Advertisement

Journal of Public Health Policy

, Volume 32, Supplement 1, pp S65–S79 | Cite as

Occupational lung disease in the South African mining industry: Research and policy implementation

  • Jill MurrayEmail author
  • Tony Davies
  • David Rees
Commentary

Abstract

South African miners face an epidemic of occupational lung diseases. Despite a plethora of research on the mining industry, and the gold mining industry in particular, research impact (including disease surveillance) on policy implementation and occupational health systems performance lags. We describe the gold mining environment, and research on silicosis, tuberculosis, HIV and AIDS, and compensation for occupational disease including initiatives to influence policy and thus reduce dust levels and disease. As these have been largely unsuccessful, we identify possible impediments, some common to other low- and middle-income countries, to the translation of research findings and policy initiatives into effective interventions.

Keywords

occupational health silicosis tuberculosis HIV/AIDS compensation policy research 

Introduction

One hundred and twenty years after the discovery of gold on the Witwatersrand in 1886, mining remains a major force in the South African economy. Despite policy and legislative reform, partly informed by extensive research, 16 years into a democratic South Africa, gold miners in particular face an epidemic of occupational lung diseases. This provides an occupational health context in which to examine the impact of research on policy implementation and occupational health systems performance. This article outlines the gold mining environment, presents disease burdens, describes initiatives to reduce disease, and concludes with factors that may have impeded effective interventions, some common to other countries.

The Gold Mining Industry

Although well below the half million employed in the 1990s, South African gold mines still employ approximately 160 000 people.1 The industry is characterized by male cross-border and internal rural-urban migrants who leave their families and live mostly in single-sex mining compounds, returning home for variable periods.2 Until 1975, work contracts were temporary and short, but labour arrangements stabilized thereafter and duration of service increased.3, 4 These social circumstances and stabilization have contributed to serious inter-related epidemics of silicosis (silica dust-induced scarring of the lung),5 tuberculosis (TB), and HIV infection in miners, in surrounding communities and in labor-sending regions.2 Post-apartheid reforms deracialized legislation, but race remains an important determinant of occupation, salary, housing, and disease burden.

Surveillance and Research

In South Africa, surveillance of occupational exposures and diseases is weak notwithstanding efforts of the Department of Mineral Resources to maintain registers such as the South African Mining Occupational Diseases database, initiated in 1998.6 The Pathology Automation System (PATHAUT), an electronic database of approximately 100 000 autopsies of deceased miners, dating back to 1975, is a striking exception. Although provision for compensation for occupational lung diseases to current and former miners and their families in life and after death has been in place since 1911, the Occupational Diseases in Mines and Works Act of 1973 catalysed the development of the database by the South African Medical Research Council.7 PATHAUT provides a rich data-source for research and monitoring disease trends.8, 9 Universities and research entities, some partially funded by the state or from levies on industry administered by the state, filled gaps in data, on black miners in particular, in the 1990s and 2000s, showing rates of disease previously unappreciated. Silicosis demonstrates these aspects well. Importantly, the proportion of black gold miners found to have silicosis at autopsy increased from 3 per cent in 1975 to 32 per cent in 2007. Key studies describing silicosis prevalence in gold miners (Table 1) show substantial disease burdens into the late 2000s, with no evidence that interventions have reduced these to acceptable levels.
Table 1

Silicosis prevalence in gold miners, 1940–2007

Authors

Study design

Study period

Study population

Mean employment (years)

Diagnostic tool

Proportion (%)

