Knowledge and perceptions of health and environmental risks related to artisanal gold mining by the artisanal miners in Burkina Faso: a cross-sectional survey

Introduction Artisanal gold mining is an activity ensuring the survival of about 700,000 families in Burkina Faso with a considerable contribution to the national economy. Techniques and chemicals used in the operation, have adverse impacts on health and the environment. Our study aims to evaluate the perceptions and knowledge of these different impacts among artisanal gold miners. Methods A cross-sectional survey was conducted in artisanal gold mines Bouda and Nagsene in the region of the North of Burkina Faso. Two hundred miners over 18 years of age were interviewed. Results All the participants have recognized that gold mining has health impacts and 88.5% felt these impacts as important with a significantly higher proportion among those with more than 3 years' seniority (p = 0.001). The environmental impacts were perceived as important by 64.5% of miners, with a significant difference according to the position (p = 0.004). Sixty percent (60%) of respondents could identify at least 3 of the 5 health impacts of gold mining listed and 49.5% acknowledged at least 3 impacts on the environment. The diggers had significantly more knowledge about the symptoms (p < 0.001). Conclusion Study highlights the lack of knowledge of the Stampeders on the health and environmental impacts of artisanal gold mining. Findings might be used to develop more effective awareness campaigns in the future. Communication with diggers must focus on the risk perception because it appears that raising risk perceptions from low to high would have a major effect on behavior.


Introduction
Artisanal gold mining knows a craze ceaselessly increasing in several countries through the world. Artisanal and small-scale gold mining produce together about 10-15% of the world's gold [1]. The United Nation Environment Program estimated that more than 15 million people, including three million women and children, participate in more than 70 countries in this activity [2]. In Burkina Faso, there are about 200 sites across the country [3]. The exact number of artisanal gold miners in activity is difficult to determine, because it is an ephemeral activity where people come and go depending on the seasons and the discoveries of new veins [4]. However, more than 200,000 people [4,5] participate actively in artisanal gold mining, of which 38% of women and 11% of children aged less than 15 years [6]. Eighty percent (80%) of the workers concerned come from rural areas, often without any level of education [6]. Artisanal gold mining is a source of livelihood for many families in Burkina Faso and contributes significantly to the national economy. In the region of the North of Burkina Faso, area with a strong mineral potential, this activity has experienced booming these past 20 years. This increase is firstly the fact of climate change with corollary the rainfall declines and the degradation of arable soils and secondly, the increase in the price of gold at the international level. Artisanal gold mining can represent an opportunity to transfer wealth to rural communities already proven.
However, extraction methods, concentration and recovery techniques of gold and chemicals such as mercury and cyanide used in the activity inevitably leads to adverse consequences on ecosystems, on workers and community health [7,8]. Artisanal mining leads to changes of the landscape and the occupation of the ground, turning large tracts of land in lunar landscape with a succession of holes and piles of rejects, not conducive to animal life and where plants are struggling to push. Environmental impacts are also relevant to the quality of waters and aquatic ecosystem degradation [7]. In addition, the infiltration of toxic substances in the soil can have side effects on the quality of soils, crops and food, even over long distances [9,10]. The presence of fine particles in the air increases the risk of lung and cardiovascular diseases. The lack of collective and individual protection measures in most stampeders (artisanal miners), potentiated the risk of contamination by the chemical components of the ore-gangue [11]. Thus, there is risk of contamination through the skin by the manipulation of gangue, risks of inhalation and/or ingestion of these chemical components. Direct exposure to elemental mercury, often used for the amalgamation of gold, causes kidney, neurological, lung and autoimmune effects [12,13]. Once it is released to the aquatic environment, microorganisms such as phytoplankton can convert inorganic mercury into methyl mercury. Methyl mercury is fatsoluble and accumulates in fish and shellfish, constituting a special danger for the development of the child in utero and at an early age. It is estimated that, among some populations dependent on fisheries livelihoods, between 1.5 and 17 children on 1000 have a deterioration of cognitive function resulting from the consumption of fish containing methyl mercury [12]. In 2013, the United Nations Moreover, accidents are not uncommon in that sector of activity especially in crushers and diggers [11]. Cases of asphyxiation among underground workers or death by rock fall are possible.
Apart from these accidents, musculoskeletal disorders (upper and lower limbs, back), sleep disruption, headache and abnormal fatigue may be observed among artisanal miners [11]. Managing risk to protect human health and the environment is a shared responsibility between communities, companies and businesses, politics and individuals including workers [15]. The assessment of the risk and its communication are major and essential elements in the process of environmental health risk management [16]. Integrated Risk assessment and risk communication methods must consider the perception of risk. This is all the more important since different theories have posited that risk perception is a predictor of risky behaviors [17,18]. However, several approaches of risk assessment not accurately represent the concerned individual's own estimate of risk [19]. So, many times it is the stakeholder´s or the experts view on a risk that guide risk management strategies. However, several studies have shown that each person probably perceives risk differently [20,21]. The perception of risk may vary with age, gender, and culture or education level [20][21][22]. Research also suggest that there is a fundamental link between the risk perception, the nature of the risk, the demographic background of the person perceiving the risk, and the social context in which the risk occurs [23][24][25]. Difference of risk perception may be more important when comparing the perception of the experts with that of the lay public [20, 26,27]. In the light of these differences, policy should not, all the time, be shaped only by experts´ opinions [27].
When local conceptualization of the problem is not well understood, this can negatively influence the efficiency of risk management Page number not for citation purposes 3 strategies [19,20] such as artisanal gold mining environmental health risk management.
Thus, actions aimed at reducing the risks associated with gold mining, whether purpose of information, awareness raising or attitude change must consider the perceptual dimensions of the problem at the local level. Data or studies that can provide guidance for communicating with the miners and help inform in a more appropriate process are critical, including miner's perception and knowledge researches. To our knowledge, if environmental and health risks of artisanal gold mining are known through studies operating in Burkina Faso and elsewhere [6,11,28,29], the perception of the main actors such as miners and their level of knowledge about these risks need to be explored. This study is designed to assess the knowledge and identify the perception of the stampeders on health and environmental risks related to artisanal gold. The aim is to provide accurate information to policy-makers for implementation of risks management strategies, especially risks communication, in a manner that miners can understand and evaluate.

