Occupational respiratory diseases in the South African mining industry

Rare Earth and Platinum Group Elements In Sub-Saharan Africa and Global Health: The Dark Side of the Burgeoning of Technology

Despite steady progress in the development and promotion of the circular economy as a model, an overwhelming proportion of technological devices discarded by the Global North still finds its way to the Global South, where technology-related environmental health problems start from the predation of resources and continue all the way to recycling and disposal. We reviewed literature on TCEs in sub-Saharan Africa (SSA), focussing on: the sources and levels of environmental pollution; the extent of human exposure to these substances; their role in the aetiology of human diseases; their effects on the environment. Our review shows that even minor and often neglected technology-critical elements (TCEs), like rare earth elements (REEs) and platinum group elements (PGEs), reveal the environmental damage and detrimental health effects caused by the massive mining of raw materials, exacerbated by improper disposal of e-waste (from dumping to improper recycling and open burning). We draw attention of local research on knowledge gaps such as workable safer methods for TCE recovery from end-of-life products, secondary materials and e-waste, environmental bioremediation and human detoxification. The technical and political shortcomings in the management of TCEs in SSA is all the more alarming against the background of unfavourable determinants of health and a resulting higher susceptibility to diseases, especially among children who work in mines and e-waste recycling sites or who reside in dumping sites.This paper demonstrates, for the first time, that the role of unjust North-South dynamics is evident even in the environmental levels of minor trace elements and that the premise underlying attempts to solve the problem of e-waste dumped in Africa through recycling and disposal technology is in fact misleading. The influx of foreign electrical and electronic equipments should be controlled and limited by clearly defining what is a 'useful' second-hand device and what is e-waste; risks arising from device components or processing by-products should be managed differently, and scientific uncertainty and One Health thinking should be incorporated in risk assessment.

Analysis of respirable dust exposure data collected at a Zambian copper mine between 2017 and 2022

Mine workers are occupationally exposed to respirable dust, which can cause irreversible lung diseases and controlling exposure concentrations to as low as reasonably practicable is, therefore, essential. To implement exposure reduction strategies and adequately manage exposure to hazardous chemicals, exposure needs to be measured and recorded according to a standard exposure management plan. This study aimed to assess the available respirable dust exposure data measured between 2017 and 2022 in various work areas and job categories at two mining shafts and a concentrator plant of a Zambian copper mine. Additionally, the monitoring program implemented at the mine was assessed for appropriateness. Descriptive data analysis was used to create an exposure matrix comprising 253 exposure measurements. Approximately 5.6% of the measured concentrations exceeded the South African time-weighted average occupational exposure limit (TWA-OEL) of 3 mg/m3. The geometric means of respirable dust exposure for shaft A, shaft B and the concentrator plant were 0.44 mg/m3, 0.44 mg/m3, and 0.68 mg/m3, respectively. The work areas with the highest maximum exposure results were the tipping area (18.0 mg/m3) at shaft A, the sump and waste bin (8.05 mg/m3) at shaft B and the screening (10.8 mg/m3), secondary crusher (14.0 mg/m3), foreign ore bin (4.43 mg/m3), and tertiary crusher (5.07 mg/m3) areas at the concentrator plant. It was found that the monitoring strategy implemented at the mine was flawed and did not collect a sufficient number of samples in each area during each year to make rigorous statistical assessment possible. This study highlights the sampling strategy's shortcomings and recommends adopting a standardized monitoring strategy, such as EN689, to improve the respirable dust monitoring program at the mine. Additionally, this strategy can be implemented across Zambia and, if implemented correctly, it has the potential to be improve exposure monitoring across the country as no standard sampling strategy is currently enforced by the Government.

Environmental hazards posed by mine dust, and monitoring method of mine dust pollution using remote sensing technologies: An overview