Hnizdo and Sluis-Cremer10

Cohort

1940–1991

Deceased white gold miners

23.5

Chest X-rays

14.0

Murray et al11

Trend analysis

1975–1991

Deceased black gold miners

4.8

Autopsy

9.3–12.8

Murray and Hnizdo12

Cohort

1940–2003

Deceased white gold miners

23.5

Autopsy

51.6

Steen et al13

Cross-sectional

1994

Living black ex-miners

15.5

Chest X-rays

26.6–31.0

Trapido et al14

Cross-sectional

1996

Living black ex-miners

12.2

Chest X-rays

22.0–36.0

Meel15

Cross-sectional

1997–1999

Living black ex-miners

Chest X-rays

34

Churchyard et al16

Cross-sectional

2000–2001

Employed black miners

21.8

Chest X-rays

18.3–19.9

Girdler-Brown et al17

Cross-sectional

1999

Living black ex-miners

25.6

Chest X-rays

24.6

Park et al18

Cohort

1999–2000

Living black ex-miners

26.1

Chest X-rays

27

Nelson et al4

Trend analysis

1975–2007

Deceased black gold miners

13.4

Autopsy

3–32

Biologic and social factors combine to create a ‘perfect storm’ for the interaction among silicosis, TB, and HIV. Thus, integrated, multifaceted remedies are required to control these epidemics. Silicosis substantially increases the risk of TB19, 20, 21, 22 to a magnitude similar to that of HIV infection.23 Importantly, silica exposure is associated with TB even in the absence of silicosis20, 24 and the increased risk is lifelong.24 Risk factors such as migrancy25 and single-sex compounds increase high-risk sexual behaviour,26, 27 and thus HIV rates, which are close to 30 per cent among these miners.28 The TB risks of silicosis and HIV infection combine multiplicatively.23 Consequently, the highest recorded rates of TB worldwide have been reported in South African gold miners.29 Mortality from TB is higher than that from mine accidents.30, 31 The prevalence of TB in gold miners has increased from 806 per 100 000 in 1991 to 3821 in 2004.32 HIV prevalence rose from less than 1 per cent in 198733 to 27 per cent in 2000.28 More recent data, after the roll out of antiretroviral treatment in 2003, are not available.

There is a large body of research on the control of TB in South African mines that addresses the use of isoniazid therapy to prevent TB in people with HIV;34, 35, 36 the spread of TB in the mining environment;37, 38, 39, 40, 41 and TB case finding.42, 43, 44 Studies have evaluated clinical management,45, 46, 47 and delayed, missed, or inaccurate diagnosis of TB in life28, 48 that have added to TB transmission. Drug resistance37, 49, 50 and recurrence of TB41, 51, 52, 53 have also complicated control. Researchers and occupational health practitioners have developed materials to assist mine health-care workers with TB management.54, 55 The Mine Health and Safety Council, a tripartite body formed under the Mine Health and Safety Act of 1996, and comprising representatives from the Department of Mineral Resources, the mining industry, and trade unions, funded and published the work. Neither the Council nor any other organization has formally measured the uptake of the materials but anecdotal evidence suggests that they are not widely used.

The migrant labour system has weakened incentives to control dust and disease by externalizing costs of disease, moving them away from the gold mining industry to communities and the State.2, 56, 57, 58, 59, 60, 61 South Africa requires multifaceted public policies to address this negative impact of migrancy that is common to many low and middle-income countries. Bilateral agreements between countries to provide industry-funded health services for former miners in labour-sending areas is one example. Another is patient-retained medical records to improve continuity of care for migrant workers.62 Accompanying this are failures of the occupational disease compensation system. Barriers to compensation are considerable and the majority of qualifying claimants have not received awards (Table 2), thus reducing the substantial financial incentive to control dust that would be brought about by compensation payments and hence increased levies on mines. Trapido et al63 estimated the unpaid occupational lung disease compensation for gold miners to be 10 billion South African rands (US$1.4 billion; $1=R7) in 1996, closer to 20 billion rands (US$2.9 billion) today. Even in poor countries, investments in compensation systems should bring greater returns in reduced disease burdens and their attendant costs to the public health system, provided that compensation costs are borne by industry.
Table 2

Studies of occupational disease compensation processes and outcomes in miners employed on South African mines

Study

Context

Study period

Outcome

Steen et al13

304 former gold miners living in Thamanga, Botswana

1994

Very few miners with occupational lung disease had been compensated (proportion not specified)

Trapido et al14

238 former gold miners living in Eastern Cape, South Africa

1996

62% of those eligible not compensated. Only 2.5% fully compensated

Murray et al64

All 2530 miners who came to autopsy

1999

446 cases (19%) had occupational lung disease not identified and submitted for compensation in life, or more severe disease than had been compensated in life. 31/446 (7%) of families had received benefits by April 2001

Roberts65

205 former miners, Eastern Cape, South Africa

2008

175/205 (85%) reported not receiving the statutory medical examination when leaving the mine (which is partly to identify compensable disease). 203/205 (99%) did not know of the Compensation Act and its benefits

Maiphetlho et al66

84 former mine workers diagnosed with silicosis at Groote Schuur Hospital, Cape Town, and submitted for compensation

1993–2005

17/84 (20%) recorded as having received compensation. Median time from submission of medical records to receipt of award was 51 months (range 22–84 months)

