Background: The International Labour Organiza-tion (ILO) International Classification of Radiographs of Pneumoconioses (ICRP) is a method for describing and systematically recording radiographic abnormalities in the chest caused by the inhalation of dusts. The objective of this classification system is to codify the radiographic signs of the pneumoconioses in a simple, reproducible manner. The Southern Africa Tuberculosis and Health Systems Support (SATBHSS) project developed a capacity-building training programme for doctors to improve their knowledge and practical skills regarding the use of the ILO ICRP at an A-reader level.
Objective: The aim of this case study was to describe the delivery of the ILO ICRP training programme and the performances of the course participants in terms of the written pre- and post-training assessments, and the practical examination.
Methods: Eleven cohorts from seven countries participated in a nine-week A-reader training programme in the use of the ILO ICPR. Pre- and post-training assessments and a practical assessment were completed and scored. The differences in pre- and post-training assessment scores were assessed using the student’s t test.
Results: One hundred and fifty-six medical practitioners underwent the training. All participants from nine cohorts in which both pre-and post-training was conducted failed the written pre-training assessment. Two participants failed the written post-training assessment and one failed the practical test. There was a notable improvement in all cohorts; the mean improvement in scores ranged from 43% to 70%. The t-test analysis showed a statistically significant improvement from the mean pre-training (25.76 ± 8.76) to post-training scores (87.90 ± 5.50) (p < 0.01).
Conclusion: The SATBHSS and TB in the Mining Sector in Southern Africa (TIMS) projects have contributed positively to capacity building in southern Africa. The training programme increased clinicians’ confidence and ability to recognise the pneumoconioses, and improved their understanding of the ILO ICRP system. There is, however, a need to provide funding for sustainability of programmes aimed at diagnosing pneumoconioses.

Background: Low- to middle-income countries (LMICs) have a high burden of noiseinduced hearing loss and occupational lung diseases, which are often undiagnosed. The situation is exacerbated by a lack of skilled and experienced healthcare practitioners who can conduct the necessary diagnostic tests, according to global standards. There is a need to train more healthcare workers on theoretical and practical skills in audiometry and spirometry.
Objective: This study aimed to assess the effectiveness of a five-day practical spirometry and audiometry training course in four LMICs in southern Africa, under the Southern Africa Tuberculosis Health Systems Support (SATBHSS) project.
Methods: Ninety-one nurses participated in a five-day audiometry and spirometry training course under the SATBHSS project from 2021 to 2022. Competency tests were conducted prior to, and after the training. The competency assessment consisted of multiple-choice and short-answer questions on audiometry and spirometry. The same test was used for the pre-and post-training assessments. Practical assessments were only conducted at the end of the training.
Results: The overall mean improvement for the participants was 32%; 96% of the participants passed the post-training assessment. The mean pre- and post-training assessment scores in Mozambique were 48.31 ± 15.05 and 69.15 ± 22.66, respectively. In Malawi, the mean scores were 36.46 ± 9.40 and 89.36 ± 7.26, respectively. The improvement in scores was statistically significant for both countries (p < 0.05).
Conclusion: Short courses in audiometry and spirometry can significantly improve knowledge and practical skills in these areas. Countries need to scale up capacity development workshops, while implementing the basic occupational health services model, which consists of integrating occupational health into primary health services.

