Abstract
BackgroundMining in the Amazon exposes gold miners to various diseases, including malaria, whose control is still a major challenge. The environment of the mines contributes to the proliferation of vector mosquitoes and the precarious housing conditions facilitate transmission of the disease. Understanding gold miners’ perceptions is essential for the formulation of strategies to fight malaria. A qualitative study was carried out in the municipality of Calçoene, state of Amapá, Brazilian Amazon adjointining the municipality of Oiapoque, that is in the border area with French Guiana and Suriname.MethodsA semi-structured interview was applied to an intentional sample of 29 miners, a number determined by the theoretical saturation criterion. Thematic analysis was adopted to obtain the results and the Cohen's Kappa index was calculated to verify the agreement between observers during coding.ResultsThe agreement between observers was verified by a Cohen's Kappa index of 0.82. Analysis of the interviews showed that gold miners were subjected to prejudice from the community due to forest diseases that they can transmit, and their activities are often associated with crime. When the miners return to their hometown after a period of mining, the urban population blames them for the onset of diseases such as malaria. Most participants in the survey did not know how malaria transmission occurs, and associated its occurrence with contaminated water and food. Participants reported not being afraid of the disease, trusting the diagnosis and available treatment, though this depends on where they are treated. The use of therapeutic resources, such as medicinal plants and medicines acquired in the illegal market, is very common in this population. Despite the challenges identified by the research subjects, they believe that the disease can be controlled, or the cases reduced, but there was low acceptability for a possible mass drug administration (MDA) intervention.ConclusionDespite a recent reduction in malaria prevalence in Brazil, there are still vulnerable populations, such as gold miners, who help to perpetuate the existence of the disease in the Amazon. The lack of knowledge regarding how the transmission of malaria occurs, associated with myths regarding this and the use of traditional health practices and illegal drugs for the treatment of the disease without a specific diagnosis, jeopardizes the country’s efforts to eliminate malaria. It is necessary to implement control programmes in these populations, especially those who frequently travel around the border region and to remote locations, which are difficult regions for health teams to access, thus hindering diagnostic and treatment actions. For this reason, understanding the perceptions of these individuals as well as their customs, beliefs and lifestyle, can assist in the production of targeted educational material and adoption of strategies in the elimination of malaria in the country.
Highlights
Mining in the Amazon exposes gold miners to various diseases, including malaria, whose control is still a major challenge
Most reports were from participants who experienced part of the gold rush in the 1970 and 1980s; a time when there was not much infrastructure in the region or the Brazilian National Health Service (SUS), as well as decentralization in the diagnosis and treatment of malaria in the Amazon Region
One of the complaints made by the miners, especially those who were diagnosed with P. vivax malaria, is the amount of pills to be taken over a period of up to 14 days, which make it difficult to return to work
Summary
Mining in the Amazon exposes gold miners to various diseases, including malaria, whose control is still a major challenge. The intense migration of workers between these areas favours the movement of infected people, increasing the possibility of transmission [6,7,8,9] Another challenge for the control and elimination of malaria in these places is the occurrence of asymptomatic infection among the miners [10]. Several authors point to the need to consider local, cultural, social and economic aspects for the engagement of populations affected by malaria and the success of health campaigns [11, 12] In this sense, mining in the Amazon presents itself as a challenging area for malaria control due to population mobility, cultural and social diversity and, above all, because this population is mostly located in remote and difficult to access areas [13]
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