Silicosis and silicotuberculosis amongst small scale gemstone miners in Northern Tanzania

坦桑尼亚北部小规模宝石矿工的矽肺和硅结核

• 批准号: MR/W024861/1
• 负责人: Patrick Howlett
• 金额: $ 34.77万
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FW024861%2F1
• 关键词: Silicosis; silicotuberculosis; amongst; small; scale

Worldwide, some 46m people work in 'artisanal, small scale mines' (ASM), a number far larger than the 7m employed in large scale mining. ASMs are located exclusively in resource-poor countries, are locally owned, unregulated and use manual methods of extraction - but collectively produce up to a quarter of global minerals and precious metals. While artisanal mining may be a route out of poverty, the risks of such work are high, yet almost entirely unmeasured. A recent review of research topics in studies of ASM, concluded that more research was needed, particularly of infectious (such as tuberculosis) and respiratory diseases.Silicosis is an incurable lung disease caused by the inhalation of crystalline silica in activities such as hard rock mining. It generally develops slowly, but when levels of silica are very high there may be a far more rapid onset with early respiratory failure and death. Importantly, silicosis increases the risk of tuberculosis (TB) by about four-fold and miners often contract the disease in addition to silicosis. Tanzanite is a gemstone exclusively found in Mererani, northern Tanzania, and mined in deep shafts using ASM methods by around 10,000 workers, across about 100 mines. Their exposures to silica appear to be very high, and there is suggestive evidence of very high rates of aggressive silicosis in young miners with fewer than 5 years of employment. Similarly, their rates of TB are high, as are those in the local non-mining community. There is concern that efforts to control TB in the area are hampered by transmission of the disease within mines, and between miners and their local contacts.I aim to measure, across time, the development and progression of silicosis and TB in tanzanite miners and determine how much these have an impact on their health and their ability to earn a living. In addition, I will examine whether the spread of TB from miners to the local community is common.To do this I propose two studies. In the first, I will recruit and follow a group of 410 miners from a selection of 10-16 mines. In them, I will make measurements of their lung function and symptoms, and perform TB tests and chest x-rays (to detect silicosis) at the beginning of the study and then again after 18 months. In a second study, I will use 'whole genome sequencing' (WGS) to identify particular strains of TB in miners with the diseases; I will use the same technique in individuals discovered to have TB through a local community screening program. WGS is technique that that allows for entire genetic codes of an organism to be read. It will allow me to identify which strains of TB are present in the population while checking for resistance to treatments, and, crucially, to map transmission between individuals.This work will be done in collaboration with the infectious disease team at the Kibong'oto Infectious Diseases Hospital, the National TB hospital of Tanzania, taking advantage of their ongoing TB screening programme and close relationships with the local ASM community. To assist with study management and to enhance impact, I will convene a study Advisory Board of stakeholders including our collaborators at the National TB and Leprosy program, expert academics, and representatives from the local mines and from organisations for persons previously treated for TB.This novel work concerns the intersection between occupational and infectious diseases and should produce findings that will be of importance in the prevention of both - in a sector that is of growing, global importance.

全球范围内，约有 4600 万人在“手工小型矿山”(ASM) 工作，这一数字远远高于大规模采矿业的 700 万人。手工和小规模采矿仅位于资源贫乏国家，属于当地所有，不受监管，并使用手工开采方法，但其总产量占全球矿物和贵金属的四分之一。虽然手工采矿可能是摆脱贫困的一条途径，但此类工作的风险很高，但几乎完全无法衡量。最近对 ASM 研究主题的回顾得出的结论是，需要进行更多研究，特别是传染病（例如结核病）和呼吸道疾病。硅肺病是一种无法治愈的肺部疾病，由在硬岩采矿等活动中吸入结晶二氧化硅引起。它通常发展缓慢，但当二氧化硅含量非常高时，可能会更快地发病，并导致早期呼吸衰竭和死亡。重要的是，硅肺病会使患结核病 (TB) 的风险增加约四倍，而矿工除了硅肺病外，还经常感染这种疾病。坦桑石是一种仅产于坦桑尼亚北部 Mererani 的宝石，约有 10,000 名工人在约 100 个矿山中使用 ASM 方法在深井中开采。他们接触的二氧化硅似乎非常高，并且有暗示性证据表明，工作时间不到 5 年的年轻矿工患侵袭性硅肺病的比例非常高。同样，他们的结核病发病率很高，当地非采矿社区的结核病发病率也很高。人们担心，该地区结核病的控制工作会因矿井内以及矿工与其当地接触者之间的疾病传播而受到阻碍。我的目标是测量坦桑石矿工中硅肺病和结核病随时间的发展和进展，并确定这些对他们的健康和谋生能力的影响有多大。此外，我将研究结核病从矿工到当地社区的传播是否常见。为此，我提出了两项​​研究。首先，我将从 10-16 个矿场中招募并跟踪 410 名矿工。在研究开始时，我将测量他们的肺功能和症状，并进行结核病检测和胸部 X 光检查（以检测矽肺），然后在 18 个月后再次进行。在第二项研究中，我将使用“全基因组测序”（WGS）来识别患有该疾病的矿工中的特定结核菌株；我将在通过当地社区筛查计划发现患有结核病的个人中使用相同的技术。全基因组测序（WGS）是一种可以读取生物体整个遗传密码的技术。它将让我能够确定人群中存在哪些结核菌株，同时检查对治疗的耐药性，最重要的是，绘制个体之间的传播图谱。这项工作将与坦桑尼亚国家结核病医院基邦奥托传染病医院的传染病团队合作完成，利用他们正在进行的结核病筛查计划以及与当地 ASM 社区的密切关系。为了协助研究管理并提高影响力，我将召集一个由利益相关者组成的研究咨询委员会，其中包括我们在国家结核病和麻风病项目的合作者、专家学者以及来自当地矿山和曾接受结核病治疗者的组织的代表。这项新颖的工作涉及职业病和传染病之间的交叉点，并且应该产生对预防这两种疾病具有重要意义的研究结果 - 在一个不断增长的全球性部门中 重要性。

项目成果

Silicosis and silicotuberculosis among respiratory hospital admissions: A cross-sectional survey in northern Tanzania.

• DOI: 10.7196/ajtccm.2023.v29i3.269
• 发表时间: 2023
• 期刊: African journal of thoracic and critical care medicine
• 作者: Dennis E;Mussa H;Sanga MP;Howlett P;Nyakunga G
• 通讯作者: Nyakunga G

Neurological disorders in Northern Tanzania: A 6-year prospective hospital-based case series.

• DOI: 10.4314/ahs.v22i1.34
• 发表时间: 2022-03
• 期刊: AFRICAN HEALTH SCIENCES
• 影响因子: 1
• 作者: Howlett, William P.;Urasa, Sarah J.;Maro, Venance P.;Walker, Richard W.;Kilonzo, Kajiru G.;Howlett, Patrick J.;Dekker, Marieke C. J.
• 通讯作者: Dekker, Marieke C. J.

Silicosis, tuberculosis and silica exposure among artisanal and small-scale miners: A systematic review and modelling paper

• DOI: 10.1101/2023.05.31.23290725
• 发表时间: 2023-06
• 作者: P. Howlett;Hader Mousa;Bibie Said;A. Mbuya;O. Kon;S. Mpagama;J. Feary