health and Medical issues in global Mining
0–99
100–249
250–499
≥500
Data not available
Source: WHO 2007b.
figure 15.2-4 global distribution of tuberculosis in 2007
World Health Organization (WHO), it infects about one-third
of the world’s population. Most of this is latent infection rather
than active, but WHO estimates that in 2006, 1.5 million peo-
ple died of TB, with another 200,000 dying of HIV-associated
TB (Attfield et al. 2009). In latent infection, the body seals
off the bacteria in small numbers and the disease remains dor-
mant. However, this dormant infection can become active if
the immune system is compromised by, for example, HIV. The
estimated risk of an infected person becoming sick is between
about 5% and 10% during their lifetime, but when HIV is a
factor, the risk rises to between 10% and 15% per year.
Most commonly, TB causes a respiratory illness (pulmo-
nary TB), but it can infect any organ in the body with devastat-
ing consequences. The disease is spread by droplet infection
through coughing.
TB is a disease with a slow onset, and the symptoms may
be insidious and difficult to diagnose, which means the diag-
nosis may often be late. Typically it will present with a cough,
weight loss, and profuse sweating at night. The cough may be
accompanied by bloodstained phlegm, but in the early stages
this may not occur. The infected person, unaware, may infect
many others before the diagnosis is made.
TB is a preventable and treatable condition. Prevention
can occur at two places in the cycle of infection, the first being
the interruption of the passage of the bacillus from an infected
person to an uninfected person, and the second being the
prevention of those who are infected (latent infection) from
developing active disease. In the first instance, the focus is on
finding and treating infectious cases, and in the second, the
focus is on maintaining good health.
Treatment consists of a prolonged course (6 months) of
multiple drugs (usually three), and good compliance to the
treatment regimen is needed for a cure; this requires rigor-
ous follow-up of cases by health care workers. The treatment
program devised by WHO to assist with these requirements is
known as “directly observed therapy short-course” (DOTS).
It aims to ensure that treatment is taken as instructed and may
1575
involve family, friends, co-workers, and health care workers
assisting the individual to comply with the treatment course.
Despite this, poor compliance with the treatment remains a
problem, and in resource-constrained countries, where medi-
cal staff numbers are low and drug supplies may not be con-
tinuous, drug-resistant strains of the bacteria have emerged.
This has been complicated by the HIV epidemic, and multi-
drug-resistant (MDR) and extensively drug-resistant (XDR)
cases are becoming commonplace in some countries. This is
an extremely serious situation in some locations as XDR cases
mostly have a fatal outcome and MDR cases are increasingly
difficult to treat. Education, awareness, and an ability to detect
cases is therefore essential for both prevention of the spread of
TB and the treatment of those who are ill.
From a mining company perspective there are several
things that can be done to manage the risk from TB. First,
hostel-type accommodations should be avoided if at all pos-
sible. Second, education programs, together with active case-
finding, should be undertaken. These can be accomplished
through collaboration with local health authorities or through
the mine’s own health services. Where the risk coexists with
HIV, the two programs can be combined.
For a detailed and thorough review of this subject, see
the ICMM Good Practice Guidance document (ICMM 2008).
ConCluSion
Although the focus may appear to be on HIV/AIDS, TB, and
malaria due to their global importance, it must not be forgot-
ten that there are numerous other infectious and noninfectious
diseases that can and do affect the productivity and health of
miners. These lend themselves equally to the approach advo-
cated in this chapter, namely, risk assessment followed by a
structured management program if the condition is found to
be a significant problem to the mining operation. The same
approach at an individual level is equally important for the
management of personal risk due to the possible health risks
that may arise.