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Nota MM, Mbuligwe SE, Kassenga GR, Gottesfeld P. Feasibility of respirable crystalline silica exposure reduction in small-scale tanzanite mining in Tanzania. Ann Work Expo Health 2024; 68:804-810. [PMID: 39007362 DOI: 10.1093/annweh/wxae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Respirable crystalline silica (RCS) exposures in tanzanite gem mining have been linked to tuberculosis and silicosis among miners. We conducted a plot study to assess RCS exposures and to introduce safer mining practices in one small-scale underground tanzanite mine. MATERIALS AND METHODS Personal and area air samples for RCS were collected during tanzanite mining operations before and after improved work practices employed to reduce exposures and analyzed using X-ray diffraction. Area samples were collected at the rest area, located approximately 300 m underground and 100 m from other work activities. Improved practices included the use of wet drilling methods and drilling with new bits. RESULTS A total of 33 personal and 4 area air samples were collected. Pre-intervention, mean exposures for all operations, drilling operations, non-drilling activities, and area samples were 122 mg/m3, 247 mg/m3, 34.3 mg/m3, and 1.95 mg/m3, respectively which exceeded the U.S. OSHA Permissible Exposure Limit (PEL) by 2,440 times for all operations, by 4,946 times for drilling operations, by 686 times for non-drilling activities and 39 times for area samples collected at an underground rest area. The post-intervention results showed a 99% reduction of RCS exposures for wet drilling operations, 98.5% reduction for non-drilling activities, and 36% reduction for area samples. Despite improvements, post-intervention RCS exposures during drilling had a mean of 2.08 mg/m3 or more than 41 times the OSHA PEL. CONCLUSIONS We successfully piloted a program to work with small-scale tanzanite miners to reduce RCS exposures and raise awareness about the occupational health risks of RCS, though additional measures are recommended to further reduce RCS exposures. Similar programs should be taken to scale throughout underground mining sites in Tanzania and other countries.
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Affiliation(s)
- Manti Michael Nota
- School of Engineering and Environmental Studies (SEES), Ardhi University, P. O. Box 35176, Dar es Salaam, Tanzania
| | - Stephen E Mbuligwe
- School of Engineering and Environmental Studies (SEES), Ardhi University, P. O. Box 35176, Dar es Salaam, Tanzania
| | - Gabriel R Kassenga
- School of Engineering and Environmental Studies (SEES), Ardhi University, P. O. Box 35176, Dar es Salaam, Tanzania
| | - Perry Gottesfeld
- Occupational Knowledge International, San Francisco, CA, United States
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Mbuya AW, Mboya IB, Semvua HH, Mamuya SH, Howlett PJ, Msuya SE. Prevalence and determinants of evidence of silicosis and impaired lung function among small scale tanzanite miners and the peri-mining community in northern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002770. [PMID: 39325711 PMCID: PMC11426446 DOI: 10.1371/journal.pgph.0002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 09/06/2024] [Indexed: 09/28/2024]
Abstract
Limited data among miners in Tanzania suggests prevalence of silicosis, obstructive lung disease and restrictive lung disease to be around 1.6%, 1.9% and 8.8% respectively. Our study aimed to determine the prevalence and factors associated with silicosis and impaired lung function among tanzanite mining community in northern Tanzania. We conducted a cross-sectional study, involving 330 miners and 330 peri-mining community members in Mererani mines. Silicosis was defined based on study participants' history of exposure to mining dust and digital chest radiological findings with reference to the 2011 ILO classification of pneumoconiosis. Impaired lung function was determined by spirometry using American Thoracic Society/European Respiratory Society recommended system 3. Association between evidence of silicosis/impaired lung function and presumed risk factors were determined using binary logistic regression analyses. The study found that 99/330 (30.0%) of miners had silicosis. Total of 65 (9.8%) participants had impaired lung function, of whom 29 (4.4%) had Chronic Obstructive Pulmonary Disease, 32 (4.8%) had restrictive lung disease and 4 (0.6%) had both obstructive and restrictive lung diseases. Unexpectedly, miners who have worked for more than 10years and those worked for 6 to 10 years had 64% (aOR 0.34, CI = 0.17-0.67, p = 0.002) and 48% (aOR 0.52, CI = 0.30-0.89, p = 0.018) lower odds of having silicosis respectively compared those worked for up to 5 years. Participants with more than 10 years of work duration had more than 3-times higher odds of impaired lung function compared to those who had worked for up to 5 years (aOR 3.11, CI = 1.53-6.34, p<0.002). We found a concerningly high prevalence of silicosis despite short durations of exposure to occupational silica dust. Immediate dust control measures including deployment of wet drilling, wearing of personal protective equipment and regular monitoring of dust exposure need to be enforced by the Occupational Safety and Health Authority-Tanzania.
