Determinants of health and health needs assessment of artisanal and small-scale gold miners in Kadoma, Zimbabwe: A mixed method approach.

ABSTRACT

BACKGROUND: The role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Small-scale miners are now responsible for over 50% of the Zimbabwean gold production. However, the sector is still characterised by high labour-intensity, low productivity and capital, limited mechanisation and outdated technologies. Since increasing efforts in recent years to improve miners' health while reducing the exposure to mercury have not been effective, a more sustainable approach is needed to identify interventions targeting the health of artisanal and small-scale miners and the mining communities. OBJECTIVE: The main objective of this study was the accurate and extensive empirical identification of the determinants of health in ASGM and of the miners' health needs. In tandem with these needs, topics which generate more effective, sustainable, and feasible future health interventions targeting occupational health should be identified. METHODS: Based on the identification of determinants of health, a health needs assessment (HNA) was used to conduct miners' needs by applying a mixed methods approach and triangulation. This included qualitative and quantitative interviews with individuals, group interviews, focus group discussions, observations and informal conversations. RESULTS: There were 85 structured and 84 semi-structured interviews, a focus group discussion, and observations conducted. Six main themes were identified around which miners' health needs can be aggregated as follows living conditions, nutrition and hygiene; safe work environment and mining processes; financial support; health care services; formalisation and education. DISCUSSION: The following aspects were considered most important for sustainable interventions: possible health impacts, feasibility, value for miners and their willingness to adapt. Accordingly, interventions aiming at increasing education, knowledge and awareness of miners were identified as most promising in improving occupational health.