The over-exploitation of mineral resources has led to increasingly serious dust pollution in mines, resulting in a series of negative impacts on the environment, mine workers (occupational health) and nearby residents (public health). For the environment, mine dust pollution is considered a major threat on surface vegetation, landscapes, weather conditions and air quality, leading to serious environmental damage such as vegetation reduction and air pollution; for occupational health, mine dust from the mining process is also regarded as a major threat to mine workers' health, leading to occupational diseases such as pneumoconiosis and silicosis; for public health, the pollutants contained in mine dust may pollute surrounding rivers, farmlands and crops, which poses a serious risk to the domestic water and food security of nearby residents who are also susceptible to respiratory diseases from exposure to mine dust. Therefore, the second section of this paper combines literature research, statistical studies, and meta analysis to introduce the public mainly to the severity of mine dust pollution and its hazards to the environment, mine workers (occupational health), and residents (public health), as well as to present an outlook on the management of mine dust pollution. At the same time, in order to propose a method for monitoring mine dust pollution on a regional scale, based on the Dense Dark Vegetation (DDV) algorithm, the third section of this paper analysed the aerosol optical depth (AOD) change in Dexing City of China using the data of 2010, 2014, 2018 and 2021 from the NASA MCD19A2 Dataset to explore the mine dust pollution situation and the progress of pollution treatment in Dexing City from 2010 to 2021. As a discussion article, this paper aims to review the environmental and health risks caused by mine dust pollution, to remind the public to take mine dust pollution seriously, and to propose the use of remote sensing technologies to monitor mine dust pollution, providing suggestions for local governments as well as mines on mine dust monitoring measures.

Evaluation of Lung Functions, Blood Pressure, and Hearing Deterioration in Tile Setters

INTRODUCTION

Tile setters in construction industries are exposed to a potent risk of silicosis as they are constantly exposed to crystalline silica dust during concrete finishing, cutting and fixing of the ceramic tiles. The noise produced by instruments used in tile settings may lead to noise-induced hearing loss. Noise above the permissible limit of 85 dB may lead to autonomic changes and alteration in blood pressure. These facts gave us an impetus to evaluate the pulmonary functions, blood pressure and hearing deterioration in tile setters and correlate these parameters for their present functional status with duration of exposure to tile cutting profession.

METHODS

The pulmonary functions were evaluated with spirometer, autonomic status by recording the blood pressure and hearing loss by calculating the Hearing Deterioration Index (HDI) for hearing loss.

RESULTS

There was significant decline in forced vital capacity (FVC), forced expiratory volume 1 sec (FEV1) and forced expiratory volume 1% (FEV1%) in tile setters. The decline in FVC, FEV1 and FEV1% was significantly higher in subjects with exposure of more than five years. There was increased systolic and diastolic blood pressure in those having more than five years of exposure in the tile setting profession as compared to less than five years. There was a positive correlation between years of service in the tile setting profession as well as sound exposure level with HDI and blood pressure in our subjects.

CONCLUSION

Prolonged exposure to the tile setting profession may lead to compromised lung function, hypertension and hearing deterioration in tile setters.

Exposure to dust and respiratory health among Australian miners

PURPOSE

Occupational exposure to dust has been recognised as a significant health hazard to mine workers. This study aimed to investigate the association between exposure to inhalable (INH) and respirable (RES) dust and respiratory health among mine workers in Western Australia using an industry-wide exposure database.

METHODS

The database comprised cross-sectional surveys conducted by mining companies for the period 2001-2012. The study population consisted of 12,797 workers who were monitored for exposure to INH and RES dust and undertook health assessments including a respiratory questionnaire and spirometry test.

RESULTS

Despite the general trend of declining exposure to both INH and RES dust observed over the 12 years period, mine workers reported a higher prevalence of phlegm and cough when exposed to elevated concentrations of INH and RES dust. Logistic regression analysis further confirmed the positive association between INH dust exposure and the prevalence of phlegm with an adjusted odds ratio of 1.033 (95% CI 1.012-1.052). Overall, 6.3% of miners might have potential airway obstruction, and exposure to INH dust was associated with impaired lung function parameters.

CONCLUSION

Exposure levels of INH and RES dust particles among mine workers have reduced considerably and were well below currently legislated occupational exposure limits. However, given the reported higher prevalence of phlegm and cough among those with elevated dust concentrations, there is a continued need for effective dust exposure monitoring and control in the mineral mining industry.