Policy, Legislative and Service Initiatives

Although the history of disease reduction initiatives dates back to the early 1900s, these cannot be seen in isolation from South Africa's apartheid history of racial discrimination.67 We describe attempts to achieve control of silica dust, reduced impact of migrancy, improved housing, and better TB management and compensation systems necessary to reduce disease burdens. In 1973, the Occupational Diseases in Mines and Works Act (ODMWA) provided compensation for occupational diseases for miners, but benefits were substantially higher for white miners than other groups. The 1993 Amendment to ODMWA established racial parity in compensation benefits but access to benefits is unsatisfactory (Table 2). In Table 3 we summarize key initiatives in the last two decades and comment on their outcomes.
Table 3

Policy, legislative and service initiatives affecting miners in South Africa: 1993–2010

Year

Initiative

Primary responsibility

Comment

1990s to present

Substantial body of research initiated and sponsored by Mine Health and Safety Council, notably the Silicosis Control Programme, to improve measurement and control of dust and awareness of the diseases and the roles of workers, management, and practitioners

Department of Mineral Resources

Important findings widely disseminated but scant evaluation of impact on practice and limited availability of key research-based tools

1993

Amendment to Occupational Diseases in Mines and Works Act to provide uniform compensation benefits, irrespective of race

Department of Health

Did not achieve purpose because of failure to award benefits to the majority of qualifying claimants, and to make benefit examinations accessible to former miners in the labour-sending areas

1993 to present

HIV/AIDS research and numerous tripartite engagements and summits. Widespread implementation at large mines of comprehensive programmes on HIV and AIDS, including prevention, treatment, community outreach, and evaluation

Department of Mineral Resources, Department of Health, academics, mining industry, trade unions

Consensus on principles and policies achieved and national and industry plans formulated. Business case for action widely accepted. Little evidence of declining HIV rates

1994

Leon Commission of Inquiry into Safety and Health in the Mining Industry to recommend measures to improve mine health and safety

Presidential Inquiry

Swift incorporation of many recommendations into law, but no published analysis of impact of these regulatory reforms

1995

Mine Health and Safety Act with subsequent amendments, regulations, codes of practice, guidelines, and standards

Department of Mineral Resources

Modern comprehensive Act. Impact not formally evaluated but probably limited by relative focus on accident prevention, poor data on exposures and occupational lung diseases, and weaknesses in enforcement of dust control and measures to reduce lung disease

1999

Task-force to integrate the occupational health and compensation systems in the country, partly to improve compensation benefits for miners

Department of Labour

Separate systems for mining and non-mining industries persist. Contested domains of authority and unfunded liabilities may explain lack of progress

2005

Social Contract for Rapid Housing Delivery partly to reduce single-sex compounds

Department of Housing

Some progress but 51% of gold miners still housed in shared single-sex dwellings in 2007

2009

Housing and Living Conditions Standard for the South African Minerals Industry to provide standards and tools for monitoring and evaluation

Department of Mineral Resources

Promulgated, but not yet implemented

2003

Formulation of milestones (targets) to reduce silica dust and eliminate new cases of silicosis in mining

Department of Mineral Resources

Extensively publicized and endorsed; task teams established to promote attainment. Insufficient data to evaluate progress

2003

Guidance Note for Occupational Medicine Practitioners: Tuberculosis Control Programmes. Detailed guide to assist employers in preparing a comprehensive TB control programme

Department of Mineral Resources

Excellent recommendations but, to date, no evaluation of implementation published and Guidance Note not updated as stipulated

2007

Tuberculosis Strategic Plan for South Africa 2007–2011 outlines key role of mining and importance of dust control and improved living conditions in TB control

Department of Health

Weak intersectoral collaboration among government departments limited impact

The 1994 Leon Commission of Inquiry into Safety and Health in the Mining Industry, whose recommendations were informed by evidence presented by the National Union of Mineworkers, researchers, and activists, has had far-reaching consequences. The inquiry led to promulgation of a modern and comprehensive Mine Health and Safety Act with ancillary tripartite structures (representation of labour, government, and industry), such as the Mine Health and Safety Council (MHSC), to promote, develop, and oversee policy, standards, and encourage relevant research. However, neither the state, academics, nor trade unions have evaluated the impact of this law on practice.

Government has not implemented its long-standing policy of improving compensation benefits for miners (under the auspices of the Department of Health), in line with those available to non-mining workers (under the auspices of the Department of Labour), probably because of the increased and unfunded costs.

