EC Clinical and Medical Case Reports

Background: Tuberculosis key affected populations (KAP) are those segments of the general population who experience higher TB burden but decreased access to services for the disease. The End TB Strategy recommends the need to cover all KAP with active TB case finding by the year 2020 (xx). In Ethiopia mineral miners are top on the long list of nationally identified TB KAP. Although Ethiopia adopts the global approach to address TB among the TB KAP, there is no nationally standardized guide on active search for TB among KAP in the country. By devising and implementing a series of steps this paper tries to show workable strategies for enhancing TB case finding among goldminers in the Oromia region of Ethiopia.  

Design and Methods: The setting for this study was selected traditional goldmining sites in Guji zone of Oromia. The study was conducted from August 03-16, 2021. Two approaches were used to identify presumptive TB among goldminers: 1) field-based search for presumptive TB at mining shafts 2) enhanced triaging among OPD attendants at 3 hospitals. Diagnosis of tuberculosis was made using the WHO approved molecular technique called GeneXpert RIF for TB.  

Results: The study covered 37 mining shafts in three selected woredas and enhanced central triaging done at three high client load hospitals. Total of 15,248 (14,952 (98%) aged > 15 years and 296 (2%) aged < 15) miners and their accessible families were screened for TB. 723 (5%) was screen positive for TB from which sputum samples were collected and evaluated at 4 GeneXpert sites. 45 (6.22%) persons are diagnosed with active TB of which 2 are cases of RR-TB. Additionally, from 202 sputum samples collected through enhanced triaging among 3,590 OPD attendants at three hospitals, 42 MTB and 1 RR-TB cases were detected and linked to treatment for TB. Altogether, from the total of 925 presumptive TB cases identified at 37 mining shafts and three hospitals, 88 (9.5%) active TB cases are detected and promptly initiated on TB treatment at nearby treatment centers. Moreover, 46 close contacts of 26 bacteriologically confirmed index TB cases were investigated from which 4 active TB cases were detected among and initiated on treatment.

Conclusion and Recommendation: The result of active search for TB among goldminers in Guji zone of Oromia has shown that goldminers are disproportionately affected by TB/MDR-TB. From the result of the study, we recommend that the procedures employed in the current initiative can be replicated in similar setups of project supported zones in Oromia region and beyond. Yet, initial consensus building, proper activity planning, clarification of roles and responsibilities to main actors and strong system commitment is crucial for the success of similar active TB case finding among goldminers.

 Keywords: Tuberculosis; Key Affected Populations (KAP); TB KAP; Goldminers; GeneXpert RIF

1. Saini V and Garg K. “Case finding strategies under National Tuberculosis Elimination Programme (NTEP)”. Indian Journal of Tuberculosis4S (2020): S101-S106.
2. Stuckler D., et al. “‘Dying for gold’: the effects of mineral mining on HIV, tuberculosis, silicosis and occupational diseases in southern Africa”. International Journal of Health Services 4 (2013): 639-649.
3. S Charalambous., et al. “Contribution of reinfection to recurrent tuberculosis in South African gold miners”. International Journal of Tuberculosis and Lung Disease 8 (2008): 942-948.
4. Stuckler D., et al. “Mining and risk of tuberculosis in sub-saharan Africa”. American Journal of Public Health3 (2011): 524-530.
5. J M teWaterNaude., et al. “Tuberculosis and silica exposure in South African gold miners”. Occupational and Environmental Medicine 3 (2006): 187-192.