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Affiliation(s)
- Alexander W Mbuya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - Innocent B Mboya
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Hadija H Semvua
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Simon H Mamuya
- Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patrick J Howlett
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Sia E Msuya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Kilimanjaro Christian Medical Center, Moshi, Tanzania
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Litvinjenko S, Magwood O, Wu S, Wei X. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. THE LANCET. INFECTIOUS DISEASES 2023; 23:1395-1407. [PMID: 37696278 PMCID: PMC10665202 DOI: 10.1016/s1473-3099(23)00372-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tuberculosis is a communicable disease of public health concern that inequitably impacts the most vulnerable populations worldwide. Vulnerable populations are those with a high risk for tuberculosis disease and whose disadvantaged or marginalised socioeconomic position limits their access to the health system. We conducted an overview of reviews that aimed to assess the burden (ie, prevalence and incidence) of tuberculosis disease among 12 vulnerable populations globally. METHODS We did an overview of reviews using a systematic search in MEDLINE, Embase, and the Cochrane Database for Systematic Reviews for articles published in English, French, and Chinese, from Jan 1, 2010 to March 8, 2023. We did an initial search on Oct 28, 2021, and updated our search on March 8, 2023. We included systematic and scoping reviews reporting on the prevalence or incidence of active tuberculosis among 12 vulnerable populations. Evidence gaps were supplemented with primary or secondary database studies. Study characteristics and outcome data related to tuberculosis burden were tabulated, including prevalence ratios and incidence rate ratios, and evidence was synthesised narratively. This trial is registered with PROSPERO (CRD42022324421). FINDINGS We screened 13 169 citations and included 44 publications (23 reviews and 21 primary or database studies) in the final synthesis. The comprehensiveness and methodological quality of the evidence differed across population groups. Prevalence of more than 1000 cases per 100 000 were reported in all vulnerable populations. On the basis of pooled estimates, prevalence ratios were often more than 25 among people experiencing homelessness, incarcerated populations, refugees, asylum seekers, and people living with HIV compared with the general population. Incidence was infrequently reported, with the best-available incidence rate ratios documented for people who were incarcerated. There was scarce evidence specific to miners, nomadic populations, sex workers, men who have sex with men, and transgender individuals. INTERPRETATION The burden of tuberculosis is substantially higher among vulnerable populations than general populations, suggesting a need for improved integration of these groups, including dedicated efforts for their identification, targeted screening and prevention measures, as well as treatment support. FUNDING WHO.
