice towards clonorchiasis and analysis of the influencing factors in Xinfeng County of Jiangxi Province in 2016[J]. Chin J Parasitol Parasit Dis, 2020, 38(5): 567-573. (in Chinese)
	(陈喆, 叶斌, 姜唯声, 等. 2016年江西省信丰县人群华支睾吸虫病知信行及影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(5): 567-573.) doi: 10.12140/j.issn.1000-7423.2020.05.007
[17]	Chen YS, Yang YJ, Wu SM, et al. Survey on the status of liver fluke infection and the knowledge, attitude and behavior of the people in Panyu District, Guangzhou[J]. China Trop Med, 2020, 20(3): 267-271. (in Chinese)
	(陈寅生, 杨燕君, 吴少敏, 等. 广州市番禺区居民肝吸虫感染状况及知信行调查[J]. 中国热带医学, 2020, 20(3): 267-271.) doi: 10.13604/j.cnki.46-1064/r.2020.03.16
[18]	Nguyen TTB, Dermauw V, Dahma H, et al. Prevalence and risk factors associated with Clonorchis sinensis infections in rural communities in northern Vietnam[J]. PLoS Negl Trop Dis, 2020, 14(8): e0008483.
[19]	Qian MB. Clonorchiasis control: starting from awareness[J]. Infect Dis Poverty, 2014, 3: 33.
[20]	Gong LF, Liu CJ, Ye LQ, et al. Investigation and analysis on the infection status of Clonorchis sinensis and its related knowledge-attitude-practice in population in Heyuan City from 2017 to 2020[J]. J Trop Dis Parasitol, 2021, 19(3): 151-154. (in Chinese)
	(龚丽芬, 刘翠娟, 叶丽群, 等. 2017—2020年河源市人群华支睾吸虫感染情况与知信行调查分析[J]. 热带病与寄生虫学, 2021, 19(3): 151-154.)
[21]	Qian MB, Jiang ZH, Ge T, et al. Association of raw-freshwater fish-eating practice with the infection of Clonorchis sinensis[J]. Chin J Parasitol Parasit Dis, 2019, 37(3): 296-301. (in Chinese)
	(钱门宝, 蒋智华, 葛涛, 等. 生食淡水鱼行为传播华支睾吸虫病的效应分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(3): 296-301.) doi: 10.12140/j.issn.1000-7423.2019.03.010
[22]	Xin HL, Yang YC, Jiang ZH, et al. An investigation of Human clonorchiasis prevalence in an endemic county in Guangxi Zhuang Autonomous Region, China, 2016[J]. Food Waterborne Parasitol, 2021, 22: e00109.
[23]	Qian MB, Jiang ZH, Zhou CH, et al. Familial assimilation in transmission of raw-freshwater fish-eating practice leading to clonorchiasis[J]. PLoS Negl Trop Dis, 2020, 14(4): e0008263.
[24]	Qian MB, Zhou CH, Jiang ZH, et al. Epidemiology and determinants of Clonorchis sinensis infection: a community-based study in Southeastern China[J]. Acta Trop, 2022, 233: 106545.

变量 Variable	检查人数 No. examined	粪检阳性例数 No. case with C. sinensis infection	感染率/% (95% CI) Prevalence/% (95% CI)	EPG几何均数（95% CI） Geometric mean of EPG (95% CI)
乡镇 Villages
宾州镇 Binzhou	203	25	12.32 (7.76~16.87)	219 (97~497)
古辣镇 Gula	201	33	16.42 (11.25~21.58)	148 (91~241)
黎塘镇 Litang	203	12	5.91 (2.64~9.18)	164 (93~288)
思陇镇 Silong	200	44	22.00 (15.84~27.38)	113 (71~180)
新圩镇 Xinxu	200	42	21.00 (15.31~26.69)	442 (278~702)
性别 Gender
男性 Male	494	130	26.32 (22.27~30.06)	223 (169~294)
女性 Female	513	26	5.07 (3.16~6.97)	94 (54~162)
年龄/岁 Age/Year
≤ 14	252	5	1.98 (0.25~3.72)	60 (13~270)
15~29	54	5	9.26 (1.27~17.25)	35 (10~124)
30~44	147	30	20.41 (13.82~27.00)	154 (96~249)
45~59	255	62	24.31 (19.01~29.61)	238 (155~364)
≥ 60	299	54	18.06 (13.42~22.15)	225 (146~346)
民族 Ethnicity
汉族 Han	872	143	16.40 (13.94~18.86)	203 (154~266)
壮族 Zhuang	130	13	10.00 (4.77~15.23)	152 (88~260)
其他^a Others^a	5	0	-	-
文化程度 Education
文盲或半文盲 Illiteracy or semi-illiteracy	78	4	5.13 (0.12~10.13)	158 (24~1058)
小学 Primary school	405	31	7.65 (5.05~10.25)	223 (124~400)
初中 Junior high school	467	111	23.77 (19.89~27.64)	193 (142~262)
高中及以上 Senior high school and above	56	9	16.07 (6.15~26.00)	125 (54~291)
总计 Total	1 007	156	15.49 (13.25~17.73)	198 (153~255)

变量 Variable	调查人数 No. surveyed	知晓华支睾吸虫病人数（占比/%） No. hearing of clonorchiasis (ratio/%)	了解感染途径人数（占比/%） No. knowing transmission (ratio/%)	了解疾病危害人数（占比/%） No. knowing the harm of disease (ratio/%)
乡镇 Villages
宾州镇 Binzhou	40	24 (60.00)	20 (50.00)	4 (10.00)
古辣镇 Gula	40	37 (92.50)	37 (92.50)	36 (90.00)
黎塘镇 Litang	40	13 (32.50)	11 (27.50)	9 (22.50)
思陇镇 Silong	40	12 (30.00)	9 (22.50)	5 (12.15)
新圩镇 Xinxu	42	24 (57.14)	24 (57.14)	23 (54.76)
性别 Gender
女性 Female	102	47 (46.08)	42 (41.18)	31 (30.39)
男性 Male	100	63 (63.00)	59 (59.00)	46 (46.00)
年龄/岁 Age/Year
≤ 14	59	8 (13.56)	8 (13.56)	7 (11.86)
15~29	10	6 (60.00)	6 (60.00)	4 (40.00)
30~44	26	21 (80.77)	19 (73.08)	10 (38.46)
45~59	44	30 (68.18)	28 (63.64)	24 (54.55)
≥ 60	63	45 (71.43)	40 (63.49)	32 (50.79)
民族 Ethnicity
汉族 Han	175	102 (58.29)	95 (54.29)	72 (41.14)
壮族 Zhuang	27	8 (29.63)	6 (22.22)	5 (18.52)
文化程度 Education level
文盲或半文盲 Illiteracy or semi-illiteracy	6	1 (16.67)	1 (16.67)	0 (0)
小学 Primary school	101	38 (37.62)	33 (32.67)	25 (24.75)
初中 Junior high school	79	57 (72.15)	54 (68.35)	42 (53.16)
高中及以上 Senior high school and above	16	14 (87.50)	13 (81.25)	10 (62.50)
合计 Total	202	110 (54.46)	101 (50.00)	77 (38.12)