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health and Medical issues in global Mining 1575

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