Precarious transition: a mortality study of South African ex-miners

Exploring medical terminology inexpediencies: Tripledemic vs. triple epidemic

Accurate and consistent medical terminology has a fundamental value in medicine. It enables medical students to understand the meaning of each term, medical physicians to communicate with each other, and it also enables science to adopt a logical language of high-level understanding and scientific regularity. Medical terminology inexpediencies caused by the adoption of etymologically illogical or linguistically false terms lead to misunderstanding and confusion among clinicians. The medical terms epidemic and pandemic are as old as Hippocrates and Sophocles, respectively. The present article evaluates the new medical terms tripledemic and triple epidemic, which were introduced during the recent COVID-19 pandemic.

Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization

Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.

Occupational Safety and Health of Women in Mining

The mining industry plays a critical role in the U.S. economy, with active mines in every state producing materials such as those used to construct houses and roads, make medicines, and manufacture cars and electronics. Throughout its history, mining has been a male-dominated industry. Recent estimates indicate that between 10% and 17% of miners are women. Previous occupational safety and health (OSH) research has focused primarily on the male experience. In more recent years, the mining industry has engaged in efforts to increase workforce diversity through the recruitment and retention of women miners. To meet the needs of a diverse workforce, it is critically important to identify OSH concerns that are unique to populations that have been understudied and to develop work-related policies and practices that improve their work experiences and health outcomes. The purpose of this article is to describe the specific OSH challenges women as miners face and to discuss how the National Institute for Occupational Safety and Health's (NIOSH) Mining Program is situated to address these challenges through its Mining Program Strategic Plan.

The Utility of Length of Mining Service and Latency in Predicting Silicosis among Claimants to a Compensation Trust

In the wake of a large burden of silicosis and tuberculosis among ex-miners from the South African gold mining industry, several programmes have been engaged in examining and compensating those at risk of these diseases. Availability of a database from one such programme, the Q(h)ubeka Trust, provided an opportunity to examine the accuracy of length of service in predicting compensable silicosis, and the concordance between self-reported employment and that officially recorded. Compensable silicosis was determined by expert panels, with ILO profusion ≥1/0 as the threshold for compensability. Age, officially recorded and self-reported years of service, and years since first and last service of 3146 claimants for compensable silicosis were analysed. Self-reported and recorded service were moderately correlated (R = 0.66, 95% confidence interval 0.64−0.68), with a Bland−Altman plot showing no systematic bias. There was reasonably high agreement with 75% of the differences being less than two years. Logistic regression and receiver operating characteristic curve analysis were used to test prediction of compensable silicosis. There was little predictive difference between length of service on its own and a model adjusting for length of service, age, and years since last exposure. Predictive accuracy was moderate, with significant potential misclassification. Twenty percent of claimants with compensable silicosis had a length of service <10 years; in almost all these claims, the interval between last exposure and the claim was 10 years or more. In conclusion, self-reported service length in the absence of an official service record could be accepted in claims with compatible clinical findings. Length of service offers, at best, moderate predictive capability for silicosis. Relatively short service compensable silicosis, when combined with at least 10 years since last exposure, was not uncommon.

Impacts of mining on local fauna of wildlife in District Mardan & District Mohmand Khyber Pakhtunkhwa Pakistan

Mining is vital for human sustenance and a crucial sector in the state economy. However, its impacts on the environment and biodiversity cannot be underestimated. Which are potent to the attract government's attention. Environment and wildlife are subject to the harmful impacts of mining and its related activities. In this study, districts, namely Mardan and Mohmand have been targeted with respect to mining impacts. The assessment was carried out on wildlife adversely affected by the mining sector. The fauna has been keenly observed to bring the calculated risks and threat perception of the regional wildlife. Total 9 species of mammals, 21 species of birds, were recorded in District Mardan. While in District Mohmand 2 species of mammals, 9 species of birds, and 4 species of reptiles were studied. The Study explored that mining primarily responsible for land degradation. Which lead to food and agriculture losses. Several other factors like blasting, pollution, hunting, deforestation, habitat loss was also observed. Deforestation surfaced one of the major causes for extinction of fauna in the said region. preemptive measures are needed to seize the man-made catastrophe.

Access of migrant gold miners to compensation for occupational lung disease: Quantifying a legacy of injustice

Background

A legacy of the South African gold mining industry, now in decline, is a large burden of silicosis and tuberculosis among former migrant miners from rural South Africa and surrounding countries, particularly Lesotho and Mozambique. This neglected population faces significant barriers in filing claims for compensation for occupational lung disease. The objective of the study was to gain insight into the extent of such barriers, particularly for former miners and cross-border migrants.

Methods

The database of a large gold mining company and the statutory compensation authority were analyzed for the period 1973–2018 by country of origin, age, and employment status at the time of claim filing. Proportions and odds ratios (ORs) for each of the compensable diseases were calculated by the above variables. Processing delays of claims were also calculated.

