TB in mines: there’s progress but certain sectors still carry greater TB risk  

By: Aphelele Buqwana

In 2024, South Africa’s mining sector was commended for making inroads to address TB, beating a 10-year target, cutting its incidence rate nearly three-fold.  

But despite these significant reductions, research looking at trends in the mining sector shows that certain mining sectors are still more of a problem than others.  

The paper, published by a team of researchers from national institute of occupational health along with minerals council in SA, the National Department of Health and the university of British Columbia in Canada, analysed trends in the sector over seven years between 2015 and 2022 and found that while overall TB incidence has declined since 2015, gold mines – in particular – continued to carry the heaviest burden.  

Here TB notification rates are two to three times higher than in the general population. 

According to the Minerals Council South Africa the incident rate dropped from 1 060 per 100 000 employees in 2015 to 278 per 100 000 employees in 2022. This was– well below the 537 per 100 000 national rate. 

The researchers identified three key trends:  

* sector wide health initiatives and workplace health checks  

* contact tracing  

* improved  co-ordination between mining company and public health authorities 

And it calls for increased multi-stakeholder initiatives to help the industry carry out its responsibility to care for the health of workers. 

Sector wide health initiatives and workplace health checks 

According to the paper, over the past decade, the mining industry has expanded TB control efforts through large-scale initiatives such as the Masoyise Health Programme (MHP) and its predecessor, Masoyise iTB. The project was launched in 2015 to reduce the impact of TB and was later expanded in 2019 into the MHP, which is an initiative led by the Minerals Council South Africa aimed at improving mineworkers’ health, addressing TB, HIV, occupational lung diseases, other chronic illnesses and mental health. 

The researchers notes that these programmes have brought together mining companies, trade unions, government and other stakeholders to expand routine TB screening, strengthen HIV counselling and testing and provide follow-up care.  

Regular workplace health checks and company-clinic partnerships have also helped detect TB earlier, link miners to treatment and support smaller mines that previously lacked the capacity to manage TB effectively. However, not all mining operations apply screening and follow-up consistently, and the mobility of workers between mines and rural communities often disrupts treatment adherence.  

Contact tracing 

As an airborne disease, TB is and easily transmitted and this means that miners often pass infections onto their families and communities. As a result contact tracing has therefore become a critical part of TB management.  

Under the Masoyise programmes, TB contact tracing extends to employees’ households and close contacts, helping to detect cases early and prevent wider outbreaks. This approach shows an understanding that TB in mining is not just an occupational disease but a public health issue with ripple effects across provinces and national borders. 

Improved coordination 

Coordination between mining companies and public health authorities has also improved in recent years though challenges remain. According to Prof. Zungu and colleagues, annual TB screening and HIV counselling are provided to all mineworkers and contractors, treatment outcomes are monitored across operations, and data is shared with structures such as the Mine Health and Safety Inspectorate (MHSI) and the Medical Bureau for Occupational Diseases (MBOD). This framework aligns mining companies with national TB priorities while extending occupational health services to ex-miners and vulnerable communities. Importantly, the MHP has broadened its scope beyond TB and HIV to include non-communicable diseases such as diabetes and hypertension, as well as occupational lung diseases like pneumoconiosis. 

While TB rates in mining are declining faster than in the general population, the sector’s distinct risks mean mineworkers remain at the epicentre of South Africa’s TB epidemic. 

The sector’s vulnerability is driven by structural and longstanding factors. Years of exposure to silica dust has left many miners with silicosis, a lung disease that dramatically increases the risk of developing TB. High rates of HIV further weaken miners’ immune systems, while overcrowded hostels, poor ventilation underground and the constant movement of workers between mines and rural homes continue to fuel the transmission of the disease. Many older miners also bear long-term lung damage from years spent underground. 

A way forward 

The paper notes that sustaining progress will require consistent screening, stronger treatment support for mobile workers and continued collaboration between industry and public health authorities. Without these efforts, the progress of the past decade risks failing, leaving both miners and their families vulnerable to a disease that remains a persistent challenge in the country’s mines.