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Affiliation(s)
- Stefan Litvinjenko
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, ON, Canada; Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Howlett P, Mousa H, Said B, Mbuya A, Kon OM, Mpagama S, Feary J. Silicosis, tuberculosis and silica exposure among artisanal and small-scale miners: A systematic review and modelling paper. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002085. [PMID: 37733799 PMCID: PMC10513209 DOI: 10.1371/journal.pgph.0002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
An estimated 44 million artisanal and small-scale miners (ASM), largely based in developing economies, face significant occupational risks for respiratory diseases which have not been reviewed. We therefore aimed to review studies that describe silicosis and tuberculosis prevalence and respirable crystalline silica (RCS) exposures among ASM and use background evidence to better understand the relationship between exposures and disease outcomes. We searched PubMed, Web of Science, Scopus and Embase for studies published before the 24th March 2023. Our primary outcome of interest was silicosis or tuberculosis among ASM. Secondary outcomes included measurements of respirable dust or silica, spirometry and prevalence of respiratory symptoms. A systematic review and narrative synthesis was performed and risk of bias assessed using the Joanna Briggs Prevalence Critical Appraisal Tool. Logistic and Poisson regression models with predefined parameters were used to estimate silicosis prevalence and tuberculosis incidence at different distributions of cumulative silica exposure. We identified 18 eligible studies that included 29,562 miners from 13 distinct populations in 10 countries. Silicosis prevalence ranged from 11 to 37%, despite four of five studies reporting an average median duration of mining of <6 years. Tuberculosis prevalence was high; microbiologically confirmed disease ranged from 1.8 to 6.1% and clinical disease 3.0 to 17%. Average RCS intensity was very high (range 0.19-89.5 mg/m3) and respiratory symptoms were common. Our modelling demonstrated decreases in cumulative RCS are associated with reductions in silicosis and tuberculosis, with greater reductions at higher mean exposures. Despite potential selection and measurement bias, prevalence of silicosis and tuberculosis were high in the studies identified in this review. Our modelling demonstrated the greatest respiratory health benefits of reducing RCS are in those with highest exposures. ASM face a high occupational respiratory disease burden which can be reduced by low-cost and effective reductions in RCS.
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Affiliation(s)
- Patrick Howlett
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Hader Mousa
- Centre for Occupational and Environmental Health, Kigali, Rwanda
| | - Bibie Said
- Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Alexander Mbuya
- Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Onn Min Kon
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Stellah Mpagama
- Kibong’oto Infectious Disease Hospital, Kilimanjaro, Tanzania
| | - Johanna Feary
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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de Groot LM, Dememew ZG, Hiruy N, Datiko DG, Gebreyes SN, Suarez PG, Jerene D. Effect of multicomponent interventions on tuberculosis notification in mining and pastoralist districts of Oromia region in Ethiopia: a longitudinal quasi-experimental study. BMJ Open 2023; 13:e071014. [PMID: 37188473 PMCID: PMC10186083 DOI: 10.1136/bmjopen-2022-071014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To demonstrate the impact of interventions on tuberculosis (TB) case detection in mining and pastoralist districts in southeastern Ethiopia over a 10-year period. DESIGN Longitudinal quasi-experimental study. SETTING Health centres and hospitals in six mining districts implemented interventions and seven nearby districts functioned as controls. PARTICIPANTS Data from the national District Health Information System (DHIS-2) were used for this study; therefore, people did not participate in this study. INTERVENTIONS Directed at training, active case finding and improving treatment outcomes. PRIMARY AND SECONDARY OUTCOME MEASURES Primarily, trends in TB case notification and percentage of bacteriologically confirmed TB-as collected by DHIS-2-between pre-intervention (2012-2015) and post-intervention (2016-2021) were analysed. Secondarily, post-intervention was split into early post-intervention (2016-2018) and late post-intervention (2019-2021) to also study the long-term effects of the intervention. RESULTS For all forms of TB, case notification significantly increased between pre-intervention and early post-intervention (incidence rate ratio (IRR): 1.21, 95% CI: 1.13, 1.31; p<0.001) and significantly decreased between pre-intervention/early post-intervention and late post-intervention (IRR: 0.82, 95% CI: 0.76, 0.89; p<0.001 and IRR: 0.67, 95% CI: 0.62, 0.73; p<0.001). For bacteriologically confirmed cases, we found a significant decrease between pre-intervention/early post-intervention and late post-intervention (IRR: 0.88, 95% CI: 0.81, 0.97; p<0.001 and IRR: 0.81, 95% CI: 0.74, 0.89; p<0.001). The percentage of bacteriologically confirmed cases was significantly lower in the intervention districts during pre-intervention (B: -14.24 percentage points, 95% CI: -19.27, -9.21) and early post-intervention (B: -7.78, 95% CI: -15.46, -0.010; p=0.047). From early post-intervention to late post-intervention, we found a significant increase (B: 9.12, 95% CI: 0.92 to 17.33; p=0.032). CONCLUSIONS The decrease in TB notifications in intervention districts during late post-intervention is possibly due to a decline in actual TB burden as a result of the interventions. The unabated increase in case notification in control districts may be due to continued TB transmission in the community.