Numerous initiatives have sought to address living conditions of miners, but progress has been slow.68 A substantial body of applied research to reduce silica dust and disease69, 70 coincides with widely published targets (milestones),71 the establishment of task teams to disseminate good practice, and campaigns by stakeholders. There is, however, limited evidence of sustained reductions in silica dust levels.72, 73 Translation of research into practice has been patchy; for example, MHSC-sponsored research-based materials to raise awareness and skills among practitioners, miners, health and safety representatives, and managers71 have not been disseminated by the MHSC, mining houses, or trade unions.

Efforts of mine medical services to control TB in the mines have had limited impact.62 Although the mining industry has made substantial progress in developing HIV and AIDS programmes for miners,74 there is little evidence of declining HIV rates. Despite research and numerous policy initiatives, South Africa's mining industry falls short of compliance with health and safety legal requirements, as demonstrated by the Department of Health,73 the AIDS and Rights Alliance for Southern Africa,75 and a Presidential Audit of compliance76 reports.

Barriers to Translating Research into Action

The mining industry, the state, trade unions, and academics have done scant formal critical analysis of factors that have impeded effective interventions to reduce disease.77 In the absence of this analysis, we have identified financial, social, and organizational factors with face-validity that might explain much of the failure to implement translation of research and policy into action (Table 4). Many of these factors could apply to other countries.
Table 4

Factors influencing translation of research findings and policy initiatives into effective interventions to reduce disease

Factor

Comment

Financial and other resources

 Unknown cost of disease reduction

Mining industry, government departments, or other agencies have not done any cost analysis, but costs perceived to be high

 Compensation system weaknesses

Low compensation costs limit the financial incentive for the mining industry to reduce dust and disease

 Declining industry

Government departments may redirect their attention to growing industries

 Competing demands for limited resources

Other public health concerns of the Department of Health and the mining industry may override occupational disease, eg the rapid escalation, scale, and the complexity of the HIV epidemic overtook existing infrastructure, policy formulation, and programme development capacity

Social

 High rates of migrancy

Integral to southern African economies but poorly developed government solutions to reduce impact as a disease-driver

 Unequal power relations among social partners

Trade unions under-resourced (finance, knowledge, etc) to contribute adequately to self-regulatory tripartite model of Mine Health and Safety Act

 Limited civil society activism

Weak occupational health and safety non-governmental organizations

Organizational

 Fragmented occupational health system

Domain-contestation among Departments of Health, Labour, and Mineral Resources inhibits formulation of integrated national policies and appropriate resource allocation

 Weak inspectorate in the Department of Mineral Resources

Capacity directed to safety issues

 Poor monitoring and evaluation

Inadequate information on dust levels and disease burdens, and evaluation of enterprise-level programmes and impact of policies/legislation has prevented identification of effective interventions. Government policies do not identify agencies responsible for monitoring and evaluation and/or allocate appropriate resources

 Focus on accident prevention

Immediacy of injuries and traumatic deaths reduces focus on the more insidious impact of disease mortality, by all role players

Conclusion

Scientific studies have motivated and informed many sound policy decisions and legislative reforms, and have identified strategies for strengthening practice and health systems. South Africa has adopted some recommendations, but very few studies seem to have fostered sustained remedial action. There are clear gaps between research, policy, and implementation in occupational health practice in the South African mining industry.

Mining is growing in southern Africa and in many low- and middle-income countries. Other countries could avoid the high levels of occupational diseases experienced in South Africa through an enhanced understanding of the implications of the failure to use research evidence. Key messages to other countries are to: monitor dust and disease levels reliably, evaluate the impact of policy and regulatory reforms, and define the roles and responsibilities of individual government departments and other agencies clearly.