Methods
Scope of the study: The study was conducted at two villages of the municipality of Yako, located in the North Region of Burkina Faso. The choice is explained by the high intensity of artisanal gold mining in this part of the country and easier access in rainy season.
Type of study and sampling: A cross-sectional survey was conducted in artisanal gold mines Bouda and Nagsene, in the municipality of Yako. The stampeders of at least 18 years were selected. Were included in the study, the stampeders with a seniority of at least 6 months and consenting. Because of absence of an exhaustive list of stampeders working on these sites, selection by simple random sampling proved impossible. A quotas sampling according to sex (1/3 of women, 2/3 of men) [6] was performed taking into account the fact that approximately one third of women work in the artisanal sites. To compensate for the selection bias associated with this type of sampling, the estimated size of the sample (n = 96) has been doubled to 192 subjects. A total sample of 200 subjects was considered to cover potential non-respondents.
The power of the target study was at least 80%, sufficient in the event where 40.6% of the Stampeders are unaware of the health effects related to the use of mercury [30]. concerning symptoms that can be attributed to the panning for gold were:"cough","weight loss","musculoskeletal pain", "heart disease", "asphyxia or suffocation". As for environmental impacts, the knowledge was assessed by the following responses: "deforestation", "land degradation", "air pollution", "the landscape deterioration", "disappearing of animals". The questionnaire was  The proportion of subjects with emphasis to health risks was significantly higher in those with a seniority of at least 3 years in activity (p = 0. 001) ( Table 3). The frequency of the stampeders giving importance to the health effect of the artisanal gold mining effects seems to vary nor with the position, nor with the study level (Table 3). The environmental impacts of the activity were perceived as important by 64.5% of the Stampeders with a significant difference according to post (p = 0, 004) ( Table 4). There is a nonsignificant difference of perception with respect to sex.
Knowledge of the health impacts of artisanal gold mining: Sixty percent (60%) of respondents acknowledged at least 3 of the 5 health impacts of artisanal gold mining, listed. Analyses reveal a statistically significant association between the post and the level of knowledge of the symptoms that may be linked to activity (p < 0.001). Indeed, the proportion of participants having been able to identify at least 3 symptoms attributable to the artisanal gold mining is higher in diggers (75%) than non-diggers (50%) ( Table   5).

