Editorial

834 www.thelancet.com Vol 382 September 7, 2013

Child labour: the high cost of gold ‘‘I was hungry and in need of money so I decided to go there”, said 13-year-old Rahim, just one of thousands of children facing hazardous conditions and long-term illness working in Tanzania’s small-scale gold mines. Toxic Toil, a report published on August 28 by Human Rights Watch (HRW), describes children as young as 8 years old living in poverty turning to mining to make money for basic necessities for themselves and their families. The children have no knowledge of the health risks they will be exposed to. During interviews of more than 200 children while visiting 11 mining sites, HRW found that young girls were sexually exploited and at risk of contracting sexually transmitted diseases. School attendance was poor and alternative employment opportunities lacking, making the mines one way to earn a living.

Tanzania exports 15% of the world’s gold, about 400 tonnes, and it is estimated that 10% comes from small-scale mines. During mining, gold is separated using mercury, which produces poisonous fumes when evaporated. Although the health risks of mercury are

acknowledged in Tanzania, which helped develop the UN treaty to reduce mercury use worldwide, mercury use is still unabated in the country, the third highest producer.

Domestic laws, which obligate the government to protect the rights of children and adhere to the 2009 National Action Plan For The Elimination of Child Labor, are not being routinely observed. HRW provide recommendations, mainly aimed at the Tanzanian Government, to help to end child labour in gold mining. These include regular inspections, enforcement of penalties for those who employ child labour, and increased access to education and vocational training for children. In the rest of the world, countries trading in artisanal gold must eliminate child labour from their supply chains. Although the report’s recommendations for Tanzania are welcome, child labour is a global problem. The International L abour Organization estimates that there are more than 215 million child labourers worldwide—robust and sustained action by nations and international bodies is needed to address this scandal. The Lancet

For the HRW report see http://www.hrw.org/sites/default/fi les/

reports/tanzania0813_ForUpload_0.pdf

For Tanzania’s action plan against child labour see http://

www.eclt.org/dev02/wp-content/uploads/2013/08/

National_Action_Plan_for_the_Elminimation_of_Child_

Labour_2009.pdf

For the ILO child labour report see http://www.ilo.org/ipecinfo/

product/download.do?type=document&id=19565

For Tusting and colleagues’ review on mosquito larval

source management see Cochrane Database Syst Rev 2013;

8: CD008923.

For Tusting and colleagues’ systematic review and meta-

analysis see Online/Articles Lancet 2013; published online

June 19. http://dx.doi.org/10.1016/S0140-

6736(13)60851-X

Malaria prevention: civilisation versus diseaseMalaria, which draws its name from the “bad air” of wetlands, has beset humankind for thousands of years and still imposes a regrettable burden of morbidity and mortality today. According to WHO estimates, in 2010 there were some 219 million cases of malaria and about 660 000 deaths, with disease concentrated in children in Africa, Asia, and South America. The malaria parasites, principally Plasmodium falciparum and Plasmodium vivax, are challenging targets for drug and vaccine development, and techniques to target the many mosquito species that transmit the disease therefore remain important.

In a publication in The Cochrane Library on Aug 29, Lucy Tusting and coworkers focus on larval source management—attacking mosquito larvae at breeding sites, usually in standing water. Among fi ve randomised trials and eight before-and-after studies, there was a reduction of malaria incidence in Sri Lanka associated with larvicide treatment of streams and other bodies of water, but in a single trial in The Gambia there was not, perhaps owing to more extensive and inaccessible larval habitats. Parasite prevalence decreased substantially in

the studies in Sri Lanka and elsewhere, but not in The Gambia. On the basis of this sparse evidence, Tusting and colleagues highlight larval source management as an accompaniment to indoor insecticide spraying and long-lasting insecticide-treated bednets where mosquito larval habitats can be defi ned. In a recent systematic review and meta-analysis in The Lancet, the same group approached the issue from a diff erent angle and assessed socioeconomic development to counter malaria, recalling that the disease was eliminated from several countries before malaria transmission had even been understood.

As Chris Cotter and colleagues note in a Review in today’s issue, substantial gains have been made by 34 malaria-eliminating countries during 2000–10 (111 countries being malaria free and 64 “controlling” malaria). The global fi ght against malaria will be protracted, but there is encouraging evidence of progress in committed national campaigns. Given the ensuing need to identify and treat malaria in new and diffi cult-to-treat population groups, universal health coverage will be a key pillar of successful future programmes. The Lancet

See Review page 900

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