Health and Safety Risk Mitigation among Artisanal and Small-Scale Gold Miners in Zimbabwe.

Artisanal and small-scale gold mining (ASGM) is often associated with no or compromised attention to health and safety. Although headlines of fatal accidents in Zimbabwe characterise ASGM, little attention is paid to prevention strategies. This study, therefore, explores health and safety risk mitigation in ASGM in Zimbabwe to inform prevention strategies. A qualitative design was used with focus group discussions and in-depth interviews. Data were analysed using thematic analysis, coding, and descriptive statistics. Reported factors contributing to compromised health and safety included immediate causes, workplace factors, ASM related factors, and contextual factors, with interconnectedness between the causal factors. In addition, factors related to ASGM were significant. For risk mitigation, formalisation, organisation of risk reduction, behaviour change, and enforcement of prevention strategies is proposed. A multi-causal analysis is recommended for risk assessment and accident investigation. A multi-stakeholder approach could be considered for risk mitigation including community and public health interventions. However, risk mitigation has been characterised by gaps and weaknesses such as lacking ASM policy, lack of capital, poor enforcement, negative perceptions, and non-compliance. Therefore, we recommend addressing the threats associated with health and safety mitigation to ensure health and safety protection in ASGM.

Accidents, Injuries, and Safety among Artisanal and Small-Scale Gold Miners in Zimbabwe.

Artisanal and small-scale gold mining (ASGM) employs 14-19 million people globally. There is limited research on accidents, injuries, and safety in Zimbabwe's ASGM. This study investigates the prevalence of accidents and injuries, as well as the associated risks and existing safety practices. A cross-sectional survey was conducted among artisanal and small-scale gold miners. Data from 401 participants were analyzed using descriptive statistics and regression analysis. The prevalence of accidents and injuries was 35.0% and 25.7%. Accidents associated with experiencing injuries included mine collapses and underground trappings. The major injury risk factors were digging, blasting, being male, being 18-35 years old, crushing, and the underground transportation of workers and materials. Injuries were reported highest among the miners working 16 to 24 h per day. Participants had heard about personal protective equipment (PPE). There was training and routine inspections mainly on PPE use. Mine owners and supervisors were reported as responsible for OSH, which was mainly PPE use. Practices including the use of wire winch ropes and escape routes were rare. There was ignorance on underground mine shaft support. The mining regulations that had the potential to introduce comprehensive safety controls were not adaptable. We recommend applicable health and safety regulations for Zimbabwe's ASGM.

Hazards and Control Measures among Artisanal and Small-Scale Gold Miners in Zimbabwe.

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.

Analysis of the Mercury Distribution in Blood as a Potential Tool for Exposure Assessment - Results from Two Artisanal and Small-Scale Gold Mining Areas in Zimbabwe.

People in artisanal and small-scale gold mining (ASGM) areas are frequently exposed to high levels of mercury (Hg). Hg analyses in urine and whole blood are the gold standard of biomonitoring, although this may not provide sufficient information about the source of exposure, e.g., due to the use of Hg for gold extraction or due to nutrition. To evaluate, whether the pharmacokinetic properties of individual Hg species may be useful for exposure assessment, we determined the Hg levels in different blood components from 199 participants. Therefore, whole blood was centrifuged on-site to yield erythrocytes and plasma. Globin was isolated from the erythrocytes by precipitation with ethyl acetate. Albumin was isolated from plasma by gradual precipitation with saturated ammonium sulfate solution. Hg levels in all samples were determined by using a direct Hg analyzer. Median Hg levels for whole blood, erythrocytes, and plasma were 2.7, 3.7, and 1.3 µg/l, respectively. In globin and albumin, median Hg levels were 10.3 and 7.9 µg/kg, respectively. The distribution of Hg was strongly correlated with whole blood Hg levels (p < 0.01) and the time between the last use of Hg and the date of the participation (p < 0.01). The results suggest that the distribution of Hg in blood is substantially affected by the extent and the frequency of the exposure to elemental Hg. Therefore, the analysis of Hg in erythrocytes and plasma may be a valuable tool for Hg exposure assessment in ASGM areas.