Identification of key pathways and genes in the progression of silicosis based on WGCNA

Silicosis, induced by inhaling silica particles in workplaces, is one of the most common occupational diseases. The prognosis of silicosis and its consequent fibrosis is extremely poor due to limited treatment modalities and lack of understanding of the disease mechanisms. In this study, a Wistar rat model for silicosis fibrosis was established by intratracheal instillation of silica (0, 50, 100 and 200 mg/mL, 1 mL) with the evidence of Hematoxylin and Eosin (HE) and Masson staining and the expressions of inflammatory and fibrotic proteins of rats' lung tissues. RNA of lung tissues of rats exposed to 200 mg/mL silica particles and normal saline for 14 d and 28 d was extracted and sequenced to detect differentially expressed genes (DEGs) and to identify silicosis fibrosis-associated modules and hub genes by Weighted gene co-expression network analysis (WGCNA). Predictions of gene functions and signaling pathways were conducted using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. In this study, it has been demonstrated the promising role of the Hippo signaling pathway in silicosis fibrosis, which will be conducive to elucidating the specific mechanism of pulmonary fibrosis induced by silica and to determining molecular initiating event (MIE) and adverse outcome pathway (AOP) of silicosis fibrosis.

Exposure Time of Silica Dust and the Incidence of Oxidative Stress, Inflammation, and Fibrosis in Rat Lungs

BACKGROUND: Until now, exposure to silica dust is still a health problem worldwide. Silica exposure in the lungs will cause pulmonary fibrosis which is initiated by inflammation. However, the results of several studies regarding the duration of inflammation and fibrosis are still inconsistent. There was a role of oxidative stress in silicosis, but there were also inconsistencies in terms of when oxidative stress occurs in silica exposure. AIM: This study aimed to study the toxic effects of silica dust exposure by looking at the picture of inflammation and fibrosis and malondialdehyde (MDA) levels in lung tissue during the observation period of 7 days, 14 days, 21 days, and 28 days. METHODS: This study used a randomized post-test only control group design. The research sample was male Wistar rat (Rattus norvegicus), aged 6–10 weeks, body weight 150–200 g (divided into 5 groups: Control group, day 7 group, group day 14, group day 21, and group day 28). We administered silica suspension through intratracheal injection of 30 mg/rat on 0.5 mL of volume. Examination of MDA level was using the ELISA technique; histopathological examination of the liver used hematoxylin-eosin (HE) staining to determine inflammation and fibrosis. Statistical test using one-way ANOVA or Kruskal–Wallis followed by post hoc test. RESULTS: The results of our study found that intratracheal silica exposure increased MDA levels on the 7th day, increased the accumulation of collagen from the 14th day, and increased the pulmonary inflammation score on the 14th day (p < 0.05). CONCLUSIONS: It was concluded that silica exposure caused significant oxidative stress on day 7 as well as significant inflammation and pulmonary fibrosis on day 14.

Assessment of asbestos contamination in soils at rehabilitated and abandoned mine sites, Limpopo Province, South Africa

Prior to its termination, asbestos mining in South Africa was centred on the large crocidolite fields of the present day Northern Cape, the amosite (grunerite)-crocidolite fields of Limpopo, and chrysotile fields of Mpumalanga provinces. The legacy of these activities continues to affect surrounding communities in contemporary South Africa. The asbestos fields of Limpopo host two important former mining areas at Penge and at the Bewaarkloof near Chuenespoort. A large abandoned site is located southeast of Penge at Weltevreden, where there is no evidence of any rehabilitation. Two former mines, Lagerdraai and Uitkyk, are rehabilitated sites in an extensive string of closed mines that operated in the southern Bewaarkloof. Samples from the abandoned and rehabilitated mine sites were studied using semi-quantitative X-ray powder diffraction (XRD) to determine asbestos contamination levels in soils, and to assess distribution patterns of asbestos mineral species in the surrounding soils. Only where below detection (typically 1-3 mass%) from XRD, samples were assessed optically. The Weltevreden site, with no observable rehabilitation efforts, contrasts with the rehabilitated sites at Lagerdraai and Uitkyk. The predominant asbestiform mineral species at each site were successfully identified, with underlying geological asbestos mineral distribution trends recognised in the soils at the Bewaarkloof. Trace amounts of asbestiform minerals were identified in soils downstream of the Weltevreden mine, as well as in surrounding hillsides. The results indicate that XRD is a potentially useful tool for benchmarking sites yet to be rehabilitated as well as monitoring the effectiveness of previous rehabilitation efforts. The method is also a suitable first-pass for target areas that may require more detailed, time-consuming, and costly analysis.

