Blantyre district, home to more than 1,337,500 people, features nine mining establishments, encompassing both artisanal and small-scale as well as large-scale operations.
Primarily engaged in quarry and lime mining, these facilities have regrettably served as vulnerable points for the spread of tuberculosis (TB) among workers and neighboring communities, largely because health and safety precautions were infrequently or never observed.
Malawi’s 2015–2020 National Strategic Plan (NSP) for TB prioritized several crucial interventions such as annual routine TB screening for miners and the provision of training to health workers employed in mining companies, to ensure their active involvement in TB screening and management.
It is against such a solid foundation that the 2021-25 NSP for TB aims to achieve, among its goals, a reduction of 50 percent in the incidence of TB and a reduction of 75 percent in mortality rates by the conclusion of the plan, as compared to the rates recorded in 2015.
The Blantyre District Health Office (DHO) has made every effort to ensure it attains these objectives.
Mary Ngulama, Blantyre District TB Officer (DTO), explains that with support from the Southern Africa Tuberculosis and Health Systems Support (SATBHSS) and the World Bank, Blantyre DHO has been conducting regular inspections in various working places to ensure that workers are not exposed to dust.
Apart from inspections, Ministry of Health personnel, with the assistance of volunteers, also conduct periodic testing of mine workers as well as people in surrounding communities.
Blantyre DHO has 45 health facilities, out of which 40 are TB centres. Among these 40 centres, 27 serve as sputum collection points, which are operated by about 300 volunteers, according Ngulama.
“This has helped a lot in case finding in mines as well as increased adherence to health safety measures within the facilities. Over the past period, we have seen TB cases declining due to a good relationship between management and health workers in as far as safety is concerned,” Ngulama says.
In 2022, Blantyre DHO registered 22 cases from the mines; it registered none from January to September 2023.
“The decrease is attributed to the good relationship between us and the companies’ management. They have opened up to us, especially health surveillance assistants (HSAs) and volunteers who go and inspect their facilities. This is unlike in 2015 when we started engaging them when it was like a cat-and-mouse chase,” she states.
In the neighboring district of Chiradzulu, their success is significant as they have not recorded an incidence of TB cases in mines over the past two years, according to DTO Patrick Chikuni.
With a population of over 390,000 people, the district has four mines — one formal and three informal. It has 15 health facilities, out of which 13 are TB registration sites and 11 are microscopic sites. The district has 440 volunteers who are manning 44 sputum collecting sites.
Chikuni explains that each TB registration site has two HSAs, a clinician and a nurse.
“Some of these centers are close to mining sites, which makes it easier for health personnel and volunteers to reach out to the workers. And the relationship we have had has helped a lot,” he said.
One of the largest mining companies in the district is Terrastone Malawi. Located at Njuli, with 28 full time employees, the company produces 800 tonnes of quarry per day depending on demand, according to Quarry Manager Chiraa Kotadia.
The company has been working hand-in-hand with Chiradzulu DHO, the Ministry of Labour and mine officials on health safety measures for its employees.
“Since we started working hand-in-hand with these officials, we have always followed standard operations procedures like conducting TB screening twice a year for our employees. We have a safety office whose mandate is to make sure that all measures are being followed within the company. The officer in charge of the office underwent training related to occupational safety and health and first aid.
“Above all, we regularly conduct refresher meetings for our employees as one way of reminding them of putting on personal protection equipment [PPE] during work,” said Kotadia.
The company, he adds, has never registered a TB case in the past four years.
Despite this progress, Chikuni notes that there are still many obstacles to overcome, including some employees’ reluctance to use PPEs even though their employers provide it, the inefficiency of some dust control methods, carelessness brought on by outdated mine safety laws, and neglect of hard-to-reach areas for small-scale miners.