Biomonitoring of arsenic, cadmium and lead in two artisanal and small-scale gold mining areas in Zimbabwe.

People living and working in artisanal and small-scale gold mining (ASGM) areas are frequently exposed to elemental mercury (Hg), which is used for gold extraction. However, additional exposure to other toxic metals such as arsenic (As), cadmium (Cd) and lead (Pb) may result from mining-related activities and could be ingested via dust, water or food. In these areas, only limited biomonitoring data is available for toxic metals other than Hg. In particular, data about the exposure to As, Cd and Pb is unavailable for the Zimbabwean population. Therefore, we conducted a cross-sectional study in two ASGM areas in Zimbabwe to evaluate the internal exposure to these metals. In total, urine and blood samples from 207 people that identified themselves as miners were collected and analysed for As and Cd in urine as well as Pb in blood by GF-AAS. Median levels (interquartile ranges in µg/l) of As and Pb were 9.7 µg/l (4.0, 18.5) and 19.7 µg/l (12.5, 34.5), respectively. The 25th percentile and the median for Cd were below the limit of detection (0.5 µg/l); the 75th percentile was at 0.9 µg/l. The results were compared to reference values found for the general population in the USA and Germany, and a significant number of participants exceeded these values (As, 33 %; Cd, 27 %; Pb, 32 %), indicating a relevant exposure to toxic metals. Although not representative for the Zimbabwean population, our results demonstrate that the exposure to toxic metals is relevant for the public health in Zimbabwe and requires further investigation.

Non-pharmacological interventions for pollen-induced allergic symptoms: Systematic literature review.

BACKGROUND: Allergic diseases pose a health problem worldwide. Pollen are widespread aeroallergens which can cause symptoms like shortness of breath, cough, itchy eyes, or rhinitis. Apart from preventive measures and pharmacological treatment, also non-pharmacological interventions have been suggested to reduce symptoms. The objective of this work was to review studies investigating the effectiveness of non-pharmacologic interventions to reduce allergic symptoms. METHODS: PubMed, EMBASE, and CENTRAL were systematically reviewed in July 2018 and April 2020. Several authors worked on the screening of titles, abstracts, and full texts. One author for each literature search performed the data extraction and the risk of bias assessment. Studies were included if they met the inclusion criteria defined by the PECOs. Studies which investigating the effect of non-pharmacologic interventions on patients with allergic rhinitis were included. RESULTS: Twenty-nine studies investigating eleven types of non-pharmacologic interventions to avoid and reduce allergic symptoms due to pollen exposure were included in this review. Out of all studies, seven studies addressed nasal rinsing and 22 included acupuncture, air filtering, artisanal tears, individual allergen avoidance advice, various nasal applications, self-hypnosis, rhinophototherapy, and wraparound sunglasses. CONCLUSION: Most studies had a high risk of bias and small sample sizes. There were only a few high-quality studies that give hints about the effectiveness of non-pharmacological interventions. For future research, more high-quality studies are required to confirm the effectiveness of simple, safe, and cost-effective interventions.

The Burden of COPD Due to Ozone Exposure in Germany.

BACKGROUND: The chronic effects of ozone have only rarely been investigated in disease burden studies to date. Our goal was to determine this disease burden in Germany over the period 2007-2016, with particular attention to estimation based on effect estimates adjusted for particulate matter (PM2.5) and nitrogen dioxide (NO2). METHODS: The nationwide, high-spatial-resolution (2 km × 2 km), population-based exposure to ozone in the summer months ("summer ozone") was calculated on the basis of modeled ozone data and population counts in Germany. Next, risk estimates derived from cohort studies were used to quantify the burden of chronic obstructive pulmonary disease (COPD). Data on population counts, life expectancy, and mortality in Germany were used to reflect the situation across the country as accurately as possible. RESULTS: The estimates of years of life lost (YLL) due to summer ozone ranged from 18.33 per 100 000 people (95% confidence interval [14.02; 22.08]) in 2007 to 35.77 per 100 000 people [27.45; 42.98] in 2015. These findings indicate that ozone affects the COPD burden independently of other harmful components of the air. No clear secular trend in the COPD burden can be seen over the period 2007 to 2016. CONCLUSION: Long-term exposure to ozone contributes to the COPD burden among the general population in Germany. As climate change may lead to a rise in the ozone concentration, more intensive research is required on the effects of ozone on health.