Shape matters-the interaction of gold nanoparticles with model lung surfactant monolayers

The lung surfactant monolayer (LSM) forms the main biological barrier for any inhaled particles to enter our bloodstream, including gold nanoparticles (AuNPs) present as air pollutants and under investigation for use in biomedical applications. Understanding the interaction of AuNPs with lung surfactant can assist in understanding how AuNPs enter our lungs. In this study, we use coarse-grained molecular dynamics simulations to investigate the effect of four different shape D AuNPs (spherical, box, icosahedron and rod) on the structure and dynamics of a model LSM, with a particular focus on differences resulting from the shape of the AuNP. Monolayer-AuNP systems were simulated in two different states: the compressed state and the expanded state, representing inhalation and exhalation conditions, respectively. Our results indicate that the compressed state is more affected by the presence of the AuNPs than the expanded state. Our results show that in the compressed state, the AuNPs prevent the monolayer from reaching the close to zero surface tension required for normal exhalation. In the compressed state, all four nanoparticles (NPs) reduce the lipid order parameters and cause a thinning of the monolayer where the particles drag surfactant molecules into the water phase. Comparing the different properties shows no trend concerning which shape has the biggest effect on the monolayer, as shape-dependent effects vary among the different properties. Insights from this study might assist future work of how AuNP shapes affect the LSM during inhalation or exhalation conditions.

Trends in global, regional and national incidence of pneumoconiosis caused by different aetiologies: an analysis from the Global Burden of Disease Study 2017

OBJECTIVES

Pneumoconiosis remains a major global occupational health hazard and illness. Accurate data on the incidence of pneumoconiosis are critical for health resource planning and development of health policy.

METHODS

We collected data for the period between 1990 and 2017 on the annual incident cases and the age-standardised incidence rates (ASIR) of pneumoconiosis aetiology from the Global Burden of Disease Study 2017. We calculated the average annual percentage changes of ASIR by sex, region and aetiology in order to determine the trends of pneumoconiosis.

RESULTS

Globally, the number of pneumoconiosis cases increased by a measure of 66.0%, from 36 186 in 1990 to 60 055 in 2017. The overall ASIR decreased by an average of 0.6% per year in the same period. The number of pneumoconiosis cases increased across the five sociodemographic index regions, and there was a decrease in the ASIR from 1990 to 2017. The ASIR of silicosis, coal workers' pneumoconiosis and other pneumoconiosis decreased. In contrast, measures of the ASIR of asbestosis displayed an increasing trend. Patterns of the incidence of pneumoconiosis caused by different aetiologies were found to have been heterogeneous for analyses across regions and among countries.

CONCLUSION

Incidence patterns of pneumoconiosis which were caused by different aetiologies varied considerably across regions and countries of the world. The patterns of incidence and temporal trends should facilitate the establishment of more effective and increasingly targeted methods for prevention of pneumoconiosis and reduce associated disease burden.

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.

GOLD: human exposure and update on toxic risks

Gold is ubiquitous in the human environment and most people are in contact with it through wearing jewelry, dental devices, implants or therapies for rheumatoid arthritis. Gold is not a nutrient but people are exposed to it as a food colorant and in food chains. The present review discusses the hazards faced in personal and domestic use of gold and the far greater risks presented through occupational exposure to the metal in mining and processing gold ores. In the last situation, regular manual contact or inhalation of toxic or carcinogenic materials like mercury or arsenic, respectively, presents far greater hazard and greatly complicates the evaluation of gold toxicity. The uses and risks presented by new technology and use of nanoparticulate gold in anti-cancer therapies and diagnostic medicine forms a major consideration in gold toxicity, where tissue uptake and distribution are determined largely by particle size and surface characteristics. Many human problems arise through the ability of metallic gold to induce allergic contact hypersensitivity. While gold in jewelry can evoke allergic reactions, other metals such as nickel, chromium and copper present in white gold or alloys exhibit more serious clinical problems. It is concluded that toxic risks associated with gold are low in relation to the vast range of potential routes of exposure to the metal in everyday life.

Platinum Mine Workers' Exposure to Dust Particles Emitted at Mine Waste Rock Crusher Plants in Limpopo, South Africa