References

  1. Chamber of Mines. (2009) Facts and Figures. Johannesburg: Chamber of Mines of South Africa.Google Scholar
  2. Rees, D., Murray, J., Nelson, G. and Sonnenberg, P. (2009) Oscillating migration and the epidemics of silicosis, tuberculosis, and HIV infection in South African gold miners. American Journal of Industrial Medicine 53 (4): 398–404.CrossRefGoogle Scholar
  3. Leger, J.P. (1992) Occupational diseases in South African mines – A neglected epidemic? South African Medical Journal 81 (4): 197–201.Google Scholar
  4. Nelson, G., Girdler-Brown, B., Ndlovu, N. and Murray, J. (2010) Three decades of silicosis: Disease trends at autopsy in South African gold miners. Environmental Health Perspectives 118 (3): 421–426.CrossRefGoogle Scholar
  5. Rees, D. and Murray, J. (2007) Silica, silicosis and tuberculosis. International Journal of Tuberculosis and Lung Disease 11 (5): 474–484.Google Scholar
  6. Torres, N.G., Boyce, J.E., Barnes, D.F., White, N. and du Plessis, A. (1998) The development of an occupational diseases database, to be managed by the Department of Minerals and Energy, to record morbidity and mortality of occupational diseases in the South African mining industry (GEN 505). Johannesburg: Safety in Mines Research Advisory Committee, http://www.mhsc.org.za/dmdocuments/Reports/GEN/gen505/Gen505.pdf, accessed 20 December 2010.Google Scholar
  7. Soskolne, C.L., Goldstein, B., Haffajee, I.A. and Cowling, G. (1976) An integrated cardio-respiratory pathology information system. South African Medical Journal 50 (45): 1832–1836.Google Scholar
  8. Ndlovu, N., Murray, J., Davies, T. and Nelson, G. (2010) Pathology Division Surveillance Report: Demographic Data and Disease Rates for January to December 2009. Johannesburg: National Institute for Occupational Health. National Health Laboratory Services, Johannesburg. NIOH Report 3/2010, ISSN 1812-7681.Google Scholar
  9. National Institute for Occupational Health. (2009) Fact Sheet: Mining industry related burden of disease. Johannesburg: National Institute for Occupational Health, National Health Laboratory Service, http://www.nioh.ac.za/docs/fact_sheets/Mining.pdf, accessed 20 December 2010.Google Scholar
  10. Hnizdo, E. and Sluis-Cremer, G.K. (1993) Risk of silicosis in a cohort of white South African gold miners. American Journal of Industrial Medicine 24 (4): 447–457.CrossRefGoogle Scholar
  11. Murray, J., Kielkowski, D. and Reid, P. (1996) Occupational disease trends in black South African gold miners. An autopsy-based study. American Journal of Respiratory and Critical Care Medicine 153 (2): 706–710.CrossRefGoogle Scholar
  12. Murray, J. and Hnizdo, E. (2005) Development of silicosis in a cohort of South African gold miners – radiological and autopsy-based study, Presented at the 10th International Conference on Occupational Respiratory Disease, Beijing, China.Google Scholar
  13. Steen, T.W. et al (1997) Prevalence of occupational lung disease among Botswana men formerly employed in the South African mining industry. Occupational and Environmental Medicine 54 (1): 19–26.CrossRefGoogle Scholar
  14. Trapido, A.S. et al (1998) Prevalence of occupational lung disease in a random sample of former mineworkers, Libode District, Eastern Cape Province, South Africa. American Journal of Industrial Medicine 34 (4): 305–313.CrossRefGoogle Scholar
  15. Meel, B.L. (2002) Patterns of lung diseases in former mine workers of the former Republic of the Transkei: An X-ray-based study. International Journal of Occupational and Environmental Health 8 (2): 105–110.CrossRefGoogle Scholar
  16. Churchyard, G.J. et al (2004) Silicosis prevalence and exposure-response relations in South African goldminers. Occupational and Environmental Medicine 61 (10): 811–816.CrossRefGoogle Scholar
  17. Girdler-Brown, B.V., White, N.W., Ehrlich, R.I. and Churchyard, G.J. (2008) The burden of silicosis, pulmonary tuberculosis and COPD among former Basotho goldminers. American Journal of Industrial Medicine 51 (9): 640–647.CrossRefGoogle Scholar
  18. Park, H.H., Girdler-Brown, B.V., Churchyard, G.J., White, N.W. and Ehrlich, R.I. (2009) Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former Basotho gold miners. American Journal of Industrial Medicine 52 (12): 901–908.CrossRefGoogle Scholar
