Nobody Left Behind: Reaching Mine Workers in Ethiopia with Tuberculosis Prevention and Treatment

 {Photo credit: Warren Zelman}Ethiopia is making progress in tackling tuberculosis, the leading infectious disease killer along with HIV.Photo credit: Warren Zelman

This week, MSH is joining researchers, advocates, civil society, scientists, healthcare professionals, and students working on all aspects of lung health around the world in Guadalajara, Mexico for the 48th Union World Conference on Lung Health, where tuberculosis is the key topic.

Tuberculosis (TB) is one of the top 10 causes of death worldwide, with over 95% of TB deaths occurring in low- and middle-income countries. Although tremendous progress has been made in the ongoing fight against this disease, some key segments of the population continue to shoulder the burden of TB more acutely.

In Ethiopia, one of the 30 high-burden TB, TB/HIV, and multi-drug resistant TB (MDR-TB) countries—per WHO’s 2016 Global TB Report—there are geographic hot spots and specific key population groups that are at particularly high risk of the disease: migrant workers in informal mining shafts in remote districts of Oromia Region and the mobile pastoralist population that often works in those mines.

Through the Help Ethiopia Address Low TB Performance (HEAL TB) project—USAID’s most notable TB activity in the country, implemented by Management Sciences for Health (MSH)—and USAID’s Challenge TB project, MSH and the National TB Program (NTP) took the initiative to determine the burden of TB in this mining community in order to tailor interventions.

What followed was an extensive and comprehensive set of interventions to decentralize TB care to the community level combined with strengthening the healthcare system. The project also recruited a cadre of volunteers and coordinators to provide health education for the workers at the mining shafts and screen the workers for TB, provide health education, and social mobilization. They referred presumptive cases to a nearby health center for TB evaluation and served as treatment supporters for those who started on TB medication. In addition, the coordinators carried out contact investigation for individuals who had come into close contact with the presumptive cases.

During the nine months of the intervention, more than 22 thousand miners received health education and sensitization on TB and TB/HIV; out of more than 42 thousand mining workers in the six districts where the project took place, a total of 11,842 (27.7%) miners were screened for TB symptoms. Overall, the TB prevalence was 1,756 per 100,000 screened mining workers. All of the diagnosed TB patients were tested for HIV. The identified presumptive TB and active TB cases as well as HIV positive miners could have been missed cases contributing to the ongoing transmission of both epidemics among the pastoralist community. Hence, the finding indicated that the tailored intervention is paramount to identifying a significant number of TB cases within the mining population.

The prevalence of 1,756 TB cases per 100,000 screened miners is seven times the WHO threshold for a health emergency, and is also nearly nine times the incidence rate in the general population of Ethiopia. These could have been missed TB cases in the mining community, and continued to fuel the transmission of TB to the general population. The evidence from this targeted implementation of active case finding strategies should be used to guide national program priorities to enhance case finding. A multi-sectoral approach is needed to address TB in such settings. The targeted intervention was critical in reaching and diagnosing the mining workers with TB cases and should be scaled up in other mining areas in Ethiopia. 

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