Determinants of health and health needs assessment of artisanal and small-scale gold miners in Kadoma, Zimbabwe: A mixed method approach.

BACKGROUND: The role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Small-scale miners are now responsible for over 50% of the Zimbabwean gold production. However, the sector is still characterised by high labour-intensity, low productivity and capital, limited mechanisation and outdated technologies. Since increasing efforts in recent years to improve miners' health while reducing the exposure to mercury have not been effective, a more sustainable approach is needed to identify interventions targeting the health of artisanal and small-scale miners and the mining communities. OBJECTIVE: The main objective of this study was the accurate and extensive empirical identification of the determinants of health in ASGM and of the miners' health needs. In tandem with these needs, topics which generate more effective, sustainable, and feasible future health interventions targeting occupational health should be identified. METHODS: Based on the identification of determinants of health, a health needs assessment (HNA) was used to conduct miners' needs by applying a mixed methods approach and triangulation. This included qualitative and quantitative interviews with individuals, group interviews, focus group discussions, observations and informal conversations. RESULTS: There were 85 structured and 84 semi-structured interviews, a focus group discussion, and observations conducted. Six main themes were identified around which miners' health needs can be aggregated as follows: living conditions, nutrition and hygiene; safe work environment and mining processes; financial support; health care services; formalisation and education. DISCUSSION: The following aspects were considered most important for sustainable interventions: possible health impacts, feasibility, value for miners and their willingness to adapt. Accordingly, interventions aiming at increasing education, knowledge and awareness of miners were identified as most promising in improving occupational health.

Health-related quality of life (EQ-5D + C) among people living in artisanal and small-scale gold mining areas in Zimbabwe: a cross-sectional study.

BACKGROUND: In Zimbabwe, an estimated 500,000 people work in the sector of artisanal and small-scale gold mining (ASGM). Two million Zimbabweans are dependent on this sector. Using mercury is common to extract gold from ore. Long term exposure to mercury can cause various adverse health conditions including chronic mercury intoxication. The influence of these adverse health effects on the health-related quality of life (HRQoL) is still unknown. The aim of this study is to assess the HRQoL of people who identify themselves as miners, and to analyze potential influencing factors, such as age, years of working with mercury and health conditions caused by mercury exposure. METHODS: This cross-sectional study assessed the HRQoL using the standardized EQ-5D + C (3 L) questionnaire and collected human specimens (blood, urine) of people living and possibly working in ASGM areas in Zimbabwe. Factors such as age, years of working with mercury and adverse health conditions possibly caused by mercury exposure were analyzed with regards to their influence on the HRQoL. RESULTS: The 207 participants (82% male, mean age 38 years) reported 40 different health states. Of the study participants 42.5% reported to be in complete good health while 57.5% reported being unwell in different ways. Nine participants (4.3%) were identified with chronic mercury intoxication, whereas 92 participants (33.3%) had mercury levels above the "Alert" threshold in at least one specimen. Having chronic mercury intoxication has a significant negative influence on the HRQoL, when taking into account age, gender and years of working with mercury. Cognitive problems were the most reported in the questionnaire, however, the association between this domain separately and the HRQoL was not verified. CONCLUSION: This study shows that adverse health effects caused by chronic exposure to mercury, have a negative influence on the HRQoL among people living in ASGM areas.

Ozone exposure and health effects: a protocol for an umbrella review and effect-specific systematic maps.