  19. Cowie, R.L. (1994) The epidemiology of tuberculosis in gold miners with silicosis. American Journal of Respiratory and Critical Care Medicine 150: 1460–1462.CrossRefGoogle Scholar
  20. teWaterNaude, J.M. et al (2006) Tuberculosis and silica exposure in South African gold miners. Occupational and Environmental Medicine 63 (3): 187–192.CrossRefGoogle Scholar
  21. Corbett, E.L. et al (1999) Risk factors for pulmonary mycobacterial disease in South African gold miners. A case-control study. American Journal of Respiratory and Critical Care Medicine 159 (1): 94–99.CrossRefGoogle Scholar
  22. Stuckler, D., Basu, S., McKee, M. and Lurie, M. (2011) Mining and risk of tuberculosis in sub-Saharan Africa. American Journal of Public Health 101 (3): 524–530.CrossRefGoogle Scholar
  23. Corbett, E.L. et al (2000) HIV infection and silicosis: The impact of two potent risk factors on the incidence of mycobacterial disease in South African miners. AIDS 14 (17): 2759–2768.CrossRefGoogle Scholar
  24. Hnizdo, E. and Murray, J. (1998) Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occupational and Environmental Medicine 55 (7): 496–502.CrossRefGoogle Scholar
  25. Lurie, M.N. et al (2003) The impact of migration on HIV-1 transmission in South Africa: A study of migrant and non-migrant men and their partners. Sexually Transmitted Diseases 30 (2): 149–156.CrossRefGoogle Scholar
  26. Hargrove, J. (2008) Migration, mines and mores: The HIV epidemic in southern Africa. South African Journal of Science 104: 53–61.Google Scholar
  27. Campbell, C. (1997) Migrancy, masculine identities and AIDS: The psychosocial context of HIV transmission on the South African gold mines. Social Science & Medicine 45 (2): 273–281.CrossRefGoogle Scholar
  28. Corbett, E.L. et al (2004) Human immunodeficiency virus and the prevalence of undiagnosed tuberculosis in African gold miners. American Journal of Respiratory and Critical Care Medicine 170 (6): 673–679.CrossRefGoogle Scholar
  29. Department of Health. (2008) Tuberculosis Strategic Plan for South Africa, 2007-2011. Pretoria, South Africa: Department of Health, Republic of South Africa.Google Scholar
  30. Murray, J., Sonnenberg, P., Nelson, G., Bester, A., Shearer, S. and Glynn, J.R. (2007) Cause of death and presence of respiratory disease at autopsy in an HIV-1 seroconversion cohort of southern African gold miners. AIDS 21 (Suppl 6): S97–S104.CrossRefGoogle Scholar
  31. Murray, J. et al (2005) Effect of HIV on work-related injury rates in South African gold miners. AIDS 19 (17): 2019–2024.CrossRefGoogle Scholar
  32. Glynn, J.R., Murray, J., Bester, A., Nelson, G., Shearer, S. and Sonnenberg, P. (2008) Effects of duration of HIV infection and secondary tuberculosis transmission on tuberculosis incidence in the South African gold mines. AIDS 22 (14): 1859–1867.CrossRefGoogle Scholar
  33. Brink, B. and Clausen, L. (1987) The acquired immune deficiency syndrome. Proceedings of the Mine Medical Officers’ Association 63: 10–17.Google Scholar
  34. van Halsema, C.L. et al (2010) Tuberculosis outcomes and drug susceptibility in individuals exposed to isoniazid preventive therapy in a high HIV prevalence setting. AIDS 24 (7): 1051–1055.CrossRefGoogle Scholar
  35. Churchyard, G.J. et al (2003) Efficacy of secondary isoniazid preventive therapy among HIV-infected Southern Africans: Time to change policy? AIDS 17 (14): 2063–2070.CrossRefGoogle Scholar
  36. Grant, A.D. et al (2005) Effect of routine isoniazid preventive therapy on tuberculosis incidence among HIV-infected men in South Africa: A novel randomized incremental recruitment study. Journal of the American Medical Association 293 (22): 2719–2725.CrossRefGoogle Scholar
  37. Calver, A.D. et al (2010) Emergence of increased resistance and extensively drug-resistant tuberculosis despite treatment adherence, South Africa. Emerging Infectious Diseases 16 (2): 264–271.CrossRefGoogle Scholar
  38. Corbett, E.L. et al (2003) Stable incidence rates of tuberculosis (TB) among human immunodeficiency virus (HIV)-negative South African gold miners during a decade of epidemic HIV-associated TB. Journal of Infectious Diseases 188 (8): 1156–1163.CrossRefGoogle Scholar
