Removal of barriers to the introduction of cleaner artisanal gold mining and extraction technologie in Kadoma, Zimbabwe Part B: Health Assessment Final Report Removal of barriers to the introduction of cleaner artisanal gold mining and extraction technologie in Kadoma, Zimbabwe Part B: Health Assessment Final Report Stephan Boese-O´Reilly, Felicitas Dahlmann, Beate Lettmeier, Gustav Drasch Institute of Forensic Medicine, Ludwig-Maximilians University, Munich, November 11th, 2004 UNIDO Project EG/GLO/01/G34 No.03/089 BRGM Project Nr 822657-3 Keywords : Mercury, Amalgamation, Gold, Environmental Assessment, Health Assessment, Artisanal mining, Cleaner Technology, Fish, Muscle, Chakari, Kadoma, Zimbabwe. In bibliography, this report should be cited as follows : Boese-O’Reilly S., Dahlmann F., Lettmeier B., Drasch G. (2004) – Removal of barriers to the introduction of cleaner artisanal gold mining and extraction technologie in Kadoma, Zimbabwe. Final report, 130 p., 28 Figures, 25 Pictures, 22 Tables, 3 Appendix. © BRGM, 2005. No part of this document may be reproduced without the prior permission of BRGM. Health Assessment Kadoma, Zimbabwe Contents 1. Executive summary..............................................................................................9 2. Study setting and clinical examinations (Stephan Boese-O´Reilly, Beate Lettmeier, Felicitas Dahlmann)..................................................................................13 2.1.INTRODUCTION...............................................................................................13 2.2.MERCURY.........................................................................................................14 2.3.ZIMBABWE - KADOMA SMALL SCALE MINING AREA...................................14 2.4.PROJECT DESIGN...........................................................................................22 2.4.1.Questionnaire.........................................................................................25 2.4.2.Neurological examination.......................................................................25 2.4.3.Neuro-psychological testing...................................................................27 2.4.4.Tremor-meter.........................................................................................28 2.4.5.Laboratory field project...........................................................................29 2.4.6.Test for protein in urine..........................................................................31 2.5.GENERAL HEALTH PROBLEMS IN KADOMA DISTRICT...............................31 2.5.1.Health care system in Kadoma district...................................................31 2.5.2.General health data................................................................................32 2.6.GENERAL HEALTH PROBLEMS IN KADOMA DISTRICT...............................36 2.6.1.Children’s health in Kadoma district.......................................................37 2.7.PRELIMINARY CLINICAL RESULTS OF THE HEALTH ASSESSMENT.........38 2.7.1.Clinical and neurological examination....................................................38 2.7.2.Children’s health in Kadoma mining area...............................................40 2.7.3.Hygienic problems..................................................................................41 2.7.4.Social problems......................................................................................41 2.7.5.General problems during the field project..............................................42 2.7.6.Participation...........................................................................................42 Final Report 3 Health Assessment Kadoma, Zimbabwe 3. Specimen analysis and statistical results (Gustav Drasch, Beate Lettmeier) ......................................................................43 3.1.LABORATORY METHODS...............................................................................43 3.1.1.Material and sample storage.................................................................43 3.1.2.Sample preparation...............................................................................43 3.1.3.Mercury determination and quality control.............................................43 3.2.STATISTICAL ANALYSIS.................................................................................44 3.2.1.Statistical methods.................................................................................44 3.2.2.Description of mercury levels in urine, blood and hair...........................44 3.2.3.Exclusion of data...................................................................................46 3.2.4.Forming subgroups due to residence and occupation...........................46 3.2.5.Mercury Levels compared to Toxicological Threshold Limits................51 3.2.6.Reducing of redundant data for statistical analysis...............................53 3.2.7.Scoring of medical results......................................................................56 3.2.8.Statistical analysis of mercury levels versus clinical data......................59 3.3.DISCUSSION OF THE STATISTICAL ANALYSIS............................................61 3.4.DECISION FOR THE DIAGNOSIS OF A CHRONIC MERCURY INTOXICATION.................................................................................................61 3.5.PREVALENCE OF THE DIAGNOSIS “MERCURY INTOXICATION”...............62 3.6.COMPARISON OF VOLUNTEERS FROM DIFFERENT MINES.....................64 3.7.INFLUENCE ON NURSED BABIES.................................................................69 3.8.SCREENING OF MERCURY URINE CONCENTRATION IN FIELD................71 4. Summary and Recommendations (Gustav Drasch, Stephan Boese-O´Reilly) .73 4.1.SUMMARY........................................................................................................73 4.2.CONCLUSIONS AND RECOMMENDATIONS.................................................75 4.2.1.How to improve “general health”?..........................................................75 4 Final Report Health Assessment Kadoma, Zimbabwe 4.2.2.How to reduce “mercury as a health hazard”?.......................................75 