Abstract
BackgroundMiners in southern Africa experience incident rates of tuberculosis up to ten times greater than the general population. Migration to and from mines may be amplifying tuberculosis epidemics in the general population.DiscussionMigration to and from mineral mines contributes to HIV risks and associated tuberculosis incidence. Health and safety conditions within mines also promote the risk of silicosis (a tuberculosis risk factor) and transmission of tuberculosis bacilli in close quarters. In the context of migration, current tuberculosis prevention and treatment strategies often fail to provide sufficient continuity of care to ensure appropriate tuberculosis detection and treatment. Reports from Lesotho and South Africa suggest that miners pose transmission risks to other household or community members as they travel home undetected or inadequately treated, particularly with drug-resistant forms of tuberculosis. Reducing risky exposures on the mines, enhancing the continuity of primary care services, and improving the enforcement of occupational health codes may mitigate the harmful association between mineral mining activities and tuberculosis incidence among affected communities.SummaryTuberculosis incidence appears to be amplified by mineral mining operations in southern Africa. A number of immediately-available measures to improve continuity of care for miners, change recruitment and compensation practices, and reduce the primary risk of infection may critically mitigate the negative association between mineral mining and tuberculosis.
Highlights
Miners in southern Africa experience incident rates of tuberculosis up to ten times greater than the general population
Summary: Tuberculosis incidence appears to be amplified by mineral mining operations in southern Africa
The effects of migration to and from the mines, the health and safety conditions within the mines, and the limitations to current tuberculosis prevention and treatment strategies offered to miners all contribute to the present tuberculosis burden among this population
Summary
Why are miners in southern Africa at high risk of tuberculosis? The mining industry is among southern Africa's largest employers, in the Republic of South Africa, where one of every ten employed men (at least 500,000 men) mines for gold, diamonds or other minerals [2,3]. HIV prevention approaches are based on 'informationdissemination', there is no evidence that this approach, or alternative peer-education and condom distribution programs, have led to changes in sexual behavior among miners [26] Structural interventions such as expanding access to family housing, addressing alcoholism, and ensuring appropriate viral suppression through antiretroviral treatment appear to be insufficiently administered in the absence of external supervision of the mining industry [27,28]. A body of key stakeholders--miners' unions, medical providers, and government representatives--should assemble to determine how to enforce high standards of follow-up care and compensation, such that the burden of tuberculosis does not continue to be placed on labor-supplying communities., Government leadership and a clear delineation of responsibilities among government responsibilities is needed to move forward.
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