Discussion
Before the discussion, it should be noted that one of the major limitations of this study is the type of sampling used. Because of absence of a list of the artisanal gold miners, we opted for a non- Personal experience is known to be very important in risk perception [31][32][33]. For example, studies on climate change have shown that people who have had direct experience of flooding are more likely to accept climate change as serious risk [34,35]. Part of this difference between the two levels of seniority may be the result of the difference of age between these two groups. Additional analysis found that the mean age of workers with less than 1 year seniority or between 1-2 years or 3-5 seniority (respectively 21.81, 24.10 and 23.57) is significantly low than those with more than 5 years of without schooling are more concerned (P= 0.127)) suggests that perception is not only the fact of knowledge. In reality, no general conclusion was reached on the differences in the level of concern about risks of people with different levels of educational qualifications [34,41]. In some studies, higher education level of the greater risk perception [41,42], while in others the higher education groups appeared to care less [43,44]. It is a complex association that can be influenced by several factors and therefore be variable across populations [41]. Finding that miners place less importance on environmental effects of gold mining compared to health-related perception is not surprising. Wang in his study on farmer's perception concerning biomass supply activities risks found that, "when risk perceptions were divided into personal-and environment-related perceptions, most of the respondent expressed concern for the personal risks" [45]. Although not reaching significance (p = 0.09), females tended to be more concerned about environmental issues. This has been reported also in many studies [42,43,47]. It seems that those who both cause the most visible impact to the environment and are in touch with them, are those who attach least importance to these impacts, as shown the significant difference between diggers and nondiggers. Even though, this does not mean they are ignorant of environmental problems (pollution of water, air or soil degradation) as caused by the activity. By being always in touch with these impacts, they become familiar to them (even banal), consequently these workers on the one hand have the detailed knowledge of effects and on the other hand they appear to care less [20,41,48,49], give consideration first to financial benefit and health-related effects. Conventional family obligations require men (especially fathers) to be the bread-winners (providing financial support) as the head of the family [41]. As all diggers are men compared to non-diggers composed of 62% women, this can partly explain why diggers were less concerned by environmental risks.
The understanding of the health impacts compared to the knowledge of the environmental impacts of gold mining could be explained by the fact that the health effects seem more obvious: history of related diseases activity, frequency of some symptoms attributable to gold panning, which is not the case of the environmental impacts, especially for non-diggers. The significant difference of knowledge between diggers and non-diggers is the proof. The diggers are those who participate and alongside the most visible environmental impacts of the activity such as degradation of the soil (well), the disappearance of the animal, the impact on the vegetation. According to Weiss, the diagnosis is based on both personal experience and a set of characteristics of the environment [50]. Even with the difference of knowledge and perception between men and women, diggers and non-diggers, environmental compared to health-related consequences, miners' still have a low awareness of environmental protection and conservation.
Despite the explosion of the activities of artisanal gold mining, the programs of awareness and health education focusing on the risks of the activity, are lacking [30]. Only 1% of the stampeders have received sensitization on the health risks associated with gold mining. Nevertheless, the impact of awareness campaigns remains questionable. Indeed, knowledges and awareness are often no influence over the way we act and the decisions we take regarding avoidance, control or protection against exposure [30]. Conversely, some authors suggest that knowledge of environmental risk and perception of this as a serious health hazard are predictors of intentions to act and implement reduction procedures [17,25].
Because of the low rate of stampeders who reported having benefited from a campaign in our sample, we could not study the impact of raising awareness on perception, behavior or knowledge of risks. In a context characterized by material deprivation, artisanal gold mining becomes a necessity, even a survival activity. Artisanal miners focus more on their economic situation. Nevertheless, we still optimistic that participatory awareness campaigns that would involve artisanal miners will make them understand the potentially serious consequences of long-term environmental-and health- perception because it appears that raising risk perceptions from low to high would have a major effect on behavior [17]. Globally, it seems like these diggers want to tell us this: we dig, we chase animals away their habitats, we cut trees, pollute water, we know all of that; but all these elements were not more important than our own or our family survival! How can't we understand that, if we know they put their health and own lives in danger in the holes of ore (they perceive it) for this same survival! What could be more important than survival? This is a question, with as much importance as his response. We think that awareness raising campaigns and efficient communication strategy targeting miners should contain a statement answering this question. In this last category, participatory approach will help to build trust between miners and policy-makers.

Conclusion
The findings provide evidence for the influence of economic factors, social factors such gender and educational differences on miners'  Miners' seem to be better acquainted with the health impacts of the artisanal gold exploitation compared to environmental impacts. Tables   Table 1: Characteristics of the sample (N = 200), 2014