Results

Annual company employment declined from 240,718 in 1989 to 43,024 in 2018 and the proportion of cross-border migrants within the workforce from 51.0 to 28.1%. The compensation database contained 68,612 claims. The majority of compensable claims in all diagnostic categories were from active miners. The odds of cross-border miners relative to South African miners filing a claim depended on employment status. For example, the OR for Lesotho miners filing while in active employment was 1.86 (95% CI 1.81, 1.91), falling to 0.94 (95% CI 0.91, 0.98) among former miners. The equivalent findings for Mozambiquan miners were 0.95 (95% CI 0.91, 1.00), falling to 0.44 (95% CI 0.41, 0.47). Median processing delays over the whole period were from 1.1 years from filing to adjudication, and 3.8 years from filing to payment.

Conclusions

The findings provide a quantitative view of differential access to occupational lung disease compensation, including long processing delays, among groups of migrant miners from the South African gold mines. There is a deficit of compensable claims for silicosis and silico-tuberculosis among former miners irrespective of country of origin. While cross-border miner groups appear to file more claims while active, this is reversed once they leave employment. Current large-scale efforts to provide medical examinations and compensation justice to this migrant miner population need political and public support and scrutiny of progress.

Factors associated with self-rated health among mineworkers in Zambia: a cross-sectional study

Background

This study aims to examine miners’ working conditions and self-rated health status in copper mines in Zambia and to identify the conditions and factors necessary to improve the safety and health of mineworkers.

Methods

A cross-sectional study using a self-administered questionnaire was conducted anonymously among copper mineworkers in Zambia in 2015 and 2016. Five targeted mining companies among 33 were introduced by the Mineworkers’ Union of Zambia. Study participants were recruited at the waiting space for underground work, waiting rooms of company clinics/hospitals, and/or at training sessions, which were places permitted by the target companies to perform data collection via convenience sampling. Bivariate analyses (e.g., t tests, Kruskal-Wallis tests, chi-square tests, or Cochran-Armitage tests) and logistic regression analysis were used to analyze differences in demographic characteristics and to compare their working conditions, health conditions, safety management at the workplace, and training opportunities by employment status.

Results

In total, 338 responses were analyzed. Regular employees had better working conditions, including higher incomes (P = 0.001), more likely to be guaranteed sickness insurance by the company (P < 0.001), paid holidays (P = 0.094), and sick leave (P = 0.064), although the difference was not statistically significant. Mineworkers’ decreased self-rated health was determined by job category (adjusted odds ratio [AOR], 0.41; 95% confidence interval [CI], 0.21, 0.82; P = 0.012). Having experienced violence from the boss/manager (AOR, 0.54; 95% CI, 0.32, 0.91; P = 0.020) was negatively associated with better self-rated health in the crude odds ratio.

Conclusions

Among mineworkers in Zambia, nonunderground work and not having experienced violence from their boss/manager contributed to increased self-rated health. From the perspective of psychological safety and human security, the management of safety and the working environment, including human resource management and preventing harassment/violence, should be assured, especially for underground mineworkers.

Accessing Occupational Health Services in the Southern African Development Community Region

Only 15% of the global population has access to occupational safety and health services. In Africa, only 5% of employees working from major establishments have access to occupational health services (OHS). Access to primary health care (PHC) services is addressed in many settings and inclusion of OHS in these facilities might increase efficiency in preventing occupational diseases. A cross-sectional study was conducted in four Southern African Development Community (SADC) countries aiming at assessing the availability of OHS at PHC facilities and the organization of OHS. We conducted a literature review to assess the provision and organization of OHS services. In addition to the review, a total of 23 doctors from Zambia were interviewed using questionnaires in order to determine the availability of OHS and training. Consultations with heads of ministries were done in four SADC countries. Results showed that in the SADC region, OHS are fragmented and lack a comprehensive approach. In addition, out of 23 PHC facilities, only two (13%) provided occupational health and PHC. However, OHS provided at PHC facilities were limited to TB screening and audiometric testing. Our study showed a huge inadequacy of trained occupational health practitioners. This study supports the World Health Organization’s advocacy to integrate OHS at the PHC level.

Predictors of silicosis and variation in prevalence across mines among employed gold miners in South Africa

Background

The stated intention to eliminate silicosis from the South African goldmining industry as well as current programmes to find and compensate ex-miners with silicosis require an understanding of variation in silicosis prevalence across the industry. We aimed to identify the predictors of radiological silicosis in a large sample of working miners across gold mines in South Africa.

