In South Africa, there is high incidence of occupational lung diseases (OLDs) in miners and recent studies on gold miners have shown that 20% of them have contracted silicosis, says University of the Witwatersrand School of Public Health lecturer Ntombizodwa Ndlovu.

She points out that the Occupational Disease in Mines and Works Act makes provision for the removal of the lungs of deceased active and former miners for compensation purposes.

Ndlovu explains that these examinations are performed regardless of the cause of death and with consent from the next of kin. The lungs are removed when the miner dies and are sent to the National Institute for Occupational Health (NIOH) for examination. From 1975, information emanating from these autopsies has been stored on the Pathology Automation (PATHAUT) database.

Records on the PATHAUT database were analysed and the trends from 1975 to 2013 of key demographic characteristics, occupational exposures and OLDs diagnosed at autopsies were described.

Ndlovu says it was found that the lungs of 109 101 miners were examined between 1975 and 2013, comprising both current (57%) and former miners (43%). Twenty-five mining commodities were represented, with 72.9%, or 78 693, of all cases being gold miners.

She cited two studies of miners who had been assessed in life and subsequently had an autopsy. Sixty-two percent of those diagnosed with active pulmonary tuberculosis (PTB) and more than 50% of those with asbestos-related diseases (asbestosis, mesothelioma or lung cancer) had not been diagnosed in-life.

In another study, nearly a third (28%) of autopsy cases had a compensable disease. Of these, only 9% had been compensated in-life. “Very worryingly, it was found that silicosis and PTB have increased since 1975. While, in recent years, there has been a decrease in PTB, silicosis continues to increase.”

Ndlovu says the autopsy data provides the only source of long-term information for monitoring OLD trends in miners and annual surveillance reports from 1975 to 2013 are available on the NIOH website.

“Autopsies play in important role in the detection of OLDs, particularly those that are not diagnosed in-life, and provide the last opportunity for miners and former miners to access compensation.

“These findings have led to improved practices, such as the development of the tuberculosis (TB) review tool and have also informed initiatives for the control of silicosis and TB,” she concludes.