title: The burden of chronic mercury intoxication in artisanal small-scale gold mining in Zimbabwe: data availability and preliminary estimates.
abstract: BACKGROUND
  Artisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe.
  
  
  METHODS
  Cases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms.
  
  
  RESULTS
  Miners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe's total population in 2004.
  
  
  CONCLUSIONS
  This analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population health in Zimbabwe in 2004 when comparing with more than 130 categories of diseases and injuries quantified in the WHO's GBD 2004 update. Improving data quality would allow more accurate estimates. However, the results highlight the need to reduce a burden which could be entirely avoided.
authors.affiliation: Department Environment & Health, Bielefeld University, School of Public Health, Universitätsstraße 25, D-33615 Bielefeld, Germany. nadine.steckling@uni-bielefeld.de.
authors.forename: Nadine
authors.initials: N
authors.lastname: Steckling
authors.forename: Stephan
authors.initials: S
authors.lastname: Bose-O'Reilly
authors.forename: Paulo
authors.initials: P
authors.lastname: Pinheiro
authors.forename: Dietrich
authors.initials: D
authors.lastname: Plass
authors.forename: Dennis
authors.initials: D
authors.lastname: Shoko
authors.forename: Gustav
authors.initials: G
authors.lastname: Drasch
authors.forename: Ludovic
authors.initials: L
authors.lastname: Bernaudat
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Claudia
authors.initials: C
authors.lastname: Hornberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000633:toxicity*; D005260:Female; D006046:Gold; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008628:Mercury / Q000633:toxicity*; D008906:Mining; D015995:Prevalence; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D004785:Environmental Pollutants; D006046:Gold; D008628:Mercury