Determinants of Delayed Tuberculosis Care-Seeking among Artisanal and Small Scale Miners in Zimbabwe: A Mixed-Methods Analysis

Abstract

Background: Artisanal and small-scale miners (ASM) in Zimbabwe face high occupational exposure to tuberculosis (TB) due to silica dust, poor ventilation, and limited access to healthcare services. Despite improvements in national TB control, little is known about the lived experiences and systemic barriers affecting TB care among ASM miners.
Methods: A mixed-methods cross-sectional study was conducted between February and May 2024 in eight high-burden mining districts in Zimbabwe. Quantitative data were collected from 250 ASM miners using structured questionnaires and analyzed using SPSS version 25. Qualitative data were obtained through 18 key informant interviews and 6 focus group discussions and analyzed thematically using NVivo. Logistic regression was used to identify predictors of delayed TB care-seeking.
Results: Delayed TB care-seeking (>4 weeks after symptom onset) was reported by 61% of miners. Significant predictors of delay included lack of formal employment (AOR = 2.1; 95% CI: 1.3–3.4), low education (AOR = 1.8; 95% CI: 1.1–3.0), and limited TB knowledge (AOR = 2.5; 95% CI: 1.5–4.2). High dust exposure was significantly associated with respiratory symptoms (χ² = 73.99; p < 0.001). Qualitative findings revealed stigma, economic insecurity, long travel distances, and health system weaknesses as key barriers.
Conclusion: TB among ASM miners in Zimbabwe is driven by occupational risk, socioeconomic vulnerability, limited health literacy, stigma, and systemic health system constraints. Integrated occupational health interventions and community-based TB services are urgently needed.