INTRODUCTION: Ambient ozone exposure may be adverse to health. Since the reported associations between ozone and health effects are heterogeneous and the underlying pathways are indistinct, the overall relationship remains unclear. Only a few overall syntheses of the evidence regarding ozone and health effects are available to date. METHODS AND ANALYSIS: We plan to summarise the current evidence on ozone-related health effects systematically. First, to identify the possible associations between ambient ozone exposure and health outcomes, we will conduct an umbrella review. PubMed, Web of Science and grey literature will be searched for systematic reviews on exposure to ambient ozone and any possible health endpoints published before 31 May 2019. Data selection and extraction will be carried out by one reviewer, and a second reviewer will check the agreement of a sample of the studies. The methodological quality of the eligible systematic reviews and level of evidence regarding ozone and every specific health effect will be evaluated. Second, for each of the identified effects with a high level of evidence, comprehensive information retrievals will be conducted, considering both epidemiological and experimental studies. The study selection and data mapping will be carried out by one reviewer and checked by the second reviewer. We will summarise the information of the filtered epidemiological and experimental studies to conduct several systematic maps presenting the currently available evidence for the specific health effect. Because the association between ozone exposure and chronic obstructive pulmonary disease (COPD) is relatively well investigated, we will at least conduct one systematic map of ozone and COPD. ETHICS AND DISSEMINATION: No ethical approval is required for this study. The completed umbrella review and systematic maps will be considered for publication and presentation. We will additionally upload the relevant data to publicly accessible online databases. PROSPERO REGISTRATION NUMBER: CRD42019123064.

Comparing the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners and the urban population in Zimbabwe using the EuroQol (EQ-5D-3L+C) questionnaire: a cross-sectional study.

BACKGROUND: The role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Besides limited epidemiological data, no data about the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners exist. The aim of the project was to access HRQoL of ASGM workers to improve the data base and compare the data to the urban Zimbabwean population. METHODS: Data from 83 artisanal and small-scale gold miners in Kadoma, Zimbabwe was analysed. The HRQoL was assessed using the EuroQol dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) accompanied by the cognition add-on questionnaire (EQ-5D-3L+C) and associated visual analogue scale (VAS). We described the EQ-5D dimensions and VAS values and computed health utility (HU) values using the Zimbabwean tariff. The proportions of miners reporting no problem in each EQ-5D dimension were compared with corresponding proportions reporting any problem (moderate or severe), and mean HU and VAS values were analysed across subgroups of the sample. To test differences between subgroups, Fisher's exact test was used and between urban and mining population, Student's t-test was used. RESULTS: The reported health states of miners were homogenous, with a large amount (42%) reporting 'full health'. Mean (SD) VAS and HU values were 81.0 (17.5) and 0.896 (0.13), respectively. Subgroup analysis showed that miners with a lower education reported significantly more problems in the dimension of daily activities and miners with mercury contact had more problems in the dimensions of pain/discomfort and cognition. Comparison between mining and urban population showed that in the oldest age group, self-rated VAS values of miners were significantly higher than of their urban counterparts. CONCLUSIONS: There were no significant differences in the HRQoL of mining and urban populations. However, the reason might be adverse health effects faced by the urban population that do not apply to rural mining areas. A higher education level of miners can improve the HRQoL, which is especially impaired by problems in the cognition dimension.

Artisanal and small-scale gold mining: A cross-sectional assessment of occupational mercury exposure and exposure risk factors in Kadoma and Shurugwi, Zimbabwe.

In artisanal and small-scale gold mining (ASGM) the toxic metal mercury is used for gold extraction. The objective of this cross-sectional study was to assess mercury concentrations in urine and blood and mercury-related symptoms of participants identifying themselves as miners from Kadoma and Shurugwi, Zimbabwe. Moreover, we aimed to explore possible risk factors influencing mercury body burden. In 2019, urine and blood samples of 207 participants were collected and analyzed for mercury using atomic absorption spectroscopy. All participants answered questions regarding their exposure risks. The median urine mercury value was 4.75 µg/L with a maximum of 612 µg/L. Median mercury concentration in creatinine corrected urine values was 3.98 µg/g with a maximum value of 478 µg/g. The median blood mercury value was 2.70 µg/L with a maximum of 167 µg/L. Correlations between exposure risks factors such as the lack of retort use and elevated mercury values were demonstrated. ASGM is very common in Zimbabwe. Thus, mercury exposure is a major occupational health risk for miners. Moreover, this study emphasizes the impact of exposure risk factors on the mercury body burden.