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This article is one of three synthesis reports resulting from an integrated assessment (IA) of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities that involve multiple drivers and diverse disciplines influencing ASGM, an IA framework was used to analyze economic, social, health, and environmental data and to co-develop evidence-based responses in collaboration with pertinent stakeholders. We look at both micro- and macro-economic processes surrounding ASGM, including causes, challenges, and consequences. At the micro-level, social and economic evidence suggests that the principal reasons whereby most people engage in ASGM involve “push” factors aimed at meeting livelihood goals. ASGM provides an important source of income for both proximate and distant communities, representing a means of survival for impoverished farmers as well as an engine for small business growth. However, miners and their families often end up in a “poverty trap” of low productivity and indebtedness, which reduce even further their economic options. At a macro level, Ghana’s ASGM activities contribute significantly to the national economy even though they are sometimes operating illegally and at a disadvantage compared to large-scale industrial mining companies. Nevertheless, complex issues of land tenure, social stability, mining regulation and taxation, and environmental degradation undermine the viability and sustainability of ASGM as a livelihood strategy. Although more research is needed to understand these complex relationships, we point to key findings and insights from social science and economics research that can guide policies and actions aimed to address the unique challenges of ASGM in Ghana and elsewhere.

186and ineffective use of barrier contraceptives 8 and the decreased value placed on virginity. 9 To date, however, few studies have investigated young people's perceptions of the problem.To design appropriate interventions, it is important to know about adolescents' knowledge of and experience with STDs and about their health-seeking behavior related to STDs. For example, we need information about adolescents' knowledge of and attitudes toward using condoms for STD prevention, their use of various types of health providers for the treatment of STDs and their attitudes toward partner notification. It is widely recognized that Nigerian adolescents do not use existing reproductive health services. 10 This poor utilization of public services is probably largely attributable to the fact that such services do not specifically address the needs and concerns of adolescents.Eliciting adolescents' views on reproductive health in communities where sexuality is not openly discussed can be problematic. A quantitative research design yields limited information on this complex Miriam J. Temin is a population and reproductive health officer/Michigan international development associate

Mercury use in small-scale gold mining is ubiquitous across Ghana but little is known about the extent to which such activities have contaminated community residents and miners. Here, occupational exposures to elemental mercury (via urine sampling) and dietary exposures to methylmercury (via hair sampling) were assessed among 120 participants recruited from a mining community located in the Talensi-Nabdam District of Ghana’s Upper East region during summer 2009. More than one-fifth of the participants had moderately high levels of urinary mercury (>10 µg/L) and 5% had urine mercury levels that exceeded the WHO guideline value of 50 µg/L. When participants were stratified according to occupation, those active in the mining industry had the highest mercury levels. Specifically, individuals that burned amalgam had urine mercury levels (median: 43.8 µg/L; mean ± SD: 171.1 ± 296.5 µg/L; n=5) significantly higher than median values measured in mechanical operators (11.6 µg/L, n=4), concession managers/owners (5.6 µg/L, n=11), excavators that blast and chisel ore (4.9 µg/L, n=33), individuals that sift and grind crushed ore (2.2 µg/L, n=47), support workers (0.5 µg/L, n=14), and those with no role in the mining sector (2.5 µg/L, n=6). There was a significant positive spearman correlation between fish consumption and hair mercury levels (r = 0.30) but not with urine mercury (r = 0.18) though further studies are needed to document which types of fish are consumed as well as portion sizes. Given that 200,000 people in Ghana are involved in the small-scale gold mining industry and that the numbers are expected to grow in Ghana and many other regions of the world, elucidating mercury exposure pathways in such communities is important to help shape policies and behaviors that may minimize health risks.

