Predictors of silicosis and variation in prevalence across mines among employed gold miners in South Africa.

BACKGROUND: The stated intention to eliminate silicosis from the South African goldmining industry as well as current programmes to find and compensate ex-miners with silicosis require an understanding of variation in silicosis prevalence across the industry. We aimed to identify the predictors of radiological silicosis in a large sample of working miners across gold mines in South Africa. METHODS: Routine surveillance chest radiographs were collected from 15 goldmine "clusters" in a baseline survey undertaken in preparation for a separate tuberculosis isoniazid prophylaxis trial. All images were read for silicosis by a health professional experienced in using the International Labour Organisation (ILO) classification. Profusion thresholds of > 1/0 and > 1/1 were used. Demographic and occupational information was obtained by questionnaire. Predictors of silicosis were examined in a multivariable logistic regression model, including age, gender, racial ascription, country of origin, years since starting mine employment, mine shaft, skill category, underground work status and tuberculosis. RESULTS: The crude silicosis prevalence at ILO > 1/1 was 3.8% [95% confidence interval (CI) 3.5-4.1%]. The range across mine shafts was 0.8-6.9%. After adjustment for covariates, the interquartile range across shafts was reduced from 2.4 to 1.2%. Black miners [adjusted odds ratio (aOR) 2.8; 95% CI 1.1-7.2] and miners in full-time underground work (aOR 2.1; 95% CI 1.3-3.4) had substantially elevated odds of silicosis, while workers from Mozambique had lower odds (aOR 0.54; 95% CI 0.38-0.77). Silicosis odds rose sharply with both age and years since starting in the industry (p for linear trend < 0.005), with 95.5% of affected miners having > 15 years since first exposure and 2.2% < 10 years. CONCLUSIONS: In surveillance of silicosis in working gold miners time since first exposure remains a powerful predictor. Age appears to be an independent predictor, while the detection of radiological silicosis in short-service miners requires attention. Public risk reporting by mines should include factors bearing on silicosis prevalence, specifically dust concentrations, with independent verification. Studies of silicosis and tuberculosis in ex-miners are needed, supported by an accessible electronic database of the relevant medical and dust exposure records of all gold miners.

The efficacy of ACTELLIC 50 EC, pirimiphos methyl, for indoor residual spraying in Ahafo, Ghana: area of high vector resistance to pyrethroids and organochlorines.

Insecticide resistance in the main malaria vectors in Africa is a major concern for malaria vector control program managers. The most common insecticides used for indoor residual spraying (IRS) and treating bed nets are becoming increasingly ineffective. The quest for safer and more effective insecticides for malaria vector control is urgent. This study sought to evaluate the efficacy of ACTELLIC 50 EC (pirimiphos methyl), an organophosphate, for IRS in Ghana, where there is high vector resistance to pyrethroids and organochlorines. Before the commencement of the study, standard World Health Organization (WHO) vector susceptibility tests against a common malaria vector, Anopheles gambiae s.l, were conducted using preparations of pyrethroids, organochlorines, carbamates, and organophosphates. The vector was found to be resistant to the pyrethroids, the organochlorines, and the carbamates, but susceptible to the organophosphates. The emulsifiable organophosphate concentrate formulation, ACTELLIC 50 EC, was then evaluated to determine the efficacy and the length of its residual effect. The wall bioassay test, using recommended cones from WHO, was conducted on sprayed surfaces with ACTELLIC 50 EC from 27 July 2009 to 16 October 2009. After 15 wk of trials on painted cement surface, it was found out that the main malaria vector, An. gambiae s.l, was susceptible to the insecticide even though the WHO Pesticide Evaluation recommends 2- to 3-mo duration of effective action. Therefore, it is recommended for use in IRS programs in this part of Ghana, where there is high vector resistance to most of the insecticides.