4.2.3.How to improve the “knowledge on mercury as a health hazard”..........76 4.2.4.How to reduce the “release of mercury into the environment”...............76 4.3.LITERATURE.....................................................................................................77 5. Acknowledgement..........................................................................................................81 List of figures Figure 1 - UNIDO project countries............................................................................................13 Figure 2 - Map of Zimbabwe – Victoria Falls.............................................................................14 Figure 3 - Local map of Kadoma area (provided by BRGM).....................................................15 Figure 4 - Age distribution of all volunteers, selected for the statistical evaluation...................47 Figure 5 - Total mercury concentration in blood samples..........................................................48 Figure 6 - Total mercury concentration in urine samples...........................................................48 Figure 7 - Total mercury concentration in hair samples.............................................................49 Figure 8 - Percentage of inorganic mercury in hair samples.....................................................50 Figure 9 - Percentage of organic bound mercury in hair samples.............................................50 Figure 10 -Frequency of the anamnestic parameter “metallic taste”..........................................54 Figure 11 -Children; frequency of the anamnestic parameter “excessive salivation”.................54 Figure 12 -Adults; frequency of the anamnestic parameter “bluish coloration of gingiva”......................................................................................................................55 Figure 13 -Adults; frequency of the anamnestic parameter “ataxia of gait”................................55 Figure 14 -Frequency of the anamnestic parameter “dysdiadochokinesia”................................56 Figure 15 -Hg-concentration in blood; comparison of the heavy drinkers with the non heavy drinkers among the group of amalgam-burners..............................................57 Figure 16 -Hg-concentration in urine; comparison of the heavy drinkers with the non heavy drinkers among the group of amalgam-burners..............................................58 Figure 17 -Medical score sum of the different subgroups...........................................................59 Figure 18 -Frequency of the diagnosis “mercury intoxication”....................................................63 Figure 19 -Distribution of age versus different mining areas; amalgam-burners only................65 Figure 20 -Distribution of gender versus different mining areas; amalgam-burners only...........65 Figure 21 -Medical score sum versus different mining areas; amalgam-burners only...............66 Figure 22 -Hg-concentration in urine versus different mining areas; amalgam-burners only............................................................................................................................66 Figure 23 -Concentration of total Hg in hair versus different mining areas; amalgam- burner only.................................................................................................................67 Final Report 5 Health Assessment Kadoma, Zimbabwe Figure 24 -Hg-concentration in blood versus different mining areas; amalgam-burner only............................................................................................................................67 Figure 25 -Frequency of the clinical parameter “ataxia of gait”; amalgam-burner only..............68 Figure 26 -Frequency of the clinical parameter “dysdiadochokinesia”; amalgam-burner only............................................................................................................................68 Figure 27 -Frequency of the diagnosis of a mercury intoxication; amalgam-burner only..........69 Figure 28 -Comparison of the concentration of inorganic Hg-U, as determined in field and the total Hg-U concentration, as determined in the lab (Linear regression line and 90% confidence intervals).........................................................71 List of pictures Picture 1- Liquid mercury used in Tix mine.............................................................................14 Picture 2 - Kadoma village and nearby area............................................................................16 Picture 3 - Tix mine copper plate and stamp mill.....................................................................16 Picture 4 - Tix mine - scratching of amalgam; squeezing amalgam through a cloth; piece of amalgam; burning amalgam......................................................................17 Picture 5 - Small artisanal open pit...........................................................................................18 Picture 6 - Muzvezve river........................................................................................................18 Picture 7 - Amber Rose mill: stamp mill; cyclotron...................................................................19 Picture 8 - Amber Rose mill - tailings; cyanidation tank; pregnant solution; filling the tanks with tailings....................................................................................................20 Picture 9 - Primitive sluice box and James table at Etna village..............................................21 Picture 10 - Panning at Etna, piece of amalgam; one sack of stones collected by a miner in a day..................................................................................................21 Picture 11 - Amber Rose village.................................................................................................22 Picture 12 - Mayflower school....................................................................................................23 Picture 13 - Kwayedza school....................................................................................................23 