ObjectiveEven when initially successful, many interventions aimed at reducing the toll of water-related infectious disease have not been sustainable over longer periods of time. Here we review historical practices in water-related infectious disease research and propose an interdisciplinary public health oriented systems approach to research and intervention design.Data sourcesOn the basis of the literature and the authors’ experiences, we summarize contributions from key disciplines and identify common problems and trends. Practices in developing countries, where the disease burden is the most severe, are emphasized.Data extractionWe define waterborne and water-associated vectorborne diseases and identify disciplinary themes and conceptual needs by drawing from ecologic, anthropologic, engineering, political/economic, and public health fields. A case study examines one of the classes of water-related infectious disease.Data synthesisThe limited success in designing sustainable interventions is attributable to factors that include the complexity and interactions among the social, ecologic, engineering, political/economic, and public health domains; incomplete data; a lack of relevant indicators; and most important, an inadequate understanding of the proximal and distal factors that cause water-related infectious disease. Fundamental change is needed for research on water-related infectious diseases, and we advocate a systems approach framework using an ongoing evidence-based health outcomes focus with an extended time horizon. The examples and case study in the review show many opportunities for interdisciplinary collaborations, data fusion techniques, and other advances.ConclusionsThe proposed framework will facilitate research by addressing the complexity and divergent scales of problems and by engaging scientists in the disciplines needed to tackle these difficult problems. Such research can enhance the prevention and control of water-related infectious diseases in a manner that is sustainable and focused on public health outcomes.

Mercury is utilized worldwide in artisanal and small-scale gold mining (ASGM) and may pose a risk for miners and mining communities. While a number of studies have characterized mercury in ASGM communities, most have focused on a single media and few have taken a holistic approach. Here, a multiple media exposure assessment and cross-sectional study of mercury was conducted in 2010 through 2012 in northeast Ghana with a small-scale gold mining community, Kejetia, a subsistence farming community, Gorogo, and an urban ASGM gold refinery in Bolgatanga. The objective was to assess mercury in a range of human (urine and hair) and ecological (household soil, sediment, fish, and ore) samples to increase understanding of mercury exposure pathways. All participants were interviewed on demographics, occupational and medical histories, and household characteristics. Participants included 90 women of childbearing age and 97 adults from Kejetia and 75 adults from Gorogo. Median total specific gravity-adjusted urinary, hair, and household soil mercury were significantly higher in Kejetia miners (5.18 µg/L, 0.967 µg/g, and 3.77 µg/g, respectively) than Kejetia non-miners (1.18 µg/L, 0.419 µg/g, and 2.00 µg/g, respectively) and Gorogo participants (0.154 µg/L, 0.181 µg/g, and 0.039 µg/g) in 2011. Sediment, fish, and ore Hg concentrations were below guideline values. Median soil mercury from the Bolgatanga refinery was very high (54.6 µg/g). Estimated mean mercury ingestion for Kejetia adults from soil and dust exceeded the U.S. Environmental Protection Agency reference dose (0.3 µg Hg/kg·day) for pica (0.409 µg Hg/kg·day) and geophagy (20.5 µg Hg/kg·day) scenarios. Most participants with elevated urinary and household soil mercury were miners, but some non-miners approached and exceeded guideline values, suggesting a health risk for non-mining residents living within these communities.

There is increasing concern about the cardiovascular effects of mercury (Hg) exposure, and that organic methylmercury and inorganic Hg2+ may affect the cardiovascular system and blood pressure differentially. In small-scale gold mining communities where inorganic, elemental Hg exposures are high, little is known about the effects of Hg on blood pressure. In 2011, we assessed the relationship between Hg exposure and blood pressure (BP) in a cross-sectional study of adults from a small-scale gold mining community, Kejetia, and subsistence farming community, Gorogo, in Ghana’s Upper East Region. Participants’ resting heart rate and BP were measured, and hair and urine samples were provided to serve as biomarkers of organic and inorganic Hg exposure, respectively. Participants included 70 miners and 26 non-miners from Kejetia and 75 non-miners from Gorogo. Total specific gravity-adjusted urinary and hair Hg was higher among Kejetia miners than Kejetia non-miners and Gorogo participants (median urinary Hg: 5.17, 1.18, and 0.154 µg/L, respectively; hair Hg: 0.945, 0.419, and 0.181 µg/g, respectively). Hypertension was prevalent in 17.7% of Kejetia and 21.3% of Gorogo participants. Urinary and hair Hg were not significantly associated with systolic or diastolic BP for Kejetia or Gorogo participants while adjusting for sex, age, and smoking status. Although our results follow trends seen in other studies, the associations were not of statistical significance. Given the unique study population and high exposures to inorganic Hg, the work contained here will help increase our understanding of the cardiovascular effects of Hg.

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