Occupational lung diseases among former goldminers in two labour sending areas.

OBJECTIVES To compare and contrast the prevalence of pneumoconiosis in two groups of former migrant mineworkers in southern Africa, and to examine the effectiveness of the South African compensation system for occupational lung diseases. DESIGN Comparison of two cross-sectional studies and follow-up data on compensation results. SETTING The village of Thamaga, Botswana and the rural area of Libode, Eastern Cape, South Africa. SUBJECTS Two hundred and thirty-four former underground mineworkers in Thamaga, and 238 in Libode. MAIN OUTCOME MEASURES Prevalence and severity of pneumoconiosis, prevalence of radiological signs of tuberculosis (TB), Medical Bureau for Occupational Diseases (MBOD) certification committee decisions, and compensation results. RESULTS Prevalence of pneumoconiosis > or = 2/1 was 15.4% in Libode and 13.6% in Thamaga. Significantly more Libode than Thamaga subjects (51.1% versus 29.0%) reported past TB treatment. Radiological signs of pulmonary TB were also more prevalent in Libode (33.3% v. 23.9%). Twenty-six per cent of Libode men and 16.1% of Thamaga men were certified with compensable disease. Libode payments were finalized within 30 months, whereas Thamaga cases only began receiving payments 52 months after medical examination, with 11 cases still pending 66 months after medical examination. CONCLUSION There was a high prevalence of pneumoconiosis in both study groups. Many men were eligible for compensation but were previously uncompensated. The higher rate of compensable disease in the Libode group may relate to the higher prevalence of TB, as well as more active follow-up by the study group, including a large number of appeals. Socio-political changes in South Africa between 1994 and 1996 may also have influenced compensation results.