  39. Godfrey-Faussett, P. et al (2000) Tuberculosis control and molecular epidemiology in a South African gold-mining community. Lancet 356 (9235): 1066–1071.CrossRefGoogle Scholar
  40. Sonnenberg, P., Glynn, J.R., Fielding, K., Murray, J., Godfrey-Faussett, P. and Shearer, S. (2004) HIV and pulmonary tuberculosis: The impact goes beyond those infected with HIV. AIDS 18 (4): 657–662.CrossRefGoogle Scholar
  41. Sonnenberg, P., Murray, J., Glynn, J.R., Shearer, S., Kambashi, B. and Godfrey-Faussett, P. (2001) HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: A cohort study in South African mineworkers. Lancet 358 (9294): 1687–1693.CrossRefGoogle Scholar
  42. Girdler-Brown, B.V., Murray, J.K.W., Thooe, S. and Godfrey-Faussett, P. (2004) Development of Sensitive Tools for Active Case Finding of Tuberculosis (Phase 1) (SIM 03-08-02). Johannesburg: Safety in Mines Research Advisory Committee2004.Google Scholar
  43. Lowe, R.E. and Murray, J. (1992) Tuberculosis case finding. Proceedings of the Mine Medical Officers’ Association of South Africa 65: 31–38.Google Scholar
  44. Lewis, J.J. et al (2009) HIV infection does not affect active case finding of tuberculosis in South African gold miners. American Journal of Respiratory and Critical Care Medicine 180 (12): 1271–1278.CrossRefGoogle Scholar
  45. Mqoqi, N.P., Churchyard, G.A., Kleinschmidt, I. and Williams, B. (1997) Attendance versus compliance with tuberculosis treatment in an occupational setting – A pilot study. South African Medical Journal 87 (11): 1517–1521.Google Scholar
  46. Sonnenberg, P., Ross, M.H., Shearer, S.C. and Murray, J. (1998) The effect of dosage cards on compliance with directly observed tuberculosis therapy in hospital. International Journal of Tuberculosis and Lung Disease 2 (2): 168–171.Google Scholar
  47. Murray, J., Sonnenberg, P., Shearer, S.C. and Godfrey-Faussett, P. (1999) Human immunodeficiency virus and the outcome of treatment for new and recurrent pulmonary tuberculosis in African patients. American Journal of Respiratory and Critical Care Medicine 159 (3): 733–740.CrossRefGoogle Scholar
  48. Murray, J., Back, P., Coetzee, L. and Lowe, J.P. (2000) Clinico-Pathological Study to reduce the rate of missed and misdiagnosis of Pulmonary Tuberculosis in the South African Mining Industry. Final Report. HEALTH 611: SIMRAC, Braamfontein.Google Scholar
  49. Churchyard, G.J., Corbett, E.L., Kleinschmidt, I., Mulder, D. and De Cock, K.M. (2000) Drug-resistant tuberculosis in South African gold miners: Incidence and associated factors. International Journal of Tuberculosis and Lung Disease 4 (5): 433–440.Google Scholar
  50. Murray, J., Sonnenberg, P., Shearer, S. and Godfrey-Faussett, P. (2000) Drug-resistant pulmonary tuberculosis in a cohort of southern African gold-miners with a high prevalence of HIV infection. South African Medical Journal 90 (4): 381–386.Google Scholar
  51. Mallory, K.F., Churchyard, G.J., Kleinschmidt, I., De Cock, K.M. and Corbett, E.L. (2000) The impact of HIV infection on recurrence of tuberculosis in South African gold miners. International Journal of Tuberculosis and Lung Disease 4 (5): 455–462.Google Scholar
  52. Charalambous, S. et al (2008) Contribution of reinfection to recurrent tuberculosis in South African gold miners. International Journal of Tuberculosis and Lung Disease 12 (8): 942–948.Google Scholar
  53. Glynn, J.R., Murray, J., Bester, A., Nelson, G., Shearer, S. and Sonnenberg, P. (2010) High rates of recurrence in HIV-infected and HIV-uninfected patients with tuberculosis. Journal of Infectious Diseases 201 (5): 704–711.CrossRefGoogle Scholar
  54. Murray, J., Wong, M.L., Hopley, M.J. and lowe, P.J. (2002) Process-based performance review for the diagnosis of pulmonary tuberculosis. Technology transfer of SIMRAC project Health 611 to enhance clinical performance.Google Scholar
  55. Page-Shipp, L., Murray, J., Churchyard, G., Girdler-Brown, B., Sonnenberg, P. and Chicksen, E. (2010) Development of a TB Programme Review Tool for the South African Mining Industry, February 2010 Revision Johannesburg: Mine Health and Safety Council.Google Scholar
  56. Calver, A. (2008) Miners’ compensation: Who cares? Labour Bulletin 32 (4): 26–28.Google Scholar