The South African mining industry is one of the largest producers of platinum (Pt) in the world. Workers in this industry are exposed to significant amounts of dust, and this dust consists of particles sizes that can penetrate deep inside the respiratory region. A cross-sectional study was conducted to evaluate dust exposure risk at two Pt mine waste rock crusher plants (Facility A and B) in Limpopo, South Africa. Workers’ demographic and occupational information was collected through a structured questionnaire, a walk-through observation on facilities’ processes, and static dust sampling for the collection of inhalable and respirable dust particles using the National Institute for Occupational Safety and Health (NIOH) 7602 and the Methods for Determination of Hazardous Substance (MDHS) 14/4 as guidelines. Only 79% of Pt mine workers, used their respiratory protective equipment (RPE), sixty-five percent were exposed to work shifts exceeding the recommended eight hours and 8.8% had been employed for more than ten years. The mean time-weighted average (TWA) dust concentrations between Facility A and B showed a significant difference (p < 0.026). The Pt mine’s inhalable concentrations (range 0.03–2.2 mg/m³) were higher than the respirable concentrations (range 0.02–0.7 mg/m³), however were all below the respective international and local occupational exposure limits (OELs). The Pt mine’s respirable crystalline silica (SiO₂) quartz levels were all found below the detectable limit (<0.01 mg/m³). The Pt miners had increased health risks due to accumulated low levels of dust exposure and lack of usage of RPE. It is recommended that an improved dust control program be put in place which includes, but is not limited to, stockpile enclosures, tire stops with water sprays, and education on the importance of RPE usage.

Effects of commodity on the risk of emphysema in South African miners

PURPOSE

To examine associations between mine commodity such as coal, platinum, or diamonds and emphysema among South African miners at autopsy.

METHODS

We examined the association between mine commodity and emphysema using the Pathology Automation (PATHAUT) database, 1975-2014. Exposure was characterized as longest tenure in each commodity. We constructed separate multivariable logistic regression models for black and white miners. Smoking was assessed in a sub-analysis of white miners.

RESULTS

Among black miners, coal mining was significantly associated with increased odds of emphysema [OR = 2.39 (95% CI 1.86, 3.07)] when compared to gold mining. Asbestos was also associated with significantly increased odds of emphysema among black miners [OR = 1.47 (95% CI 1.01, 2.12)]. No associations between commodity and emphysema were observed among white miners. Cumulative years of exposure and age at death were significant predictors for emphysema for both black and white miners. Smoking was a significant predictor of emphysema in the sub-analysis of white miners with smoking information, but no effect of commodity was observed.

CONCLUSIONS

We observed a significant association between coal mining and emphysema among black miners. Adverse health effects of coal mining are evidenced by more than twofold increase in emphysema among black coal miners compared to gold miners. This suggests that South African Coal miners are exposed to high dust concentrations or more damaging components compared to other commodities, resulting in elevated risk of emphysema.

Characteristics and Trends of Pneumoconiosis in the Jiangsu Province, China, 2006⁻2017

This study aims to describe the characteristics and trends of pneumoconiosis in the Jiangsu Province, China, and provide information for the occupational diseases control. We collected and analyzed the data of pneumoconiosis cases reported annually from 2006 to 2017. The information of the cases mainly includes case distributions, clinical types and stages, enterprise types and scales, as well as diagnosis age and exposure duration. A total of 9243 pneumoconiosis cases were reported between 2006 and 2017, among which silicosis and coal workers’ pneumoconiosis accounted for the vast majority (87.5%). The incidence of pneumoconiosis was relatively higher in Wuxi, Yancheng, Suzhou and Xuzhou, compared to the other district. Most pneumoconiosis cases occurred in the state-owned (58.4%) and collective enterprises (23.8%). Most cases worked in industries related to geology and coal production. The median exposure duration and diagnosis age of the total pneumoconiosis cases was 13.2 and 61.0 years, respectively. Therefore, more measurements are needed to control pneumoconiosis in the Jiangsu Province.

The epidemiology of idiopathic pulmonary fibrosis and interstitial lung diseases at risk of a progressive-fibrosing phenotype

The availability of epidemiological data relating to interstitial lung diseases (ILDs) has increased over recent years, but information on the prevalence and incidence of ILDs of different aetiologies remains limited. Despite global distribution, the proportion of patients who develop a progressive phenotype across different ILDs is not well known. Disease behaviour is well documented in idiopathic pulmonary fibrosis but idiosyncratic in other ILDs that may present a progressive fibrosing phenotype. Possible reasons may include the heterogeneous nature of the aetiology, the complexity of diagnosis (and subsequent documentation of cases) and the methods employed to retrospectively analyse patient databases. This review presents a broad overview of the epidemiological data available for ILDs that may present a progressive-fibrosing phenotype, collectively and stratified according to clinical classification. We also note where further data are needed in comparison to the well-studied IPF indication.

