Abstract
The application of a health impact assessment (HIA) for a large-scale copper mining project in rural Zambia triggered the long-term monitoring and evaluation of determinants of health and health outcomes in communities living in proximity to the mine. Three consecutive cross-sectional surveys were conducted at intervals of four years; thus, at baseline (2011), four (2015) and eight (2019) years into the project’s development. Using the same field and laboratory procedures, the surveys allowed for determining changes in health indicators at the household level, in young children (<5 years), school attendees (9–14 years) and women (15–49 years). Results were compared between communities considered impacted by the project and communities outside the project area (comparison communities). The prevalence of Plasmodium falciparum infection increased in both the impacted and comparison communities between 2011 and 2019 but remained consistently lower in the impacted communities. Stunting in children < 5 years and the prevalence of intestinal parasite infections in children aged 9–14 years mostly decreased. In women of reproductive age, selected health indicators (i.e., anaemia, syphilis, underweight and place of delivery) either remained stable or improved. Impacted communities generally showed better health outcomes than comparison communities, suggesting that the health interventions implemented by the project as a consequence of the HIA have mitigated potential negative effects and enhanced positive effects. Caution is indicated to avoid promotion of health inequalities within and beyond the project area.
Highlights
The economy of Zambia depends heavily on the extraction of natural resources, copper [1]
We used an inventory of household assets and amenities, similar to the one developed by the Demographic and Health Survey (DHS), to measure levels of household wealth [16]
Apart from the apparent significant increase in malaria point prevalence variations), the increasing P. falciparum malaria prevalence found in the study area coincided with in both the impacted and comparison communities, living in a community considered impacted by observations at the provincial level
Summary
The economy of Zambia depends heavily on the extraction of natural resources, copper [1]. While mining of copper and other metals can contribute substantially to government revenue and create employment opportunities, the negative effects on the environment and human health, both important resources of the country, can be detrimental and warrant protection [3,4]. The HIA applied the determinants of a health model—comprising of the social, economic and physical environment, as well as individual characteristics and behaviours—to cover the full range of potential direct and indirect health effects of the project on the population [9,10]. The monitoring plan included both collection of routine health information system data as well as periodic, cross-sectional survey data for indicators that were considered potential determinants for human health within the HIA. Indicators of health outcomes and determinants of health were assessed in children and women, and at the household-level, in both project-impacted and non-impacted comparison communities
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