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Affiliation(s)
- Liza Marlette de Groot
- Tuberculosis Elimination and Health Systems Innovation, KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| | | | - Nebiyu Hiruy
- Management Sciences for Health Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Pedro G Suarez
- Management Sciences for Health, Arlington, Virginia, USA
| | - Degu Jerene
- Tuberculosis Elimination and Health Systems Innovation, KNCV Tuberculosis Foundation, Den Haag, The Netherlands
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Moyo D, Ncube R, Kavenga F, Chikwava L, Mapuranga T, Chiboyiwa N, Chimunhu C, Mudzingwa F, Muzvidziwa O, Ncube P, Mando TC, Moyo F, Chigaraza B, Masvingo H, Timire C. The Triple Burden of Tuberculosis, Human Immunodeficiency Virus and Silicosis among Artisanal and Small-Scale Miners in Zimbabwe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113822. [PMID: 36360701 PMCID: PMC9657277 DOI: 10.3390/ijerph192113822] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 05/31/2023]
Abstract
Artisanal and small-scale mining is characterized by an excessive exposure to silica-containing dust, overcrowding, poor living conditions and limited access to primary health services. This poses a risk to tuberculosis, HIV infection and silicosis. The main purpose of the study is to evaluate the burden of tuberculosis, HIV and silicosis among artisanal and small-scale miners. We conducted a cross sectional study on 3821 artisanal and small-scale miners. We found a high burden of silicosis (19%), tuberculosis (6.8%) and HIV (18%) in a relatively young population, with the mean age of 35.5 years. Men were 1.8 times more likely to be diagnosed with silicosis compared to women, adjusted prevalence ratio [aPR = 1.75 (95% CI: 1.02-2.74)]. Artisanal and small-scale miners who were living with HIV were 1.25 times more likely to be diagnosed with silicosis compared to those who were negative, [aPR = 1.25 (1.00-1.57)]. The risk of silicosis increased with both duration as a miner and severity of exposure to silica dust. The risk of tuberculosis increased with the duration as a miner. Zimbabwe is currently experiencing a high burden of TB, silicosis and HIV among artisanal and small-scale miners. Multi-sectoral and innovative interventions are required to stem this triple epidemic in Zimbabwe.
