![]() Mine shafts themselves are crowded and poorly-ventilated, but so are hostels where over a dozen men can share a small room. Living and working conditions are also a cause for concern. In a recent study of nearly 700 South African goldminers, 24% had silicosis of the miners with silicosis, 44% had a history of tuberculosis, as compared to 26% among those without silicosis. Miners with the scarring lesions characteristic of silicosis-about 18% to 31% of goldminers in Botswana and South Africa-have about a three-fold increased risk of pulmonary tuberculosis compared with those without silicosis. Silica exposureĮxposure to silica dust increases the risk of pulmonary tuberculosis, particularly among gold miners who drill through hard rock. A combination of environmental and occupational explanations have been proposed to explain the elevated risk of morbidity and mortality from tuberculosis among miners. These risks of tuberculosis have evolved over the past century at least as far back as 1903, mining was recognized as a risk factor for TB incidence and mortality. Miners have 3.6-fold greater odds of dying from tuberculosis than other workers in the region. Very high rates of over 1,000 per 100,000 have been reported among miners in other southern African countries. The South African government reports the incidence of tuberculosis to be as high as 7,000 cases per 100,000 miners, about ten times higher than among the general population. The mining industry is among southern Africa's largest employers, particularly 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. ![]() Why are miners in southern Africa at high risk of tuberculosis? 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. ![]() Tuberculosis incidence appears to be amplified by mineral mining operations in southern Africa. 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. 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. 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. Health and safety conditions within mines also promote the risk of silicosis (a tuberculosis risk factor) and transmission of tuberculosis bacilli in close quarters. Migration to and from mineral mines contributes to HIV risks and associated tuberculosis incidence. Migration to and from mines may be amplifying tuberculosis epidemics in the general population. Miners in southern Africa experience incident rates of tuberculosis up to ten times greater than the general population.
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