TB prevalence remains high in mines

JOHN Jason (not his real name) is 30 years old but struggles to breathe and has to sit down on a shop veranda at Chachacha Growth Point in Shurugwi to catch his breath.

BY BYRON MUTINGWENDE

In his right hand he holds an echocardiography report from a doctor in Harare indicating that he has breathing problems.

“This unfortunate young man has chronic restrictive airways disease. He mined gold for 10 years using informal methods. He would go underground soon after blasting and inhale explosive fumes. He was also exposed to mercury and other chemicals for processing and refining gold. He now finds it difficult to breathe with restricted chest movements,” reads a part of the doctor’s report.

Jason’s case is just a replica of the health hazards that thousands of artisanal and small-scale miners face in their day-to-day lives.

For that reason, the United States Agency for International Development (USAid), in partnership with University Research Council (URC) and the Ministry of Health and Child Care funded a programme aimed at reducing the prevalence of tuberculosis (TB) in the mines, particularly among artisanal and small-scale miners.

Recently the partners held a stakeholders’ meeting in Harare aimed at discussing and proffering solutions to the prevalence of TB in mines; to be informed of the occupational statistics as they relate to dusty environments by National and Social Security Authority (NSSA) and to be informed of the TB/HIV situation in Zimbabwe and the current situation as it relates to regional Global Fund grant on TB/HIV in mines.

Charles Sandy, the deputy director of the Aids and TB Unit in the Ministry of Health and Child Care, said Zimbabwe is one of 22 TB high burden countries in the world. He said HIV drives TB and there was a high rate of co-infection at 70%.

Feature Pic - Gold Panners

“Drug-resistant TB is an emerging public health problem. Drug-resistant TB patients notified and initiated on the standard second line treatment regimen have been increasing with decentralised access to diagnosis, care and treatment.

“Treatment outcomes remain suboptimal due to high mortality, which was at 10% in 2013. TB prevention, care and treatment services are provided as part of the package of essential primary integrated health care services,” Sandy said.

Speaking on the epidemiology of TB in Zimbabwe, Sandy said treatment success and cure rates have shown an upward trend since 2007.

However, the high death rate (10% in 2013) remains a major concern, especially in the southern parts of the country.

“The ministry must be applauded for completing a National TB Prevalence Survey in 2014 which shows a falling incidence of TB in line with international trends. The prevalence was lower than previous estimates by a significant margin and highest in the 25-44 age groups, almost twice as high in males than females. The smear positive TB was just below 20%. The case detection rate for 2014 increased to 70% from 44% in the previous year,” Sandy said.

According to Sandy, community-based TB response remains low, although it is improving. He said geographical access to diagnostic and care service is inadequate. In addition, he said, there is insufficient availability of laboratory reagents and consumables and underutilisation of X-ray equipment for TB diagnosis.
He said this could be improved through better integration in planning and implementation, adoption of active case finding approaches like Mobile Screening that includes, X-Ray, Microscopy, GeneXpert Services for hard-to-reach communities.

He called for the use of e-health and m-health in programming in case finding, results transmission and notifications of TB cases.

Sandy said the TB National Strategic Policy (NSP 2015 – 2017) was meant to increase case notification rate of all forms of tuberculosis from 267/100 000 (35 566 patients) in 2013 to 371/100 000 (52 060 patients) by 2017.

Among the other key objectives of the strategy are to increase treatment success rate for all forms of tuberculosis from 81% in 2012 to 90% by 2017; to increase the number of drug-resistant TB cases detected annually from 393 in 2013 to 743 in 2017, and to increase treatment success rate of drug-resistant TB from 59% in 2011 to 75% in 2017.

Speaking on the prevalence of tuberculosis in the mines, Martha Name, an occupational health services expert with National Social Security Authority (NSSA), said there was need to scale up awareness campaign on tuberculosis in the mines.

Name encouraged miners to undergo medical screening of respiratory disorders like pneumoconiosis and TB. She urged mining companies to compensate the diseased workers and their dependents.

“Employers in the mines are expected to report TB cases to the Accident Prevention and Workers Compensation Scheme [WCIF] in terms of Statutory Instrument 68 of 1990.

“Some of the TB cases are picked during pneumoconiosis screening and are referred back to the employer for further investigations and channelling to the compensation system.”

On pneumoconiosis and TB statistics, Name said from January to July 2015, 27 suspected TB cases have been picked by the Medical Bureau. Out of the 27 cases, 25 were active cases while two were old, healed TB cases. As of July 2015, the Medical Bureau had diagnosed 17 pneumoconiosis cases.

She said existing challenges were under-reporting of TB cases and lack of local documentation to declare TB in the mines an occupational disease. Name added that artisanal miners are not insured against any workplace accidents, hence respiratory disorders they may have are not captured and channelled to the compensation system.

National coordinator for TB in mines programme, Panganai Dhliwayo said from their studies they had unearthed that an estimated 70-85% of the rural population is in artisanal mining, with 30% of them being women and children.

“This population has very limited access to health services and are at an even higher risk of contracting HIV, TB, silicosis and mercury poisoning. Crime is also high in areas where artisanal and small-scale mining takes place,” Dhliwayo said.

Dhliwayo said most small to medium and artisanal mines are not members of the Chamber of Mines, hence do not meet the minimum safety standards due to lack of capital. He said that the absence of wet drilling and water drowning on re-entry after blasting in the mines due to lack of water reticulation systems exposes the miners to TB and other respiratory complications.

“In Manicaland we realised that Ministry of Mines inspectors lacked equipment to measure the dust levels and characterise dust into different types [e.g. silica] and could not validate self-reporting from large mines. The laboratory in Midlands was not functional and inspectors lacked transport to go and inspect the mines.

“Inspectors cannot inspect informal or artisanal mines because they are not legal entities. This also means that NSSA cannot enforce the Pneumoconiosis Act on them, but can only encourage them to meet standards,” Dhliwayo said.

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