What's Happening?

Could primary healthcare help curb TB in mines?



A recent article explores the reported implications of mine-linked air pollution on a Mpumalanga coal town. Residents of the region report continuous health concerns including tuberculosis (TB), though nothing conclusive has been found. The incident forms part of a larger question on whether the mining sector is doing enough to mitigate TB. Martin Neethling, Head: Sanlam Health Insurance and Distribution, says the benefits of affordable access to on-site primary healthcare could greatly assist to curb the epidemic.  

Heidi Albert, Head of the Foundation for Innovative New Diagnostics (FIND) in SA, elaborates on this epidemic. She references a World Bank report that TB rates within the mining workforce are estimated at 2 500 to 3 000 cases per 100 000 individuals – an incidence that’s ten times higher than the World Health Organisation’s threshold for a health emergency, and three times the general population’s incidence rate, which is the third highest incidence rate in the world.

Albert says that according to the World Bank, 70% of TB cases among miners go undiagnosed, which puts families and communities at risk. The risk also spreads across borders, with 40% of mine workers coming from neighbouring countries to work on SA mines. The mining sector has taken positive steps to improve living conditions and digitally screen for illness regularly, which has resulted in a decline in reported cases, but there’s more to be done from a primary healthcare perspective.

“The big risks for miners are cramped living conditions, HIV, and silica dust, which can lead to silicosis. Mineworkers with silicosis are six times more likely to develop active TB. Providing easy access to primary healthcare means patients can be diagnosed and treated quickly and close to home. This means they’re more likely to seek and adhere to care and treatment, which can cure TB and manage HIV.”

WHO reports that TB is conclusively linked to HIV, with 66% of people with TB being co-infected with HIV. Additionally, certain strains of TB are getting harder and harder to treat. “Drug-resistant forms of the disease, like the multi-drug resistant MDR-TB and XDR-TB, are caused by antibiotic-resistant bacteria and are a huge concern. SA had over 16 000 of these cases in 2017, according to the 2018 WHO Global Tuberculosis report. Inevitably, these illnesses are challenging and costly to treat, with high mortality rates, ” says Albert.

Neethling agrees, “Early detection is imperative, but obviously the ideal is for illness to be circumvented altogether. There’s a broader benefit to primary healthcare in that it can provide preventative services to reduce the risk of TB and HIV, and other health conditions like diabetes. “You need to treat the person, not the illness. This means prioritising continuity of care, with screening for mineworkers and their families.”

Albert notes World Bank’s report on the big job that needs to be done in making miners feel comfortable seeking treatment. Many mineworkers are on contract, therefore the risk of not having a contract renewed is a huge disincentive to seek care for TB and HIV. So, tackling TB in the mining sector needs more than just medical interventions.

Neethling says that offering access to primary healthcare and insurance can dramatically improve the wellness of a team and reduce incidents of absenteeism, thereby improving productivity and growth for the mining sector. “The cost of TB for the mining sector has not been officially quantified, but the industry has committed to reducing TB incidence rates to being at or below the country’s incidence rate by 2024.”