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Affiliation(s)
- Dingani Moyo
- Baines Occupational Health Services, Harare 024, Zimbabwe
- Occupational Health Division, School of Public Health, University of the Witwatersrand, Johannesburg 2000, South Africa
- Faculty of Medicine and Health Sciences, The National University of Science and Technology, Bulawayo 029, Zimbabwe
- Faculty of Medicine and Health Sciences, Midlands State University, P Bag 9005, Gweru 054, Zimbabwe
| | | | | | | | | | - Nathan Chiboyiwa
- Ministry of Health and Child Care, Harare 024, Zimbabwe
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare 024, Zimbabwe
| | | | - Frank Mudzingwa
- Hospice and Palliative Care Association of Zimbabwe, Harare 054, Zimbabwe
| | | | | | - Tariro Christwish Mando
- Ministry of Health and Child Care, Harare 024, Zimbabwe
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare 024, Zimbabwe
| | - Florence Moyo
- Baines Occupational Health Services, Harare 024, Zimbabwe
- Department of Health Sciences, Faculty of Sciences, Zimbabwe Open University, Harare 024, Zimbabwe
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Abeid R, Mergenthaler C, Muzuka V, Goodluck A, Nkwabi T, Bigio J, Vasquez N A, Pande T, Haraka F, Creswell J, Rahman T, Straetemans M. Increasing TB/HIV Case Notification through an Active Case-Finding Approach among Rural and Mining Communities in Northwest Tanzania. J Trop Med 2022; 2022:4716151. [PMID: 35432549 PMCID: PMC9007682 DOI: 10.1155/2022/4716151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
While Tanzania is among the high TB burden countries to reach the WHO's End TB 2030 milestones, 41% of the people estimated to have had TB in 2020 were not diagnosed and notified. As part of the response to close the TB treatment coverage gap, SHDEPHA+ Kahama conducted a TB REACH active case-finding (ACF) intervention among rural and mining communities in Northwest Tanzania to increase TB/HIV case notification from July 2017 to June 2020. The intervention successfully linked marginalized mining communities with integrated TB/HIV screening, diagnostic, and referral services, screening 144,707 people for TB of whom 24,200 were tested for TB and 4,478 were tested for HIV, diagnosing 1,499 people with TB and 1,273 people with HIV (including at least 154 people with TB/HIV coinfection). The intervention revealed that community-based ACF can ensure high rates of linkage to care among hard-to-reach populations for TB. Providing integrated TB and HIV screening and diagnostic services during evening hours (Moonlight Events) in and around mining settlements can yield a large number of people with undiagnosed TB and HIV. For TB, this is true not only amongst miners but also FSW living in the same communities, who appear to be at similar or equally high risk of infection. Local NGOs can help to bridge the TB treatment coverage gap and to improve TB and HIV health outcomes by linking these marginalized groups with public sector services. Capturing the number of referrals arriving at CTCs is an important next step to identify how well the integrated TB/HIV outreach services operate and how they can be strengthened.
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Affiliation(s)
- R. Abeid
- SHDEPHA+ Kahama, Shinyanga, Tanzania
| | | | - V. Muzuka
- SHDEPHA+ Kahama, Shinyanga, Tanzania
| | | | - T. Nkwabi
- SHDEPHA+ Kahama, Shinyanga, Tanzania
| | - J. Bigio
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Aguilera Vasquez N
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - T. Pande
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - F. Haraka
- Ifakara Health Institute, TB Interventions and Clinical Trials Department, Ifakara, Tanzania
- Elizabeth Glaser Pedatric AIDS Foundation, Dar esa Salaam, Tanzania
| | - J. Creswell
- Innovations & Grants Team, Stop TB Partnership, Geneva, Switzerland
| | - T. Rahman
- Innovations & Grants Team, Stop TB Partnership, Geneva, Switzerland
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Data-driven identification of communities with high levels of tuberculosis infection in the Democratic Republic of Congo. Sci Rep 2022; 12:3912. [PMID: 35273212 PMCID: PMC8913845 DOI: 10.1038/s41598-022-07633-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
When access to diagnosis and treatment of tuberculosis is disrupted by poverty or unequal access to health services, marginalized communities not only endorse the burden of preventable deaths, but also suffer from the dramatic consequences of a disease which impacts one’s ability to access education and minimal financial incomes. Unfortunately, these pockets are often left unrecognized in the flow of data collected in national tuberculosis reports, as localized hotspots are diluted in aggregated reports focusing on notified cases. Such system is therefore profoundly inadequate to identify these marginalized groups, which urgently require adapted interventions. We computed an estimated incidence-rate map for the South-Kivu province of the Democratic Republic of Congo, a province of 5.8 million inhabitants, leveraging available data including notified incidence, level of access to health care and exposition to identifiable risk factors. These estimations were validated in a prospective multi-centric study. We could demonstrate that combining different sources of openly-available data allows to precisely identify pockets of the population which endorses the biggest part of the burden of disease. We could precisely identify areas with a predicted annual incidence higher than 1%, a value three times higher than the national estimates. While hosting only 2.5% of the total population, we estimated that these areas were responsible for 23.5% of the actual tuberculosis cases of the province. The bacteriological results obtained from systematic screenings strongly correlated with the estimated incidence (r = 0.86), and much less with the incidence reported by epidemiological reports (r = 0.77), highlighting the inadequacy of these reports when used alone to guide disease control programs.
