Respirable silica and noise exposures among stone processing workers in northern Thailand.

Silica and noise are highly prevalent occupational exposures in the stone processing industry. Monitoring for silica and noise are expensive tasks that may be especially difficult to perform in low-resource settings, but exposure awareness is vital for protecting worker health. This study evaluated personal noise and silica measurements at a stone processing facility in northern Thailand to investigate the differing exposure potentials and risk for overexposure among the varying job categories. Our research team performed repeated personal noise and respirable silica measurements on 46 workers, over three separate workshifts for each of 46 workers. While 36.2% of noise measurements exceeded the recommended exposure limit of 85 dBA, only three silica measurements (2.4%) were above the threshold limit value (TLV) of 25 µg/m3. Self-reported personal protective equipment use was low, with only 27.5% of participants wearing hearing protection in noisy environments during their monitored shift and 29.7% of workers wearing respiratory protection during dusty portions of their shift. We identified a significant positive correlation between measured noise and silica levels (r = 0.54, p < 0.01), with stone loaders having the highest average noise (mean = 89 dBA, standard deviation = 4.9 dBA) and silica (geometric mean = 6.4 µg/m3, geometric standard deviation = 1.8) exposure levels. In a multivariate model, the stone loader job category was a significant predictor of exposure to detectable levels of respirable silica (p < 0.01). These results provide useful guidance regarding the need for noise and silica exposure interventions in order to reduce incidences of workplace disease in the stone processing industry.

Pulmonary function and respiratory health of rural farmers and artisanal and small scale gold miners in Ghana.

The recent increase in artisanal and small scale gold mining (ASGM) worldwide has elicited a number of public health concerns for miners and mining communities, including respiratory health. The two primary inhalational exposures of concern are crystalline silica expected to be present in gold ore and smoke from biomass fuels used in cooking. Here, measurements of pulmonary function and of respiratory symptoms were performed in an ASGM community, Kejetia, and a comparison agricultural community, Gorogo, in the Upper East Region of Ghana in May-July 2011. Of 172 participants, 159 performed spirometry, yielding 119 and 95 valid measurements for FEV1 and FVC, respectively. Percent predicted FEV1, FVC and FEV1/FVC, which were lower than predicted for a healthy population, were not significantly different between Kejetia and Gorogo or by mining status in Kejetia. Abnormal lung function was elevated for predicted FEV1 (15.0%) and FEV1/FVC (22.0%) beyond an expected five percent in healthy populations. This first examination of pulmonary function in an ASGM community in Ghana (and possibly worldwide) did not show an obvious relationship between mining involvement and lung function abnormality, but did show associations between the use of biomass fuels, adverse respiratory symptoms, and reduced pulmonary function in both populations. A number of factors including age differences between the populations and the required lag time after silica exposure for the onset of respiratory disease may have affected results. Additional research is needed with larger sample sizes and with more detailed questionnaires to further assess the impact of multiple stressors on respiratory health in ASGM communities.

Injury Risk and Noise Exposure in Firefighter Training Operations.

INTRODUCTION: Firefighters have high rate of injuries and illnesses, as well as exposures to high levels of noise. This study explored the relationship between noise exposure and injury among firefighters. METHODS: We recruited firefighters undergoing vehicle extrication and structural collapse emergency response training at a highly realistic training facility. Demographics, health status, body mass index (BMI), and history of serious injuries (i.e. injuries requiring first aid treatment, treatment in a medical clinic or office, or treatment at a hospital) were assessed at baseline, and daily activities, injury events, and near misses were assessed daily via surveys. Participants' noise exposures were monitored for one 24-h period using noise dosimeters. We used a mixed-effects logistic regression model to estimate the odds of injury events and near misses associated with noise exposure as an independent variable. RESULTS: Of 56 subjects, 20 (36%) reported that they had ever suffered a serious injury during firefighting activities, and 9 (16%) reported a serious injury within the past year. We estimated rates of 6.6 lifetime serious injuries per 100 FTE 16.1 serious injuries per 100 FTE within the past year. Our models indicated a significant increase in injury events and near misses among those with higher BMI, and as well as a dose-response relationship between near misses/injuries and increasing noise levels. Noise levels >90 dBA in the 30 min prior to time of injury or near miss were associated with substantially increased odds ratios for injury or near miss. Our models further indicated that perceived job demands were significantly associated with increased risk of injury or near miss. CONCLUSION: Our results suggest that noise exposures may need to be incorporated into injury prevention programs for firefighters to reduce injuries among this high-risk occupational group.

