No silicosis-TB anymore? Doubting Gujarat govt claim, NGO seeks scientific study

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In a representation, Jagdish Patel, director, Peoples Training and Research Centre (PTRC), a Gujarat-based health rights group, has made a plea to the director-general, Indian Council of Medical Research (ICMR) on the need for systematic surveillance study on the prevalence of tuberculosis and silicosis among agate polishers in Khambhat, Gujarat.
Doubting the Government of Gujarat claims that since wet method is adopted for agate polishing by Khambhat units, the problems related with the prevalence of TB and silicosis have been resolved, he says, lately,no scientific study has been carried out to know the status of the problem and results of the efforts to reduce silica dust at work and its impact.
Stating that it is now 18 long years that a systematic study was done on the issue, he insists, the National Institute of Occupational Health (NIOH) be directed to take up a study again that can guide one to plan out strategies not only to end TB and silicosis but also to achieve UN Sustainable Development Goal (SDG) 8.8. Such a study alone would “demonstrate progress toward eliminating both silico-tuberculosis as well as silicosis and TB individually”, he adds.

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PTRC is a voluntary organization established in 1992 to work on Occupational Health and safety. It has relentlessly worked to generate awareness of Occupational diseases, locate hot spots, help generate scientific data on occupational diseases and help victims of the occupational diseases receive social justice.
Agate items are popular and the country is so proud of this craft that foreign dignitaries are gifted agate items from Khambhat. Recently, Prime Minister Narendra Modi gifted agate bowls to President Putin of Russia.
Polishing agate and other stones to make ornaments and other show case items is an old craft that has flourished in Khambhat. The craft has received Geographical Indication tag in the year 2008. As part of census of India 1961 “Agate Industry of Cambay” was published to document the craft [Volume V-part VII-A (1)]. In this report there are several case studies which refer to several deaths in a craftsman family due to Tuberculosis (TB).
Industrial Toxicology Research Centre, Lucknow, took up a study (date not mentioned but believed to be in 1983 or so) and published report “Respiratory morbidity in Agate workers: A Case Study in Khambhat, Gujarat, India”. In this study, the prevalence of all chronic lung diseases in agate workers and controls was 63.4 and 35.6% respectively, maximum morbidity in the former being in 21-30 years age group. The prevalence of pneumoconiosis and pulmonary TB, was 18.4%, 15.5% respectively in agate workers. Amongst all lung diseases percentage of pneumoconiosis was 30.8% in grinders and 22.2% in chippers. Prevalence of pneumoconiosis and TB was 14.3% in children.
In 1987 the National Institute of Occupational Health (NIOH) carried out epidemiological study of agate workers. Silicosis prevalence for all agate workers was 29% and the prevalence among grinders was 38%. Progressive Massive Fibrosis (PMF) was observed among 8% of the workers and the prevalence of TB was 30%.
In 1993 NIOH did a follow-up study of 150 randomly selected subjects from the 1987 study. Among the 91 subjects who were available in 1993 for follow-up, silicosis prevalence was 41% and the prevalence among the grinders was 64% and non-grinders at 23%.
NIOH carried out a third study during 1999-2004. It was an environmental and medical survey. Prevalence of silicosis among all agate workers was 29-36%, prevalence of TB was 27-50% and prevalence of SilicoTB was 15-26%. Prevalence of silicosis among non-workers was found to be 6-13%, TB 20-23% and SilicoTB 2-8%. Children and women working near the agate units were suffering from silicosis and silicoTB.
A 2007 study of 123 suspect cases of silicosis among agate workers reporting to a weekly clinic set up the NGO in collaboration Medical College, Karamsad found that 70% of them had silicosis confirmed by chest X-ray. Analysis showed that every extra year of exposure the odds of getting silicosis increased by about 12%.
The weekly clinic set up by PTRC examined over 10 years over 1,200 exposed persons during 2007 to 2017 and of them 415 were found to be suffering from silicosis/silicoTB.
Several efforts were done by NIOH and NGOs and the industry to reduce silica levels at work in last decade. The National Human Rights Commission (NHRC) published recommendations on preventive, remedial, rehabilitative and compensation aspect of silicosis (in 2011) and presented a comprehensive report to Parliament.

The Revised National TB Control Programme (RNTCP) has recognised silicosis as risk factor for TB. The Ministry of Health in collaboration with the Ministry of Labour and Employment has developed a framework to address TB and related co-morbidities in the world of work in India in April 2019 which lays down standards for employers/employees and guides supervisors in ensuring TB prevention and care at workplace settings.
There is clear link between TB and silica exposure. Universal screening for TB in this community on a regular basis has not been done by anyone.
The agate industry has claimed that all the agate processing units have adopted wet method. The Government of Gujarat claims that since wet method is adopted, the problem has been resolved. No scientific study has been carried out to know the status of the problem and results of the efforts to reduce silica dust at work and its impact.
Reduced exposure to silica in the workplace has been shown to reduce TB incidence. Silica exposure can increase the risk of TB even in absence of silicosis.
It will be prudent to take up a silicosis and TB prevalence study in Khambhat through NIOH in collaboration with RNTCP to assess the current situation and help plan for further improvement.
It is now 18 long years that have passed after the last NIOH study. We appeal you to direct NIOH to take up a study again now which can guide us to plan our strategies not only to end TB but also to achieve UN Sustainable Development Goal (SDG) 8.8.

A new study is needed not only to assess the effectiveness of the prevention intervention efforts over the past 10 or 18 years, but also to re-establish an updated current prevalence measure that can be used as a reference for surveillance and prevention interventions going forward for the next 5-10 years that can demonstrate progress toward eliminating both silico-tuberculosis as well as silicosis and TB individually.
We look forward hearing from you soon.

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