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Moyo D, Zishiri C, Ncube R, Madziva G, Sandy C, Mhene R, Siziba N, Kavenga F, Moyo F, Muzvidziwa O, Ncube P, Chigaraza B, Nyambo A, Timire C. Tuberculosis and Silicosis Burden in Artisanal and Small-Scale Gold Miners in a Large Occupational Health Outreach Programme in Zimbabwe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111031. [PMID: 34769551 PMCID: PMC8583466 DOI: 10.3390/ijerph182111031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
Artisanal and small-scale miners (ASMs) labour under archaic working conditions and are exposed to high levels of silica dust. Exposure to silica dust has been associated with an increased risk of tuberculosis and silicosis. ASMs are highly mobile and operate in remote areas with near absent access to health services. The main purpose of this study was to evaluate the prevalence of tuberculosis, silicosis and silico-tuberculosis among ASMs in Zimbabwe. A cross-sectional study was conducted from 1 October to 31 January 2021 on a convenient sample of 514 self-selected ASMs. We report the results from among those ASMs who attended an outreach medical facility and an occupational health clinic. Data were collected from clinical records using a precoded data proforma. Data variables included demographic (age, sex), clinical details (HIV status, GeneXpert results, outcomes of chest radiographs, history of tuberculosis) and perceived exposure to mine dust. Of the 464 miners screened for silicosis, 52 (11.2%) were diagnosed with silicosis, while 17 (4.0%) of 422 ASMs were diagnosed with tuberculosis (TB). Of the 373 ASMs tested for HIV, 90 (23.5%) were sero-positive. An HIV infection was associated with a diagnosis of silicosis. There is need for a comprehensive occupational health service package, including TB and silicosis surveillance, for ASMs in Zimbabwe. These are preliminary and limited findings, needing confirmation by more comprehensive studies.
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Affiliation(s)
- Dingani Moyo
- Baines Occupational Health Services, Harare 024, Zimbabwe; (G.M.); (F.M.); (O.M.); (P.N.); (B.C.)
- Occupational Health Division, School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa
- Department of Community Medicine, Faculty of Medicine, Midlands State University, Gweru 054, Zimbabwe
- Department of Community Medicine, Faculty of Medicine, National University of Science and Technology, Bulawayo 029, Zimbabwe
- Correspondence: ; Tel.: +26-(37)-7215-0115
| | | | | | - Godknows Madziva
- Baines Occupational Health Services, Harare 024, Zimbabwe; (G.M.); (F.M.); (O.M.); (P.N.); (B.C.)
| | - Charles Sandy
- Ministry of Health and Child Care, Harare 024, Zimbabwe; (C.S.); (R.M.); (N.S.); (F.K.); (A.N.); (C.T.)
| | - Reginald Mhene
- Ministry of Health and Child Care, Harare 024, Zimbabwe; (C.S.); (R.M.); (N.S.); (F.K.); (A.N.); (C.T.)
| | - Nicholas Siziba
- Ministry of Health and Child Care, Harare 024, Zimbabwe; (C.S.); (R.M.); (N.S.); (F.K.); (A.N.); (C.T.)
| | - Fungai Kavenga
- Ministry of Health and Child Care, Harare 024, Zimbabwe; (C.S.); (R.M.); (N.S.); (F.K.); (A.N.); (C.T.)
| | - Florence Moyo
- Baines Occupational Health Services, Harare 024, Zimbabwe; (G.M.); (F.M.); (O.M.); (P.N.); (B.C.)
| | - Orippa Muzvidziwa
- Baines Occupational Health Services, Harare 024, Zimbabwe; (G.M.); (F.M.); (O.M.); (P.N.); (B.C.)
