By Sara Duddy, Public Relations Manager, International SOS

WORLD Tuberculosis Day was on 24 March and provided an opportunity to review the burden of tuberculosis (TB) worldwide as well as the status of TB prevention and control efforts.

Progress towards global targets for reduction in TB cases and deaths has been impressive. The TB mortality rate has fallen more than 40 per cent worldwide since 1990, and incidence rates are declining.

However, the incidence of TB has actually risen in Papua New Guinea, from 308 per 100,000 population in 1990, to 348 per 100,000 population in 2012. It is a leading cause of death in the country.

In high incidence settings such as PNG, TB within the workforce demands attention. One case of active TB can spread the infection to many others. Because of the effect of TB on health and productivity, the mining industry has a vested interest in preventing its spread and ensuring effective treatment of workers.

TB is an infectious bacterial disease caused by Mycobacterium Tuberculosis. It spreads through the air when an infected person coughs, most commonly affecting the lungs.

The PNG mining sector supports the identification and reduction of TB in the country through screening of employees and contractors, those “inside the fence”. The International Council on Mining & Metals, in its publication Good Practice Guidance on HIV/AIDS, TB and Malaria advises “for mining companies in medium- to high-risk areas, active TB programs are typically justified and should be supported.”

Screening “outside the fence” of people who live and work with employees may further reduce the risk of transmission of TB, not only within the community but among expatriate staff.

“The PNG mining sector has been extremely active in screening for TB in direct employees however where TB programs do not include household members and staff, there are significant gaps,” International SOS PNG general manager Bruce Clark said.

“All the good work a company has done in terms of screening processes can be undone very quickly.”

Including these populations in an organisation’s TB program will reduce the risks.

Screening programs use different methods to identify people who have TB. Passive screening refers to encouraging people to present themselves if they suspect symptoms of TB, such as fever, persistent cough, night sweats and weight loss. Active screening refers regular examination including tests looking for TB. The International Council of Mining and Minerals advises that the “gold standard” TB program includes active screening of employees.

The purpose of identifying workers who have evidence of a TB infection is to reduce the duration of infectiousness, prevent further spread and allow effective treatment to achieve cure and reduce the risk of complications. If a case of active TB is identified, public health measures to identify at risk contacts, and provide testing and treatment is appropriate.

Newcrest Mining’s Lihir Medical Centre (LMC) run by International SOS is currently implementing such a control strategy aimed at active screening and effective management of TB cases to reduce transmission of the disease in the work-force.

The PNG Health Department supports the facility by supplying fixed-drug combination kits which have the advantage of reducing the quantity of pills patients are required to take and the kits are quality assured.

In most cases, patients with active disease can be treated successfully, but it is important that patients with TB comply with their treatment. Directly observed therapy (DOTS) has been shown to be effective in treatment of TB and also diminishes the risk of emergence of drug-resistant TB.

“The Lihir medical centre started its TB control program in 2008 and received accreditation in May 2011 for DOTS from the health department. From 2008 to 2013, the medical centre has diagnosed and successfully treated more than 400 cases of Tuberculosis,” said LMC public health director Dr Oriol Mitjà.
The next steps for the TB program on Lihir are active case detection within the Lihir village communities to reduce the prevalence of tuberculosis there.

“Newcrest has been actively involved in the TB control program through increasing awareness of TB through education programs, enhancing laboratory facilities and improving early case diagnosis. Lihir Gold also funds the positions of two TB control officers,” Dr Mitjà said.

By implementing programs that address TB inside and outside the fence, mining companies operating in PNG are not only improving the health status of local community in which they operate, they can also yield health and productivity results within their own workforces.