Tuberculosis in the mines of Zambia: A case for intervention

Chanda‐Kapata, Pascalina; Osei-Afriyie, Doris; Mwansa, Connrad; Kapata, Nathan

doi:10.1016/j.apjtb.2016.06.015

Cited by 11 publications

(13 citation statements)

References 18 publications

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“…The multivariable analysis conducted revealed that after removing the not evaluated category whose outcomes were unknown; HIV positive TB patients were more likely to develop unfavourable outcomes. Similar to other studies [27, 28] our study found HIV positive TB patients to be associated with unfavourable outcome. HIV is known to affect the immune system of individuals making them more susceptible to opportunistic infections such as TB [29].…”

Section: Discussionsupporting

confidence: 91%

Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data

Nanzaluka¹,

Chibuye

Kasapo³

et al. 2019

Pan Afr Med J

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Introduction Focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors. Methods We defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1 st level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1 st January to 31 st December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results We included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1 st Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients > 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19). Conclusion Unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are > 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.

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Section: Discussionsupporting

confidence: 91%

Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data

Nanzaluka¹,

Chibuye

Kasapo³

et al. 2019

Pan Afr Med J

Self Cite

View full text Add to dashboard Cite

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“…Mines there have an average total of respirable dust concentrations that is well above the limit recommended by safety authorities yet can operate because levels are still below the legal limit enforced by the Zambian government. 42 Another example is easily found in South Africa, whose mining sector is regulated by its Department of Minerals rather than its Department of Health. As a result, despite TB's skyhigh prevalence among miners, regular screenings of TB are not implemented widely, and there are few programs in place to educate miners about the occupational risks they are taking and their vulnerability to acquiring TB.…”

Section: Organizationmentioning

confidence: 99%

“…In Zambia, for example, not only are miners infected with TB removed from the mines but prospective miners found to test positive for TB prior to employment may not work. 42 This can create distrust between the mining institution and the miners. The social and historic context of poverty, low education, and a legacy of racism in the mining sector make changing this policy especially difficult.…”

Section: Behaviormentioning

confidence: 99%

Responding to Health System Failure on Tuberculosis in Southern Africa

Hartel

Yazbeck

Osewe

2018

Health Systems & Reform

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The characteristics of tuberculosis (TB)-such as links to poverty, importance of patient actions, and prevalence of multisectoral drivers-require more from health systems than traditional medically oriented interventions. To combat TB successfully, health systems must also address social risk factors and behavior change in a multisector response. In this, many health systems are failing. To explore why, and how they can do better, we apply the Flagship Framework and its five "control knobs" (financing, payment, organization, regulation, and behavior) to the literature on TB control programs, focusing on the mining population of Southern Africa, among whom the incidence of TB is highest in the world. We conclude by recommending a patientcentered approach that broadens a system's engagement to a wholeof-health sector, whole-of-government response.

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“…TB being an airborne disease entails that enclosed areas such as mining sites with poor ventilation create favorable environments for TB transmission. The higher TB incidence rates in the mines have been attributed to higher rates of exposure to silica dust and silicosis (silicosis increases risk of tuberculosis by up to three times), the HIV/AIDS epidemic (HIV/AIDS increases risk of tuberculosis by up to ten times) and the environmental factors associated with the mines (Chanda-Kapata et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

“…They found that 22.7% had silicosis, 65.4% had TB, while 11.9% suffered from silico-tuberculosis. Analysis of data from OHSIZ of a sample of copper miners by Chanda-Kapata et al. (2016) revealed that the weighted average incidence rate of bacteriologically confirmed pulmonary TB (PTB) within the Zambian mines for the period 1994–2014 was 658 per 100,000 persons.…”

Section: Main Textmentioning

confidence: 99%

Preliminary review of mine air pollution in Zambia

Mwaanga

Silondwa

Kasali

et al. 2019

Heliyon

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Zambia is endowed with mineral wealth that includes copper, cobalt, gold, nickel, lead, silver, uranium, zinc, and numerous precious and semi-precious stones. Mining activities are predominantly found on the Copperbelt and North-Western Provinces, although these minerals are dotted all over the country. Copper mining in Zambia dates back to the 1900s and this period witnessed massive investment in mine development with concomitant increase in support facilities including building of new towns, roads and other commercial infrastructure. The mining sector has therefore evoked considerable national attention for its potential to contribute towards economic growth, job creation and poverty alleviation. However, mining and mineral processing by its very nature comes with environmental costs and the effects can continue long after the mining has stopped. The aim of this article was to review the relevant publications on the impacts of air pollution arising from mining operations with respect to human health, plants, animals and infrastructure and synthesize the views of researchers and suggest any additional research required to inform policy and remedial actions. This review has revealed that there is a paucity of studies on mining-related air pollution in Zambia. The main identified air pollutants were SO2 and particulate matter (PM), both fine and ultrafine (PM10, PM5.0, PM2.5 and PM0.1). The main sources of these pollutants were flue gases from smelter operations and dusts within the mines and those blown from both operational and abandoned waste rock, overburden and tailings dump sites. The identified occupational diseases for miners in Zambia were silicosis and tuberculosis, which have been compounded by the prevalence of HIV/AIDS. In the hotspot townships of air-borne exposures from smelter emissions in Mufulira, ambient air SO2 levels exceeded the ‘safe’ limits of international and National standards. Moreover, the top soils have turned acidic and have become laden with heavy metals (Pb, Zn, Cu, Co and Fe). These metals were also found in the dust deposited on leaves of crops. There were also visual signs of impaired vegetation cover and corroded housing infrastructure in the affected areas. In the vicinity of the abandoned Pb–Zn mine in Kabwe, the soils have been contaminated by heavy metals and pathological lead poisoning of children and wild mammals have occurred. The review article has further examined study gaps and suggested areas that need further research in order to address the challenges arising from the legacy of copper mining in Zambia. These include comprehensive PM characterization from mining environments, extent of occupation exposure to air pollutants, efficiency and efficacy of airborne control technologies, health risks and epidemiological studies in mining towns, and the influence of exposure to PM on pulmonary tuberculosis and HIV/aids among miners.

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Tuberculosis in the mines of Zambia: A case for intervention

Cited by 11 publications

References 18 publications

Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data

Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data

Responding to Health System Failure on Tuberculosis in Southern Africa

Preliminary review of mine air pollution in Zambia

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