Methods

Routine surveillance chest radiographs were collected from 15 goldmine “clusters” in a baseline survey undertaken in preparation for a separate tuberculosis isoniazid prophylaxis trial. All images were read for silicosis by a health professional experienced in using the International Labour Organisation (ILO) classification. Profusion thresholds of > 1/0 and > 1/1 were used. Demographic and occupational information was obtained by questionnaire. Predictors of silicosis were examined in a multivariable logistic regression model, including age, gender, racial ascription, country of origin, years since starting mine employment, mine shaft, skill category, underground work status and tuberculosis.

Results

The crude silicosis prevalence at ILO > 1/1 was 3.8% [95% confidence interval (CI) 3.5–4.1%]. The range across mine shafts was 0.8–6.9%. After adjustment for covariates, the interquartile range across shafts was reduced from 2.4 to 1.2%. Black miners [adjusted odds ratio (aOR) 2.8; 95% CI 1.1–7.2] and miners in full-time underground work (aOR 2.1; 95% CI 1.3–3.4) had substantially elevated odds of silicosis, while workers from Mozambique had lower odds (aOR 0.54; 95% CI 0.38–0.77). Silicosis odds rose sharply with both age and years since starting in the industry (p for linear trend < 0.005), with 95.5% of affected miners having > 15 years since first exposure and 2.2% < 10 years.

Conclusions

In surveillance of silicosis in working gold miners time since first exposure remains a powerful predictor. Age appears to be an independent predictor, while the detection of radiological silicosis in short-service miners requires attention. Public risk reporting by mines should include factors bearing on silicosis prevalence, specifically dust concentrations, with independent verification. Studies of silicosis and tuberculosis in ex-miners are needed, supported by an accessible electronic database of the relevant medical and dust exposure records of all gold miners.

Mining is bad for health: a voyage of discovery

Mining continues to be a dangerous activity, whether large-scale industrial mining or small-scale artisanal mining. Not only are there accidents, but exposure to dust and toxins, along with stress from the working environment or managerial pressures, give rise to a range of diseases that affect miners. I look at mining and health from various personal perspectives: that of the ordinary man (much of life depends on mined elements in the house, car and phone); as a member of the Society for Environmental Geochemistry and Health (environmental contamination and degradation leads to ill health in nearby communities); as a public health doctor (mining health is affected by many factors, usually acting in a mix, ranging from individual inheritance-genetic makeup, sex, age; personal choices-diet, lifestyle; living conditions-employment, war; social support-family, local community; environmental conditions-education, work; to national and international constraints-trade, economy, natural world); as a volunteer (mining health costs are not restricted to miners or industry but borne by everyone who partakes of mining benefits-all of us); and as a lay preacher (the current global economy concentrates on profit at the expense of the health of miners). Partnership working by academics with communities, government and industry should develop evidence-based solutions. Employment, health, economic stability and environmental protection need not be mutually exclusive. We all need to act.

Excess Mortality Due to External Causes in Women in the South African Mining Industry: 2013-2015

Mining is a recognized high-risk industry with a relatively high occurrence of occupational injuries and disease. In this study, we looked at the differences in mortality between male and female miners in South Africa. Data from Statistics South Africa regarding occupation and cause of death in the combined years 2013–2015 were analyzed. Proportional mortality ratios (PMRs) were calculated to investigate excess mortality due to external causes of death by sex in miners and in manufacturing laborers. Results: Women miners died at a significantly younger age on average (44 years) than all women (60 years), women manufacturers (53 years), and male miners (55 yrs). There was a significantly increased proportion of deaths due to external causes in women miners (12.4%) compared to all women (4.8%) and women manufacturers (4.6%). Significantly increased PMRs were seen in car occupant accidents (467, 95% confidence interval (CI) 151–1447), firearm discharge (464, 95% CI 220–974), and contact with blunt objects (2220 95% CI 833–5915). Conclusion: This descriptive study showed excess deaths in women miners due to external causes. Road accidents, firearm discharge, and contact with blunt objects PMRs were significantly increased. Further research is required to confirm the underlying reasons for external causes of death and to develop recommendations to protect women miners.

The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States

OBJECTIVE

To determine and compare the prevalence and odds of chronic diseases among ex- and current miners.

METHODS

Fourteen-year pooled data from the National Health Interview Survey between 2004 and 2017 were analyzed. Ex- and current miners ages 18 to 64 years were defined based on employment status at the time of National Health Interview Survey (NHIS) interview. We calculated age-adjusted prevalence rates and odds ratios of association of chronic diseases. The analysis was adjusted for respondent's age, sex, race, marital status, poverty-income ratio, health insurance, and smoking status.

RESULTS

Ex-miners have significantly increased prevalence of most chronic diseases. The age-adjusted prevalence and the adjusted odds of heart disease, cancer, hypertension, diabetes, and psychological stress were significantly higher among ex-miners as compared with current miners.

CONCLUSIONS

Ex-miners have worse health outcomes that may persist for years after leaving the mining industry.