Respiratory Impairment and Personal Respirable Dust Exposure among the Underground and Open Cast Gold Miners in Tanzania

Background:

Mining is one of the most hazardous sectors to work in because it predisposes workers to various hazards including dust. Exposure to dust is inevitable in the mines because the process of extracting gold involves breaking rocks. This dust can penetrate up to the alveoli of the pulmonary system and cause respiratory impairment.

Objectives:

To determine respiratory impairment, personal respirable dust exposure levels and associated factors among miners in a gold mine in Tanzania.

Methods:

Cross-sectional study design, employing questionnaire, was used for data collection on respiratory symptoms. Lung functions were measured using spirometry. Personal respirable dust exposure was collected from similar exposure groups using air sampling pumps. A simple random sampling technique was used to select 112 participants of the study. Data analysis was done using SPSS computer software version 20.0.

Results:

The overall geometric mean (GM) of respirable dust was 0.26 mg/m³ (GSD = 0.32) over a mean sampling time of 8 hours (with a range between 7–11 hours). The GM of respirable dust for underground workers was significantly higher (0.41 ± 0.28 mg/m³) compared to the open pit workers (0.17 ± 0.23 mg/m³) with p < 0.01. For underground workers, the GM of respirable dust was the highest among the bogger operators at 0.53 mg/m³ (GSD = 0.27). For open pit workers, the highest GM of respirable dust was found among the quality controllers at 0.39 mg/m³ (GSD = 0.18). Respiratory symptoms were phlegm (49.1%), breathlessness (42.9%), cough (37.5%), wheezing (18.8%) and chest tightness (10.7%). Cigarette smokers were more likely to suffer from breathlessness than nonsmokers. The prevalence of airflow obstruction (FEV1/FVC < 0.7) was 1.9%; whereas, the prevalence of lung restriction was 8.8%. The study established that age, smoking habit and previous exposure to dust could not predict lung function impairment.

Conclusion:

Despite levels of respirable dust exposure being below the recommended occupational exposure limits, the prevalence of respiratory symptoms was still found to be high among the studied gold miners. This calls for a need to conduct further studies on quartz content of the respirable dust.

Tackling injustices of occupational lung disease acquired in South African mines: recent developments and ongoing challenges

BACKGROUND

South Africa's mineral resources have produced, and continue to produce, enormous economic wealth; yet decades of colonialism, apartheid, capital flight, and challenges in the neoliberal post-apartheid era have resulted in high rates of occupational lung disease and low rates of compensation for ex-miners and their families. Given growing advocacy and activism of current and former mine workers, initiatives were launched by the South African government in 2012 to begin to address the legacy of injustice. This study aimed to assess developments over the last 5 years in providing compensation, quantify shortfalls and explore underlying challenges.

METHODS

Using the database with compensable disease claims from over 200,000 miners, the medical assessment database of 400,000 health records and the employment database with 1.6 million miners, we calculated rates of claims, unpaid claims and shortfall in claim filing for each of the southern African countries with at least 25,000 miners who worked in South African mines, by disease type and gender. We also conducted interviews in Johannesburg, Eastern Cape, Lesotho and a local service unit near a mine site, supplemented by document review and auto-reflection, adopting the lens of a critical rights-based approach.

RESULTS

By the end of 2017, 111,166 miners had received compensation (of which 55,864 were for permanent lung impairment, and another 52,473 for tuberculosis), however 107,714 compensable claims remained unpaid. Many (28.4%) compensable claims are from Mozambique, Lesotho, Swaziland, Botswana and elsewhere in southern Africa, a large proportion of which have been longstanding. A myriad of diverse systemic barriers persist, especially for workers and their families outside South Africa. Calculating predicted burden of occupational lung disease compared to compensable claims paid suggests a major shortfall in filing claims in addition to the large burden of still unpaid claims.

CONCLUSION

Despite progress made, our analysis reveals ongoing complex barriers and illustrates that the considerable underfunding of the systems required for sustained prevention and social protection (including compensation) needs urgent attention. With class action suits in the process of settlement, the globalized mining sector is now beginning to be held accountable. A critical rights-based approach underlines the importance of ongoing concerted action by all.

Respiratory health of dust-exposed Congolese coltan miners

PURPOSE

In Democratic Republic of the Congo (DRC), informal coltan mining has been expanding amidst increased insecurity due to armed conflicts. We investigated the impact of occupational dust-exposure on the respiratory health of Congolese coltan miners.

