Tuberculosis (TB) is among diseases of global health importance with Sub Saharan Africa (SSA) accounting for 25% of the global TB burden. TB prevalence among miners in SSA is estimated at 3,000–7,000/100,000, which is about 3 to 10-times higher than in the general population. The study’s objective was to determine the prevalence of TB and associated risk factors among mining communities in Mererani, northern Tanzania. This was a cross-sectional study conducted from April 2019 to November 2021 involving current Small Scale Miners (SSM) and the General Community (GC). A total of 660 participants, 330 SSM and 330 GC were evaluated for the presence of TB. Data were analysed using Statistical Package for the Social Sciences (SPSS) database (IBM SPSS Statistics Version 27.0.0.0). Binary logistic regression (Generalized Linear Mixed Model) was used to determine the association between TB and independent predictors. Prevalence of TB was 7%, about 24-times higher than the national prevalence of 0.295%. Participants from the general community had higher prevalence of TB 7.9% than SSM (6.1%). Both for SSM and the GC, TB was found to be associated with: lower education level (aOR = 3.62, 95%CI = 1.16–11.28), previous lung disease (aOR = 4.30, 95%CI = 1.48–12.53) and having symptoms of TB (aOR = 3.24, 95%CI = 1.38–7.64). Specifically for the SSM, TB was found to be associated with Human Immunodeficiency Virus (HIV) infection (aOR = 8.28, 95%CI = 1.21–56.66). Though significant progress has been attained in the control of the TB epidemic in Tanzania, still hot spots with significantly high burden of TB exists, including miners. More importantly, populations surrounding the mining areas, are equally affected, and needs more engagement in the control of TB so as to realize the Global End TB targets of 2035.

Abstract. In tuberculosis (TB)-prevalent settings, patients admitted for retreatment of TB may account for a high burden of poor treatment outcome. We performed a retrospective cohort study to characterize retreatment patients and outcomes at a TB referral hospital in northern Tanzania. From 2009 to 2013, 185 patients began a retreatment regimen, the majority for relapse after prior treatment completion. Men accounted for an unexpected majority (88%), 36 (20%) were human immunodeficiency virus (HIV) infected and for 45 (24%) mining was their primary occupation. A poor outcome (death, default, or persistent smear positivity after 7 months of treatment) was found in 37 (23%). HIV infection was the only significant predictor of poor outcome (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI] = 1.07-5.83, P = 0.034). Interventions to minimize need for retreatment or improve retreatment success may be regionally specific. In our setting, community-based diagnosis and management among at-risk subpopulations such as miners and those HIV infected appear of highest yield.In Tanzania, like many tuberculosis (TB) endemic countries, patients categorized as undergoing retreatment for TB account for proportionally the highest rates of death, treatment failure, and default among all TB patients excluding those with known drug resistance.1 The national estimate for treatment success rate in human immunodeficiency virus (HIV)-negative patients without prior treatment was 90%, but was 80% in patients with a history of TB treatment.1 Patients undergoing retreatment are often prescribed the World Health Organization (WHO) Category II regimen of extended total duration, which contains the daily intramuscular injection of streptomycin, a medication with considerable cumulative side effects including ototoxicity and vestibular toxicity that may further compromise treatment completion. Kibong'oto Infectious Diseases Hospital (KIDH) is a regional referral hospital for retreatment TB cases, and the national referral hospital for multidrug-resistant (MDR) TB. The Mererani region includes numerous small-scale mining operations, principally involved in the mining of the precious gemstone tanzanite. The mines are run with low-level mechanization, use roughly 8,000 transient workers, and are situated in a community of approximately 200,000 people with interdependence on the mining industry.3 The mining occupation in other TB-endemic settings has been associated with high rates of HIV coinfection, comorbid lung disease such as silicosis and risk of TB reinfection.4 Perception suggests that miners account for a considerable number of patients admitted to KIDH for retreatment and may account for a greater proportion of those with poor retreatment outcome.We therefore sought to perform a retrospective cohort study of all patients admitted to KIDH for a retreatment regimen over the past 5 years to define the local burden of retreatment, clinical characteristics among retreatment patients, and predictors of retreatment outcome.The hospi...

Tuberculosis (TB) and malnutrition co-exist. Malnutrition predisposes to development of TB, and may further predict treatment outcomes. Given the paucity of data regarding malnutrition in specific populations with multidrugresistant (MDR)-TB, we aimed to determine the pre-treatment and post-treatment change in nutrition status, as measured by body mass index (BMI), in patients from Tanzania initiating MDR-TB treatment, as well as potentially modifiable determinants of BMI in this population at high-risk for treatment failure.Design: A retrospective cohort was followed consisting of patients admitted for MDRTB treatment at Kibong'oto National MDR-TB Center of Excellence, the national referral hospital for all cases in Tanzania.Results: Of 104 MDR-TB cases admitted from November 2013 through June 2014, 96 (92%) cases were assessed for nutrition status. Fifty-one (53%) were malnourished, of which 15 (30%), 15 (30%) and 21 (45%) were classified as mild (BMI <18.5 -17), moderate (BMI <17 ≥ 16) and severe (BMI <16) respectively. Gender, HIV status, and pre-treatment CD4 count among those HIV infected did not influence pre-treatment nutrition status. Thirty-seven (39%) of MDR-TB patients improved grades (e.g. from severe to moderate malnutrition) and gained a mean BMI of 2 kg/m 2 (95% CI: 1-3), yet 9 (9%) deteriorated grades and thus developed acute adult malnutrition during treatment. In those that developed acute malnutrition during treatment, the mean lost BMI was 3 kg/m 2 (95% CI; 0.3-8). Categorical change in BMI grade trended toward association with the duration of inpatient admission (p=0.05). Conclusion:Malnutrition is a common comorbidity in MDR-TB patients receiving treatment in Tanzania. Importantly, some MDR-TB patients while on treatment developed acute malnutrition. Given the lack of predictors of developing malnutrition, these findings suggest the need for frequent assessment of nutrition status during the course of MDR-TB treatment, to identify patients that may require additional therapeutic supplements.

Background An estimated 44 million artisanal and small-scale miners (ASM), largely based in developing economies, face significant occupational risks for respiratory diseases. We aimed to review studies that describe silicosis and tuberculosis prevalence and respirable crystalline silica (RCS) exposures among ASM and use background evidence to attempt to understand the relationship between exposures and disease outcomes. Methods We searched PubMed, Web of Science, Scopus and Embase for studies published before the 24th March 2023. A systematic review and narrative synthesis was performed and risk of bias assessed. Logistic and Poisson regression models with predefined parameters were used to estimate silicosis prevalence and tuberculosis incidence at different distributions of cumulative silica exposure. Results We identified 18 eligible studies of 13 distinct populations in 10 countries. Silicosis prevalence ranged from 11 to 37%, despite four of five studies reporting an average median duration of mining of <6 years. Tuberculosis prevalence was high; microbiologically confirmed disease ranged from 1.8 to 12% and clinical disease 3.0 to 17%. Average RCS intensity was very high (range 0.19-89.5 mg/m3) and respiratory symptoms were common. Our modelling demonstrated decreases in RCS result in reductions in silicosis and tuberculosis, with greater effects at higher mean exposures. Discussion Prevalence of silicosis and tuberculosis were high in the studies identified in this review. Our modelling demonstrated the greatest respiratory health benefits of reducing RCS are in those with highest exposures. ASM face a high occupational respiratory disease burden which can be reduced by low-cost and effective reductions in RCS.