Tuberculosis (TB) in the mines has been and remains an issue in Southern Africa. Despite efforts in addressing TB over the years, none of the earlier interventions sufficiently responded to mineworkers, ex-mineworkers and their immediate families as a key target group.
ADPP Mozambique is leading in implementing the TB in the Mining Sector in Southern Africa (TIMS) programme across 8 countries with the aim of providing TB screening services to 218,500 mineworkers, ex-mineworkers and their families. TB Alert is a technical partner in the delivery of interventions that are being undertaken by local members of the Humana People to People network in Botswana, Malawi, Namibia and Zambia and with strong partners such as Partners in Health in Lesotho, SAfAIDS in Swaziland and Ariel Glaser Pediatric Healthcare Initiative in Tanzania. The programme is funded by The Global Fund through the Wits Health Consortium.
TB and the Mining Sector of Southern Africa
The World Bank indicates that, of the estimated 500,000 mineworkers in South Africa’s mines, approximately 40% originate from Mozambique, Swaziland, and Lesotho. Many of these workers come from the neighbouring countries of South Africa such as Mozambique, Swaziland and Lesotho. Other countries with large mining sectors like Zimbabwe, Zambia, Namibia, Botswana and Tanzania attract significant numbers of people dedicated to mining both in large scale mining operations and small and artisanal mining sites.
Mineworkers in the Southern African region have among the highest rates of TB in the world (2.500-3.000 TB cases out of 100.000) with 10 times more TB than among general population (250/100.000).
The Stop TB Partnership refers to the mining industry as a “perfect storm” of conditions that interact to put miners and their communities at a higher risk of contracting TB, as well as create barriers to effectively treat the disease. By the nature of working conditions, mines have higher instances of lung diseases. Cramped and informal living situations allow the diseases to spread more easily. Miners tend to travel between mines and their home communities, leaving their families for long periods of time. This separation has shown to increase the likelihood of risky sexual behavior and the prevalence of HIV. It can also move the burden of care for sick people back to their home communities, where there might be less access to treatment options and the disease can be easily spread to caregivers and family members.
ADPP Mozambique leads efforts to identify & treat TB patients in TIMS Programme
TIMS is a coordinated approach to increase case detection or identification rates amongst mineworkers through a targeted approach of active case finding and contact tracing amongst hotspots of mineworkers in the Southern African region.
ADPP Mozambique’s approach has resulted in the provision of TB screening services to hundreds of thousands of key population groups and facilitated TB diagnostics for mineworkers and their family members who were found with TB-like symptoms. ADPP Mozambique and its implementing partners’ activities have also improved adherence to TB treatment, and increased awareness on TB as a disease and how to minimize infections through door-to-door campaigns, local radios sensitization campaigns, and training ex-mineworkers to be peer educators on TB health.
Field activities have been led by dedicated and trained Field Officers who have worked closely with community volunteers and health facilities. Field Officers have played a crucial role in the daily door-to-door TB screening and awareness raising campaigns. In TB screening and TB case identification, they use a screening questionnaire to assess at-risk-groups for TB symptoms. When a person is found with symptoms, Field Officers follow up to facilitate testing TB. This sometimes includes collection of sputum, which is then transported for examination by professional technicians at medical centers, or referral of the person to the health facility for testing. TB diagnosis is not always straightforward and a person with symptoms can often be tested more than once before they are found with TB, hence significant follow up is required from the Field Officers.
Engagement of local stakeholders
The engagement of local heath stakeholders assists in building linkages and synergies to achieve TIMS goals. An example is how nurses are pivotal in the TIMS TB treatment actions. A case in point is the role of Sister Lucia Sheehama.
Among others, Sister Lucia Sheehama, a Wellness and Health Nurse has been instrumental in the establishment of a partnership with Dundee Precious Metals, a mining company in Northern Namibia. Sister Lucia runs a first-aid clinic at the mine and was very supportive in presenting TIMS activities in Namibia to mine management and in the daily organisation and planning of activities. During the month of March 2017, she dedicated health awareness activities at the mine specifically to TB and sent weekly reminders to supervisors about the screening being done by DAPP Namibia (a Namibia implementing partner of ADPP Mozambique), encouraging them to send their employees for screening.
She says of the TIMS programme: “Before, you could watch someone getting sick and you would have to wait until they were seriously sick before you could refer to a health facility. With the TIMS program, you can rule out the possibility of TB early on”. Sister Lucia is particularly proud of the joint screening and awareness activities organised in the mine on World TB Day with 117 mine workers and 2 of DAPP Namibia’s Field Officers.
TB Contact Tracing and Treatment Adherence
Once a patient has been identified as a TB case, the Field Officers carry out contact tracing, which is to screen all people the person has been in contact with including family members and neighbors. Due to the way in which TB bacteria is spread (through the air, speaking, coughing, singing etc), it is important to also screen the people around the TB patients who have had close physical contact with them.
As there is high co-infection rate for HIV and TB, once a person is diagonised with TB, she/he is recommended to undergo HIV testing to ensure immediate early HIV treatment.