METHODS

In total, 441 Congolese workers participated in this study, including 199 informal coltan miners and 242 office workers (controls). Information on respiratory complaints was collected using two standardized questionnaires. Physical examination (vital signs, auscultation) and lung function test (Peak Flow meter) were performed. In addition, workplace airborne PM2.5 and volatile organic compounds (VOC) concentrations were measured.

RESULTS

Higher airborne PM2.5 (range 180-210 µg/m³) and VOC (range 1.4-2.3 µg/m³) levels were detected at coltan mining work stations as compared with control sites (19-44 and 0.5-0.8 µg/m³, respectively). All respiratory complaints and disorders were more prevalent in informal coltan miners than in controls. Additionally, a markedly lower mean PEFR was observed in coltan miners than in controls (347.93 ± 6.88 vs. 493.23 ± 67.38 L/min, respectively). Moreover, positive associations between informal coltan mining and almost all respiratory complaints were observed, except wheezing at effort and night cough. On the other hand, an inverse association was observed between lung function (PEFR) and PM2.5 exposure, between PEFR and VOC exposure, and also between PEFR and current smoking.

CONCLUSIONS

This study showed high prevalence of respiratory complaints in Congolese informal coltan miners, suggesting the necessity to implement efficient occupational safety measures and regulate this informal mining business.

Exceedance of environmental exposure limits to crystalline silica in communities surrounding gold mine tailings storage facilities in South Africa

BACKGROUND

Unlike occupational silica exposures, the association between non-occupational silica exposures and adverse health effects is not well researched, despite its occurrence in communities close to dust-generating sources such as tailings storage facilities (TSFs). Recent studies have shown that communities surrounding TSFs in South Africa often complain about the onset of dust-related health effects. Even though international interim non-occupational crystalline silica limits have been established, South Africa is yet to enforce its own limits for residential areas close to TSF sites.

OBJECTIVE

The objective of the study was to assess the need to enforce non-occupational crystalline silica limits for South Africa.

METHODS

The methods involved (1) Quantifying the silica polymorph content in bulk dust collected from TSFs in South Africa; (2) Assessing the possibility of the dust to reach surrounding communities through ambient and personal filter sampling and; (3) Conducting risk characterisation for both cancer and non-cancer endpoints.

RESULTS

All bulk dust samples consisted mostly of crystalline silica (73.14-87.09%). Large percentages of nanoparticles were identified in all bulk samples (66.8-70.7%) indicating the possibility of the dust to lodge deep within the lungs. The crystalline silica levels obtained from ambient PM₁₀ sampling and personal PM₄ sampling all exceeded the international crystalline silica interim limits and reached maximum levels of 90 and 50.9μg·m^-3, respectively. For three TSFs, sampling sites close to the TSFs showed higher PM₄ silica levels compared to sites further from TSFs. Risk characterisation revealed the possibility of cancer and non-cancer health effects when chronically exposed to silica levels recorded during the study.

CONCLUSION

The results indicate unacceptable crystalline silica exposures in surrounding communities and the need for enforcement of an ambient silica limit for South Africa.

Risk Factors for Influenza-Associated Severe Acute Respiratory Illness Hospitalization in South Africa, 2012-2015

Background

Data on risk factors for influenza-associated hospitalizations in low- and middle-income countries are limited.

Methods

We conducted active syndromic surveillance for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) in 2 provinces of South Africa during 2012–2015. We compared the characteristics of influenza-positive patients with SARI to those with ILI to identify factors associated with severe disease requiring hospitalization, using unconditional logistic regression.

Results

During the study period, influenza virus was detected in 5.9% (110 of 1861) and 15.8% (577 of 3652) of SARI and ILI cases, respectively. On multivariable analysis factors significantly associated with increased risk of influenza-associated SARI hospitalization were as follows: younger and older age (<6 months [adjusted odds ratio {aOR}, 37.6], 6–11 months [aOR, 31.9], 12–23 months [aOR, 22.1], 24–59 months [aOR, 7.1], and ≥65 years [aOR, 40.7] compared with 5–24 years of age), underlying medical conditions (aOR, 4.5), human immunodeficiency virus infection (aOR, 4.3), and Streptococcus pneumoniae colonization density ≥1000 deoxyribonucleic acid copies/mL (aOR, 4.8). Underlying medical conditions in children aged <5 years included asthma (aOR, 22.7), malnutrition (aOR, 2.4), and prematurity (aOR, 4.8); in persons aged ≥5 years, conditions included asthma (aOR, 3.6), diabetes (aOR, 7.1), chronic lung diseases (aOR, 10.7), chronic heart diseases (aOR, 9.6), and obesity (aOR, 21.3). Mine workers (aOR, 13.8) and pregnant women (aOR, 12.5) were also at increased risk for influenza-associated hospitalization.

