Background: In 2017 around 14–19 million miners were exposed to multiple hazards in artisanal and small-scale gold mining (ASGM). ASGM is characterized by basic and compromised mining methods with either very limited control of hazards or none at all. There is little knowledge about health and safety among artisanal and small-scale gold miners in Zimbabwe. Objective: This study explores the interaction between hazards, control measures, and health and safety in Zimbabwe’s ASGM. Methods: Triangulation and mixed methods were applied using standardized questionnaires, Hazard Identification and Risk Assessment (HIRA), focus group discussions (FGDs), and summary notes from in-depth interviews (IDIs). Data were analyzed using descriptive statistics, regression analysis, and thematic analysis. Findings: Quantitative data were collected through HIRA, which was conducted on 34 mining sites. 401 participants, selected through multi-stage sampling, were assessed through standardized questionnaires. Qualitative data was collected through six FGDs, and existing summary notes from 84 IDIs. The most prioritized hazards from the questionnaires were silica dust, noise, and workplace violence as indicated by 238 (62.0%), 107 (26.8%), and 104 (26.7%) respondents (respectively). HIRA identified noise, dust, unsafe shafts, violence, poor sanitation, and poor hygiene as key hazards requiring urgent attention. A key finding of this study was the poor application of the hierarchy of controls in managing workplace hazards. After adjusting for confounders, association with experiencing health and safety challenges was working underground (AOR = 2.0, p = 0.03), workplace violence (AOR = 3.3, p = 0.002), and long working hours (AOR = 2.8, p = 0.019). Injuries and fatalities were common without mitigation strategies. Conclusions: ASGM in Zimbabwe is characterized by underground mining, long working hours, and workplace violence. The poor application of the hierarchy of controls is characterized by increased workplace injuries and fatalities. We recommend following the hierarchy of control measures in ASGM: elimination, substitution, engineering, administrative, and personal protective equipment.

Artisanal and small-scale miners (ASMs) labour under archaic working conditions and are exposed to high levels of silica dust. Exposure to silica dust has been associated with an increased risk of tuberculosis and silicosis. ASMs are highly mobile and operate in remote areas with near absent access to health services. The main purpose of this study was to evaluate the prevalence of tuberculosis, silicosis and silico-tuberculosis among ASMs in Zimbabwe. A cross-sectional study was conducted from 1 October to 31 January 2021 on a convenient sample of 514 self-selected ASMs. We report the results from among those ASMs who attended an outreach medical facility and an occupational health clinic. Data were collected from clinical records using a precoded data proforma. Data variables included demographic (age, sex), clinical details (HIV status, GeneXpert results, outcomes of chest radiographs, history of tuberculosis) and perceived exposure to mine dust. Of the 464 miners screened for silicosis, 52 (11.2%) were diagnosed with silicosis, while 17 (4.0%) of 422 ASMs were diagnosed with tuberculosis (TB). Of the 373 ASMs tested for HIV, 90 (23.5%) were sero-positive. An HIV infection was associated with a diagnosis of silicosis. There is need for a comprehensive occupational health service package, including TB and silicosis surveillance, for ASMs in Zimbabwe. These are preliminary and limited findings, needing confirmation by more comprehensive studies.