In Rwamagasa, along with the high proportion of people earning their livelihood from mining, the low literacy levels of the random sample of individuals who participated in this study suggest that risk reduction through education, training, behavioral modifications, land use decisions, and health care delivery could be challenging. However, a lesson on improving the livelihood of artisanal miners can be taken from Sadiola in western Mali, where a successful diversification of artisanal miners was achieved in 1997 by introducing alternative means for securing livelihood . Fundamentally, the environmental health of the community must be addressed without jeopardizing the rights of individuals to secure a livelihood.
Even with the increase in artisanal mining activities in Tanzania, community-based and/or occupational health education programs that focus on the health hazards of Hg and/or As exposure are severely lacking. In Tanzania, the amount of money and effort spent on the risks education of miners is considerably lower than that spent on enforcement and monitoring [27, 28]. In Rwamagasa for instance, there was only one poster advocating the use of cleaner technology located at the ward executive’s office. This likely had little effect because of the low level of literacy of the individuals who visit the office. Health promotion campaigns on the recognition of the symptoms and signs of Hg and As poisoning should be established in rural communities with artisanal mining, including Rwamagasa. Further, local health facilities should be equipped and health workers trained to conduct heavy metal testing .
Even with knowledge and awareness, there is often no relationship between how one acts and the decisions one makes concerning avoidance, control or protection against exposure [22, 28]. So, while the findings of this study indicated that the majority of the miners had some basic knowledge about Hg toxicity and associated morbidities, it has been reported that artisanal miners continued to use Hg with their bare hands and to burn the amalgam in open air [24, 27]. The necessity of generating a livelihood often outweighs the potential negative health outcomes.
Women and children carry a particular burden with regard to toxic exposures. Even though women are usually the primary caregivers to children, they are less likely to know about the health effects associated with Hg exposure compared to men and so are disadvantaged in making decisions about exposure reduction. Additionally, at every mining location visited by the researchers, women miners were observed with their infants and young children. Children were also often directly involved in working directly in the mining activities. Thus, not only is the mother directly exposed to Hg, but so are her children.
Among the respondents, almost half reported knowing about abnormalities, including birth defects and skin discoloration, among infants in the study area. Although not all birth defects are caused by toxic chemicals, birth defects are more common in areas where industries, such as artisanal gold mining use or produce toxic chemicals or wastes such as Hg . Further research is needed that examines the relationships among Hg and As exposure and congenital anomalies in this population.
Some signs of Hg poisoning are easy to confuse with malaria [17, 30, 31], which has implications for awareness and subsequent prevention and treatment. The following symptoms are associated with both malaria and Hg poisoning: peripheral neuropathy, itching, hypotonia (muscle weakness), tachycardia, nausea and sometimes vomiting, visual problems, profuse sweating, headache, respiratory tract infections, fever, rigors, tiredness, myalgia (limbs and back), abdominal pain, loss of appetite, hypertension (especially for Hg poisoning) and postural hypotension (especially in malaria), enlarged liver and spleen, coma and eventually death [17, 31]. Malaria is a common chronic health problem in this region , and so people generally have a relatively high degree of awareness and familiarity with it. In addition to the questions about Hg, respondents were also asked about malaria symptoms; perhaps not surprisingly, most participants were able to correctly identify at least one symptom of malaria, but were not able to do the same for Hg poisoning. There is a need for further investigation on the co-morbidities of chronic Hg exposure with malaria in artisanal mining areas.
Partnership is absolutely essential in addressing the elements of environmental health and in reducing the health risks due to artisanal mining, as noted in the Ottawa Charter for Health Promotions . Governments, donors, NGOs and other stakeholders should emphasize the necessity of recognizing the importance of artisanal mining and focus on creating supportive environments for building social-economic capital, including legal, financial, technical, cultural, and political issues . This could provide individuals and groups with access to resources and support that reduce the health risks to those involved in artisanal mining and the surrounding communities, as well as reducing the impact of artisanal mining on the environment.