  57. Davies, J.C. (2001) Silicosis and tuberculosis among South African goldminers – An overview of recent studies and current issues. South African Medical Journal 91 (7): 562–566.Google Scholar
  58. Gonsalves, G. and Akugizibwe, P. (2008) Migrants and TB in Southern Africa: Reaching across borders. Labour Bulletin 32 (4): 29–31.Google Scholar
  59. Grainger, L. (2010) Silicosis compensation editorial. Occupational Health Southern Africa 16 (2): 2.Google Scholar
  60. Trapido, A. and Goode, R. (1999) Polluters should pay. South African Labour Bulletin 23: 53–58.Google Scholar
  61. White, N. (1997) Dust related diseases in former miners-the ODMWA legacy. Occupational Health South Africa 3 (4): 20–24.Google Scholar
  62. Basu, S., Stuckler, D., Gonsalves, G. and Lurie, M. (2009) The production of consumption: Addressing the impact of mineral mining on tuberculosis in southern Africa. Globalization and Health 5: 11.CrossRefGoogle Scholar
  63. Trapido, A., Goode, R. and White, N. (1998) Costs of occupational lung disease in South African gold mining. Journal of Mineral Policy, Business and Environment 13 (2): 26–33.Google Scholar
  64. Murray, J., Coetzee, L., Back, P., Banyini, A. and Ross, M. (2002) Analysis of occupational lung disease identified at autopsy and compensated in the South African mining industry. Occupational Health South Africa 8: 3–5.Google Scholar
  65. Roberts, J. (2009) The Hidden Epidemic amongst Former Miners: Silicosis, Tuberculosis and the Occupational Diseases in Mines and Works Act in the Eastern Cape, South Africa. Westville, South Africa: Health Systems Trust.Google Scholar
  66. Maiphetlho, L. (2010) Claims experience of former gold miners with silicosis – A clinic series. Occupational Health Southern Africa 16 (2): 10–16.Google Scholar
  67. Murray, J. and Rees, D. (2003) Tuberculosis and silicosis in South African gold mining. Occupational Safety, Health and Development 5: 2–10.Google Scholar
  68. AngloGold Ashanti. (2007) Country Report South Africa West Wits operations: AngloGold Ashanti, http://www.anglogold.co.za/NR/rdonlyres/576A5C42-3524-49EE-A4A2-9A4D161572D0/0/west_wits.pdf, accessed 28 April 2011.
  69. Banyini, A. (2006) Simrac 03-06-03. Occupational Health Southern Africa 12 (1): 18–21.Google Scholar
  70. Stanton, D. (2006) Best practices on silicosis prevention. Occupational Health Southern Africa 12 (1): 13.Google Scholar
  71. Rees, D., Murray, J. and Ingham, F. (2009) Silicosis Elimination Programme (Track C). Silicosis elimination awareness for persons affected by mining operations in South Africa (SIM 03 06 03). Johannesburg: Mine Health and Safety Council.Google Scholar
  72. Kemsley, D.M. (2008) Respirable Dust and Quartz Exposure of Rock Drill Operators in Two Free State Gold Mines. Johannesburg: University of the Witwatersrand.Google Scholar
  73. Department of Health, South Africa. (2010) Report on Tuberculosis in the Mining Industry. Pretoria, South Africa: Department of Health.Google Scholar
  74. Brink, B. and Pienaar, J. (2007) Business and HIV/AIDS: the case of Anglo American. AIDS 21 (Suppl 3): S79–S84.CrossRefGoogle Scholar
  75. AIDS and Rights Alliance for Southern Africa (ARASA). (2008) The Mining Sector, Tuberculosis and Migrant Labour in Southern Africa: Policy and Programmatic Interventions for the Cross-Border Control of Tuberculosis between Lesotho and South Africa, Focusing on Miners, Ex-Miners and Their Families, http://arasa.info/sites/default/files/pub_ARASA_Mines_TB_and_Southern_Africa.pdf, accessed 28 April 2011.
  76. Department of Mineral Resources. (2008) Presidential Audit on Health and Safety in the Mining Industry. Pretoria, South Africa: Department of Mineral Resources.Google Scholar
  77. Stuckler, D., Basu, S. and McKee, M. (2010) Governance of mining, HIV and tuberculosis in Southern Africa. Global Health Governance IV (1), http://www.ghgj.org/Stuckler_final.pdf, accessed 28 April 2011.

Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2011

Authors and Affiliations

  1. 1.National Institute for Occupational Health (NIOH), National Health Laboratory ServiceJohannesburgSouth Africa
  2. 2.School of Public Health, Faculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa

Personalised recommendations