Conclusions

The risk groups identified in this study may benefit most from annual influenza immunization, and children <6 months of age may be protected through vaccination of their mothers during pregnancy.

Lung function, inflammation and cardiovascular mortality in Africans

BACKGROUND

The link between impaired lung function and cardiovascular outcome is well established in European and American populations. It is possible that this association may be driven by a systemic spillover of inflammation occurring within the lungs. As several studies have found an increased level of inflammatory markers in African populations, we aimed to establish the contribution of lung function in predicting all-cause and cardiovascular mortality in Africans, whilst taking inflammatory markers into account.

DESIGN

We followed 1442 black South Africans from the North West Province participating in the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study, over a five-year period. Spirometry, cardiovascular and metabolic measures were performed, and cardiovascular mortality as well as all-cause mortality used as endpoints.

RESULTS

In univariate Cox regression models, both forced expiratory volume in 1-s (FEV₁ ) and forced vital capacity (FVC) predicted all-cause (P = 0·022; P < 0·001) and cardiovascular mortality (P = 0·004; P < 0·001). In multivariate adjusted standardized Cox regression analyses, only FVC predicted cardiovascular mortality independent of several covariates (hazard ratio, 0·57 [0·35-0·94]), including C-reactive protein (CRP). When CRP was replaced by interleukin-6 in the model, the significance of FVC was lost (hazard ratio, 0·85 [0·55-1·30]).

CONCLUSION

FVC, but not FEV₁ , is a strong predictor of both all-cause and CV mortality in black South Africans, which may be mediated by inflammation.

Hazards identified and the need for health risk assessment in the South African mining industry

Although mining plays a prominent role in the economy of South Africa, it is associated with many chemical hazards. Exposure to dust from mining can lead to many pathological effects depending on mineralogical composition, size, shape and levels and duration of exposure. Mining and processing of minerals also result in occupational exposure to toxic substances such as platinum, chromium, vanadium, manganese, mercury, cyanide and diesel particulate. South Africa has set occupational exposure limits (OELs) for some hazards, but mine workers are still at a risk. Since the hazard posed by a mineral depends on its physiochemical properties, it is recommended that South Africa should not simply adopt OELs from other countries but rather set her own standards based on local toxicity studies. The limits should take into account the issue of mixtures to which workers could be exposed as well as the health status of the workers. The mining industry is also a source of contamination of the environment, due inter alia to the large areas of tailings dams and dumps left behind. Therefore, there is need to develop guidelines for safe land-uses of contaminated lands after mine closure.

Occupational respiratory diseases in the South African mining industry

Background

Crystalline silica and asbestos are common minerals that occur throughout South Africa, exposure to either causes respiratory disease. Most studies on silicosis in South Africa have been cross-sectional and long-term trends have not been reported. Although much research has been conducted on the health effects of silica dust and asbestos fibre in the gold-mining and asbestos-mining sectors, little is known about their health effects in other mining sectors.

Objective

The aims of this thesis were to describe silicosis trends in gold miners over three decades, and to explore the potential for diamond mine workers to develop asbestos-related diseases and platinum mine workers to develop silicosis.

Methods

Mine workers for the three sub-studies were identified from a mine worker autopsy database at the National Institute for Occupational Health.

Results

From 1975 to 2007, the proportions of white and black gold mine workers with silicosis increased from 18 to 22% and from 3 to 32% respectively. Cases of diamond and platinum mine workers with asbestos-related diseases and silicosis, respectively, were also identified.

Conclusion

The trends in silicosis in gold miners at autopsy clearly demonstrate the failure of the gold mines to adequately control dust and prevent occupational respiratory disease. The two case series of diamond and platinum mine workers contribute to the evidence for the risk of asbestos-related diseases in diamond mine workers and silicosis in platinum mine workers, respectively. The absence of reliable environmental dust measurements and incomplete work history records impedes occupational health research in South Africa because it is difficult to identify and/or validate sources of dust exposure that may be associated with occupational respiratory disease.