Understanding the Social Context of the ASGM Sector in Ghana: A Qualitative Description of the Demographic, Health, and Nutritional Characteristics of a Small-Scale Gold Mining Community in Ghana.

This descriptive paper describes factors related to demographics and health in an artisanal and small-scale gold mining (ASGM) community in Ghana's Upper East Region. Participants (n = 114) were surveyed in 2010 and 2011, adapting questions from the established national Demographic Health Survey (DHS) on factors such as population characteristics, infrastructure, amenities, education, employment, maternal and child health, and diet. In the study community, some indicators of household wealth (e.g., radios, mobile phones, refrigerators) are more common than elsewhere in Ghana, yet basic infrastructure (e.g., cement flooring, sanitation systems) and access to safe water supplies are lacking. Risk factors for poor respiratory health, such as cooking with biomass fuel smoke and smoking tobacco, are common. Certain metrics of maternal and child health are comparable to other areas of Ghana (e.g., frequency of antenatal care), whereas others (e.g., antenatal care from a skilled provider) show deficiencies. Residents surveyed do not appear to lack key micronutrients, but report lower fruit and vegetable consumption than other rural areas. The results enable a better understanding of community demographics, health, and nutrition, and underscore the need for better demographic and health surveillance and data collection across ASGM communities to inform effective policies and programs for improving miner and community health.

An Integrated Assessment Approach to Address Artisanal and Small-Scale Gold Mining in Ghana.

Artisanal and small-scale gold mining (ASGM) is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics) were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally.

Mercury Exposure Assessment and Spatial Distribution in A Ghanaian Small-Scale Gold Mining Community.

Mercury is utilized worldwide in artisanal and small-scale gold mining (ASGM) and may pose a risk for miners and mining communities. While a number of studies have characterized mercury in ASGM communities, most have focused on a single media and few have taken a holistic approach. Here, a multiple media exposure assessment and cross-sectional study of mercury was conducted in 2010 through 2012 in northeast Ghana with a small-scale gold mining community, Kejetia, a subsistence farming community, Gorogo, and an urban ASGM gold refinery in Bolgatanga. The objective was to assess mercury in a range of human (urine and hair) and ecological (household soil, sediment, fish, and ore) samples to increase understanding of mercury exposure pathways. All participants were interviewed on demographics, occupational and medical histories, and household characteristics. Participants included 90 women of childbearing age and 97 adults from Kejetia and 75 adults from Gorogo. Median total specific gravity-adjusted urinary, hair, and household soil mercury were significantly higher in Kejetia miners (5.18 µg/L, 0.967 µg/g, and 3.77 µg/g, respectively) than Kejetia non-miners (1.18 µg/L, 0.419 µg/g, and 2.00 µg/g, respectively) and Gorogo participants (0.154 µg/L, 0.181 µg/g, and 0.039 µg/g) in 2011. Sediment, fish, and ore Hg concentrations were below guideline values. Median soil mercury from the Bolgatanga refinery was very high (54.6 µg/g). Estimated mean mercury ingestion for Kejetia adults from soil and dust exceeded the U.S. Environmental Protection Agency reference dose (0.3 µg Hg/kg·day) for pica (0.409 µg Hg/kg·day) and geophagy (20.5 µg Hg/kg·day) scenarios. Most participants with elevated urinary and household soil mercury were miners, but some non-miners approached and exceeded guideline values, suggesting a health risk for non-mining residents living within these communities.

Injury Risk Factors in a Small-Scale Gold Mining Community in Ghana's Upper East Region.

Occupational injury is one of many health concerns related to small-scale gold mining (ASGM), but few data exist on the subject, especially in sub-Saharan Africa. In 2011 and 2013, we examined accidents, injuries, and potential risk factors in a Ghanaian ASGM community. In 2011, 173 participants were surveyed on occupational history and health, and 22 of these were surveyed again in 2013. Injury rates were estimated at 45.5 and 38.5 injuries per 100 person-years in 2011 and in 2013, respectively; these rates far surpass those of industrialized mines in the U.S. and South Africa. Demographic and job characteristics generally were not predictive of injury risk, though there was a significant positive association with injury risk for males and smokers. Legs and knees were the most common body parts injured, and falling was the most common cause of injury. The most common type of injuries were cuts or lacerations, burns and scalds, and contusions and abrasions. Only two miners had ever received any occupational safety training, and PPE use was low. Our results suggest that injuries should be a priority area for occupational health research in ASGM.

Integrated assessment of artisanal and small-scale gold mining in Ghana--part 1: human health review.

This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors' recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.