Occupational lung diseases among former goldminers in two labour sending areas

OBJECTIVES

To compare and contrast the prevalence of pneumoconiosis in two groups of former migrant mineworkers in southern Africa, and to examine the effectiveness of the South African compensation system for occupational lung diseases.

DESIGN

Comparison of two cross-sectional studies and follow-up data on compensation results.

SETTING

The village of Thamaga, Botswana and the rural area of Libode, Eastern Cape, South Africa.

SUBJECTS

Two hundred and thirty-four former underground mineworkers in Thamaga, and 238 in Libode.

MAIN OUTCOME MEASURES

Prevalence and severity of pneumoconiosis, prevalence of radiological signs of tuberculosis (TB), Medical Bureau for Occupational Diseases (MBOD) certification committee decisions, and compensation results.

RESULTS

Prevalence of pneumoconiosis > or = 2/1 was 15.4% in Libode and 13.6% in Thamaga. Significantly more Libode than Thamaga subjects (51.1% versus 29.0%) reported past TB treatment. Radiological signs of pulmonary TB were also more prevalent in Libode (33.3% v. 23.9%). Twenty-six per cent of Libode men and 16.1% of Thamaga men were certified with compensable disease. Libode payments were finalized within 30 months, whereas Thamaga cases only began receiving payments 52 months after medical examination, with 11 cases still pending 66 months after medical examination.

CONCLUSION

There was a high prevalence of pneumoconiosis in both study groups. Many men were eligible for compensation but were previously uncompensated. The higher rate of compensable disease in the Libode group may relate to the higher prevalence of TB, as well as more active follow-up by the study group, including a large number of appeals. Socio-political changes in South Africa between 1994 and 1996 may also have influenced compensation results.

Breastfeeding and complementary feeding practices in a Swaziland population

Before construction of the Maguga Dam near Pigs Peak in Swaziland commenced, a baseline cross-sectional study was conducted to assess the nutritional status of the population a part of a health status survey. In this article we report the breastfeeding and complementary feeding practices of children younger than two years of age. The study population consisted of people living in three areas, which are likely to be affected by the construction of the Maguga Dam in Swaziland, and two areas approximately 150km away, which were selected because of socio-economic and demographic similarities. The initiation rate of breastfeeding was high, and most of the children were breastfeed for at least 12 months. Sixty percent of infants were introduced to solid foods at the age of 4-6 months. Maize meal porridge was the solid food introduced first to more than 80% of the infants. Approximately two months lapsed before the next solid food was introduced. Although only a small percentage (9.4%) of the mothers used formula milk, less than half of these mothers followed the correct mixing proportions (one scoop formula on 25ml water). When breast milk and solid foods were given during the same feeding session, approximately one third of the mothers gave breast milk first and then the solid foods. This study showed that the initiation and duration of breastfeeding are not a problem in this population residing in Swaziland. The complementary feeding practices of concern were the age of introducing solid foods (28.2% before 4 months and 11.8% after 6 months), the lapse of 2 months before the next solid food was introduced, and the order of feeding breast milk and solids, and the incorrect mixing of formula milk.

Prevalence of occupational lung disease in a random sample of former mineworkers, Libode District, Eastern Cape Province, South Africa

BACKGROUND

Gold mineworkers in South Africa are exposed to high levels of silica dust as a result of which they are at risk of developing silicosis, which is a compensable disease. The incidence of tuberculosis is also high.

METHODS

To determine the prevalence of occupational lung disease and the previous compensation history in former migrant mineworkers, a study was undertaken in a random sample of men living in Libode, a rural district of Eastern Cape Province, South Africa. Two hundred thirty-eight ex-mineworkers were examined according to a protocol that included chest radiography and spirometry. Chest radiographs were read into the International Labour Organisation (ILO) classification for pneumoconioses by two readers.

RESULTS

The mean age was 52.8 years, and the mean length of service was 12.15 years. The prevalence of pneumoconiosis (> or = ILO 1/0) was 22% and 36% (variation by reader). For both readers, a significant association between length of service and pneumoconiosis and between pneumoconiosis and reduction in FVC and FEV was found. Twenty-four percent of study subjects were eligible for compensation.

CONCLUSION

There is a high prevalence of previously undiagnosed, uncompensated pneumoconiosis in the study group. As a result of the failure to diagnose and compensate occupational lung disease, the social and economic burden of such disease is being borne by individuals, households, and the migrant labor-sending communities as a whole.

Attendance versus compliance with tuberculosis treatment in an occupational setting--a pilot study

AIM

To determine the prevalence of non-compliance with tuberculosis treatment at Freegold Mines.

OBJECTIVES

1. To establish the rates of attendance and collection of anti-tuberculosis drugs. 2. To determine prevalence of non-compliance by means of urine tests.

DESIGN

A cross-sectional study conducted over 2 weeks at mine medical stations.

METHOD

Urine samples were collected from tuberculosis patients 3 hours after drug ingestion. Non-compliance was established by testing these samples for rifampicin and/or isoniazid (INH) metabolites. Non-compliance was defined as a negative urine test result for these drugs in participants whose treatment regimens included one or both. Daily attendance and collection of drugs statistics are recorded in the medical station tuberculosis register. The patient rate of adherence was calculated as the observed number of days on which medication had been collected over the expected treatment days in a given period.

RESULTS

Urine test results showed an overall prevalence of non-compliance of 14.6 +/- 3.3%. The study showed that non-compliance with tuberculosis treatment was underestimated by the surveillance data. The rate of non-adherence with treatment established from the formal surveillance procedure was 0.2%. The poor response rate of patients was found to be a major problem and fewer than 40% per day returned to bring urine specimens. The mean prevalences of non-compliance established by rifampicin and INH tests were 19.5 +/- 5.3% and 9.8 +/- 3.9%, respectively, and these were significantly different (Chi 2 = 7.44; P < 0.05). The proportion of false-positive results for INH and rifampicin urine tests were 21% (11/53) and 35% (17/48), respectively, showing that some patients were taking the wrong treatment.

CONCLUSIONS

It is clear that attendance at the clinics does not accurately reflect compliance. Both programme compliance (dispensing of the correct treatment) and patient compliance need to be improved. This has important implications for the new national tuberculosis control policy adopted by the South African government that stresses the importance of directly observed therapy, short-course (DOTS) and a patient-centred approach.

Prevalence and intensity of Schistosoma haematobium urinary schistosomiasis in the Port St Johns district

A urinary schistosomiasis survey undertaken in the Port St Johns district of the former Transkei showed the parasite to be endemic and noted an increase in overall infection rates in the region compared with previous studies. There was a general stability in infection over the sampling period 1987-1989. Prevalence rates were low to moderate with an overall prevalence of 42%. These ranged from approximately 10% in the low-prevalence settlement to 89.9% in the settlement with the highest prevalence. Infection rates were found to decrease nearer the coast, and settlements closest to the sea had the lowest prevalence rates. The intensity of infection was low, with the majority of patients having fewer than 200 eggs per 10 ml urine. Very few sufferers were treated with Ambilhar at clinics and hospitals.