| | - Petronella Ncube
- Baines Occupational Health Services, Harare 024, Zimbabwe; (G.M.); (F.M.); (O.M.); (P.N.); (B.C.)
| | - Blessings Chigaraza
- Baines Occupational Health Services, Harare 024, Zimbabwe; (G.M.); (F.M.); (O.M.); (P.N.); (B.C.)
| | - Andrew Nyambo
- Ministry of Health and Child Care, Harare 024, Zimbabwe; (C.S.); (R.M.); (N.S.); (F.K.); (A.N.); (C.T.)
| | - Collins Timire
- Ministry of Health and Child Care, Harare 024, Zimbabwe; (C.S.); (R.M.); (N.S.); (F.K.); (A.N.); (C.T.)
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Factors Affecting Motivation among Key Populations to Engage with Tuberculosis Screening and Testing Services in Northwest Tanzania: A Mixed-Methods Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189654. [PMID: 34574579 PMCID: PMC8469176 DOI: 10.3390/ijerph18189654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022]
Abstract
In northwest Tanzania, many artisanal small-scale miners (ASMs) and female sex workers (FSWs) live in informal communities surrounding mines where tuberculosis (TB) is highly prevalent. An active case finding (ACF) intervention to increase TB case notification was undertaken in two districts. Alongside this, a study was implemented to understand engagement with the intervention through: (1) quantitative questionnaires to 128 ASMs and FSWs, who either engaged or did not engage in the ACF intervention, to assess their views on TB; (2) qualitative interviews with 41 ASMs and FSWs, 36 community health workers (CHWs) and 30 community stakeholders. The mean perceived severity of TB score was higher in the engaged than in the non-engaged group (p = 0.01). Thematic analysis showed that health-seeking behaviour was similar across both groups but that individuals in the non-engaged group were more reluctant to give sputum samples, often because they did not understand the purpose. CHWs feared contracting TB on the job, and many noted that mining areas were difficult to access without transportation. Community stakeholders provided various recommendations to increase engagement. This study highlights reasons for engagement with a large-scale ACF intervention targeting key populations and presents insights from implementers and stakeholders on the implementation of the intervention.
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Gottesfeld P, Khoza NN. Urgent Need for a Comprehensive Public Health Response to Artisanal Small-Scale Mining. Ann Work Expo Health 2021; 66:1-4. [PMID: 34347031 DOI: 10.1093/annweh/wxab058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022] Open
Abstract
Informal sector mining is a growing enterprise in countries around the world providing livelihood to >40 million self-employed miners. The use of mercury in gold processing has been the sole focus of most research and public health interventions in artisanal mining. Few programs work to improve health among communities mining other commodities including sand, aggregates, quartz, lead, gemstones, coal and other materials. Although mercury is a major environmental challenge in countries with extensive gold mining, artisanal miners are also exposed to silica dust, metals and other safety hazards. The available evidence regarding hazardous exposures among self-employed miners suggests that the public health implications are much broader. There is a growing body of evidence linking exposures to silica dust to tuberculosis and other lung diseases among artisanal miners. Studies have also documented exposures to lead and other metals including arsenic, cadmium, cobalt and chromium in informal mining communities. Silica-dust exposures are higher in artisanal mining than levels reported in large industrial mining. There is ample evidence that artisanal miners are experiencing health impacts not just from mercury but also from exposures to noise, silica dust and metals. Practical, low-cost solutions have been pilot tested and shown to reduce respirable silica dust and metal exposures among miners and ore processors. Governments, development agencies and global health funders should invest in comprehensive public health programs to respond to these needs.
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Affiliation(s)
- Perry Gottesfeld
- Occupational Knowledge International, 4444 Geary Boulevard, Suite 208, San Francisco, CA, USA
| | - Norman Nkuzi Khoza
- African Union Development Agency-NEPAD (AUDA-NEPAD), Randjespark, 1685 Johannesburg, South Africa
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