Picture 14 - Mobile field clinic at Amber Rose mill – neuro-psychological testing; history; laboratory; blood sampling.........................................................................24 Picture 15 - Nurses taking the history.........................................................................................25 Picture 16 - Neurological examination (PSR reflex; finger-finger-nose test)..............................26 Picture 17 - Visual field test........................................................................................................27 Picture 18 - Match box text, memory test, pencil tapping test, Frostig test................................28 Picture 19 - Tremor-meter..........................................................................................................29 Picture 20 - Hair and urine sampling..........................................................................................30 Picture 21 - Mobile Hg analyser for urine (Lumex).....................................................................30 Picture 22 - Children from Kadoma, all working as miners........................................................38 6 Final Report Health Assessment Kadoma, Zimbabwe Picture 23 - Participants with hypertrophic skin, scars due to mining accident, scar due to a knife injury........................................................................................................39 Picture 24 - Dental malformation................................................................................................40 Picture 25 - Control area Chikwaka............................................................................................40 List of tables Table 1 - Kadoma district demographic data (by Mr. Gift from Kadoma District Hospital).....................................................................................................................32 Table 2 - Main causes of out-patient morbidity (under 5 years) (data from Mr. Gift from Kadoma District Hospital)..................................................................................33 Table 3 - Main causes of out-patient morbidity (all ages) (date from Mr. Gift from Kadoma District Hospital...........................................................................................33 Table 4 - Main causes of in-patient morbidity (under 1 year of age) (data from Mr. Gift from Kadoma District Hospital)..................................................................................34 Table 5 - Main causes of in-patient morbidity (5 years and over) (data from Mr. Gift from Kadoma District Hospital)..................................................................................34 Table 6 - Top five causes of mortality (under 1 year) (data from Mr. Gift from Kadoma District Hospital).........................................................................................................35 Table 7 - Top five causes of mortality (5 years and over) (data from Mr. Gift from Kadoma District Hospital)..........................................................................................35 Table 8 - HIV/ AIDS (data from Mr. Gift from Kadoma District Hospital...................................35 Table 9 - Concentration of total mercury in blood, urine and hair.............................................45 Table 10 - Concentration of organic mercury in hair..................................................................46 Table 11 - Toxicologically established threshold limits for mercury in blood, urine and hair (HBM = Human Bio-Monitoring; BAT = “Biologischer Arbeitsstoff- Toleranzwert” (biological work-exposure tolerance limit); BEI = Biological Exposure Indices)......................................................................................................52 Table 12 - Anamnestic, clinical, neurological and neuro-psychological scoring scale...............58 Table 13 - ignificant correlations between anamnestic data and mercury concentration in bio-monitors (group of amalgam-burners only, n = 116).+ = p < 0.05...................59 Table 14 - Significant correlations between anamnestic data and mercury concentration in bio-monitors (group of amalgam-burners only, n = 116).+ = p < 0.05......................................................................................................................60 Table 15 - Significant correlations between clinical data and mercury concentration in bio-monitors (group of amalgam-burners only, n = 116) .+ = p < 0.05......................60 Table 16 - Significant correlations between neuro-psychological test classes and mercury concentration in bio-monitors (group of amalgam-burners only, n = 116). + = p < 0.05......................................................................................................61 Table 17 - Significant correlations between medical scores and mercury concentration in bio-monitors (group of amalgam-burners only, n = 116). + = p < 0.05..................61 Table 18 - Decision for the diagnosis “chronic mercury intoxication”.........................................62 Final Report 7 Health Assessment Kadoma, Zimbabwe Table 19 - Frequency of mercury intoxication............................................................................62 Table 20 - Distribution of the formed subgroups in the different mining areas..........................64 Table 21 - (Total) mercury concentration in breast-milk samples compared to other data from the mothers...............................................................................................70 Table 22 - Comparison of the preliminary classified “mercury intoxicated” in field and by all lab results........................................................................................................72 List of appendix Appendix 1 – Tables...................................................................................................................83 Appendix 2 – Health assessment questionnaire........................................................................99 Appendix 3 – Zimbabwe clinical main data..............................................................................119 8 Final Report