Background: The engagement of the private sector in healthcare, particularly in tuberculosis (TB) prevention and care, is crucial for addressing the TB burden in high-prevalence regions, yet the understanding of the extent of private care, and how the collaboration with government works, remains limited in many countries.
Objectives: We examined the landscape of private sector engagement in TB prevention and care across high TB burden districts in Lesotho, Malawi, Mozambique and Zambia.
Methods: A sample of 251 private facilities was surveyed in a cross-sectional study. The sample encompassed for-profit clinics/hospitals, corporate clinics/hospitals, faith-based organisation/nongovernmental organisation (FBO/NGO) clinics/hospitals, and stand-alone pharmacies and laboratories, with a focus on their roles, expansion trends, and collaborative efforts with the Ministry of Health/national TB programme (MoH/NTP). Respondents were asked how long the facility had been operating, if they had any collaboration with the MoH in TB prevention and care, and what that collaboration entailed (including challenges and incentives). Non-collaborating facilities were asked the reasons for non-collaboration and their intertest in collaboration, including needs, benefits, and challenges.
Results: The most common types of facilities were for-profit clinics/hospitals (41%), followed by stand-alone pharmacies (38%). Private for-profit facilities experienced rapid expansion over the past decade, with approximately 50% being registered in the last seven years. In Lesotho, 80% of for-profit hospitals/clinics collaborated with the Government, benefiting from various support mechanisms such as free TB drugs, diagnostic services, training, mentorship, and national guidelines. In Malawi, 73% of private facilities were collaborating with the MoH in TB prevention and care. There was minimal collaboration between the MoH and private facilities in TB prevention and care in Mozambique, with no implementation of the public-private mix for TB control in the surveyed districts. In Zambia, the collaboration was in its infancy, primarily involving corporate facilities, and lacked formal memoranda of understanding.
Conclusion: The results of the survey underscored the heterogeneous nature of public-private collaboration in TB prevention and care across the four countries, emphasising the need for tailored strategies to enhance collaboration, particularly in Mozambique and Zambia.

Background:: Workers in copper mines are exposed to respirable dust (RD) and respirable crystalline silica (RCS), which could lead to the development of silicosis. With the expected increase in copper production in the next two decades due to the world’s green energy pathway, the number of miners exposed to RCS and incidents of exposure exceeding the recommended occupational exposure and other limits may increase. However, data for RD and RCS concentrations in the copper mining industry are limited.
Objective: The objectives of this study were to assess the current state of knowledge about exposure to RD and RCS in copper mines, and to provide recommendations for the development of an airborne dust monitoring programme in Zambia.
Methods: A systematic literature review was conducted, using the PRISMA methodology. The following online databases were searched for relevant research articles about RD and RCS in copper mines: Clarivate’s Web of Science, Google Scholar, PubMed, Science Direct, EBSCO Host, and Scopus, using keywords and phrases with boolean operators. Articles were eligible for inclusion regardless of the sampling method used to measure airborne RD and/or RCS (personal exposure or area monitoring), were published in the period 1970–2023, and met the quality requirements.
Results: After full-text screening, nine out of 6 710 potential articles remained. We found that area and personal RD and RCS data in copper mines are not widely documented in the open-access online literature. For personal RCS data, exposure exceeded the occupational exposure or other recognised limits in most sites; the highest personal RCS exposures occurred in sections of the mine where ore was crushed and transported. For mines that only conducted area monitoring of RD, the airborne dust concentrations that were potentially available for personal exposure were relatively low, compared to the RD exposure limit of 3 mg/m3 . Overexposure to RCS occurred even though personal exposure to RD complied with applicable limits in most cases.
Conclusion: We found evidence of personal overexposure to RCS in copper mines, globally. Assessment of RD concentrations alone (even when exposure is under control) is not adequate to protect workers against overexposure to RCS. Zambia needs to develop an RCS monitoring programme for the copper mining industry. The programme should be based on established standards such as the European Standardisation Committee (CEN) standard (BS EN 689:2018), or the South African Mining Industry Code of Practice as the socio-economic conditions of miners are similar in Zambia and South Africa.

Artisanal and small-scale alluvial gold mining in Zimbabwe is a common economic activity in Mwenezi district. In most artisanal and small-scale mining areas, there is lack of access to occupational health services. A five-day mobile occupational health screening service was offered in Mwenezi district with the aim of providing health screening services to artisanal and smallscale alluvial gold miners (ASAGMs) and community members; 68 ASAGMs and 81 community members were screened for tuberculosis (TB). The ASAGMs were predominantly female (n = 38; 55.9%). Four cases of TB were diagnosed among the community members. No silicosis or TB cases were diagnosed among the ASAGMs. Eight (11.8%) ASAGMs were HIV-positive. Almost half (n = 15; 42%) of the screening audiometry tests showed impaired hearing. The local health staff reported that ASAGMs in the region lack access to occupational health services and were constrained by financial costs to travel for screening for occupational health diseases. Unlike in most artisanal and small-scale mining in Zimbabwe, which is male-dominated, Mwenezi district had more women who accessed the five-day mobile occupational health screening services. Providing mobile occupational health services in remote mining sites improves access to healthcare services for both women and men.