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Turusbekova Akshoola Kozmanbetovna
Email: aturusbekova@oshsu.kg, Osh State University, Department of Public Health, ORCID: 0000-0002-4868-0792 https://orcid.org/0000-0002-4868-0792
Abhay Raj Chauhan
5th Year, Student, International Medical Faculty, Osh state university, Osh Kyrgyzstan
Silicosis and coal workers’ pneumoconiosis (CWP) remain two of the most pervasive occupational lung diseases in India, despite decades of evidence showing that both are entirely preventable through dust control and surveillance. Silicosis results from inhalation of respirable crystalline silica in industries such as sandstone mining, agate polishing, construction, foundry work, and slate-pencil production. Coal workers’ pneumoconiosis arises from prolonged exposure to coal mine dust, particularly in underground mines. India’s workforce includes millions employed in small-scale and informal mining and stone-processing sectors, many lacking regulated safety standards or occupational health surveillance. These structural weaknesses contribute significantly to the country’s persistent disease burden. The relationship between silica exposure and tuberculosis is a major public health concern; silica dust severely impairs macrophage function, increasing the risk of TB by up to threefold in exposed workers, as documented by Sharma et al. (2016). High TB prevalence in India compounds the problem, resulting in widespread silico-TB in mining districts such as Jodhpur, Karauli and Dholpur in Rajasthan. Historic data from the Indian National Institute of Occupational Health (NIOH) and Directorate General of Mines Safety (DGMS) consistently highlight dust levels far exceeding permissible limits in both formal and informal sectors. The Indian government, in collaboration with ILO and WHO, has initiated programmes aimed at elimination of silicosis, yet implementation barriers continue due to insufficient surveillance and poor enforcement of workplace dust controls. This review aims to provide a comprehensive synthesis of real epidemiological studies, official reports and international standards to clarify the current burden and challenges of silicosis and CWP in India.
This narrative review was conducted using only real, verifiable sources including peer-reviewed journal articles, DGMS regulations, NIOH/NIMH field reports, and WHO-ILO publications. Searches were performed using PubMed, Google Scholar, the NIOH archive and DGMS documents. Search terms included “silicosis India”, “silico-tuberculosis”, “stone mining Rajasthan”, “agate workers Gujarat”, “slate-pencil workers silicosis”, “coal workers’ pneumoconiosis India”, “coal miners respiratory morbidity”, “ILO classification pneumoconioses India” and “occupational lung disease India”. Only articles with authenticated authors, real institutions and traceable publication details were included. Important studies from Rajasthan sandstone mines (Rajavel et al., 2020), Gujarat agate industry (Tiwari et al., 2010), Madhya Pradesh slate-pencil sector (Saiyed et al., 1995), quartz grinders (Tiwari et al., 2007), and coalfields of Madhya Pradesh and Odisha (Parihar et al., 1997) were prioritized. The review excluded opinion pieces lacking epidemiological data and excluded any sources without verifiable bibliographic existence. International guidelines such as the ILO International Classification of Radiographs (2011) and WHO dust control manuals were also included, as they contribute essential diagnostic and regulatory frameworks. All included literature was evaluated for methodological clarity, diagnostic criteria used (clinical, radiological or ILO-classification based), dust measurement approaches, workforce characteristics, and disease prevalence.
Rajasthan remains the largest hotspot for silicosis in India due to its extensive sandstone mining and processing industry. In a rigorous study, Rajavel et al. (2020) examined sandstone mine workers in Jodhpur and found a silicosis prevalence of 37.3%, silico-TB prevalence of 7.4% and overall TB positivity of 10%. These figures highlight not only the burden of pneumoconiosis but also the synergy between silica exposure and tuberculosis. Earlier research by NIOH and NIMH documented similar patterns in Karauli, Jalore, Bhilwara and Dholpur districts, where thousands of workers employed in small mines operate without dust control measures. Quartz grinding units, historically known for extremely high dust loads, were studied by Tiwari et al. (2007), who reported silicosis prevalence ranging from 20% to over 50%, depending on years of exposure. Gujarat’s agate workers face similar hazards: Tiwari et al. (2010) documented a silicosis prevalence of approximately 34%, often occurring at younger ages due to intense exposure during dry polishing. Slate-pencil workers in Mandsaur, Madhya Pradesh experienced one of the world’s highest recorded silicosis burdens; Saiyed et al. (1995) reported prevalence rates exceeding 50% in some worker groups. Among construction workers, Krishnan et al. (2019) found high rates of respiratory symptoms and reduced lung function, strongly correlated with silica exposure. Environmental monitoring studies in stone-crushing units (Majumdar & Rao, 2014; Singh et al., 2017) consistently show dust concentrations far above Indian permissible levels. Informal sectors, which employ the majority of silica-exposed workers, lack engineering controls such as wet drilling, local exhaust ventilation and respirators.
CWP prevalence in India, though lower than silicosis, remains substantial. The most comprehensive study remains the large radiograph-based analysis by Parihar et al. (1997), who re-read 43,504 chest radiographs from coal miners in eastern Madhya Pradesh and Odisha, finding an overall CWP prevalence of 3.03%. This study also noted a small but important presence of progressive massive fibrosis (PMF), the most severe form of CWP. Later studies confirmed ongoing disease in coalfields: Chakraborty et al. (2010) reported significant respiratory impairment in coal miners, while Pandey et al. (2011) observed chronic bronchitis and early pneumoconiosis in underground miners in Jharia and Raniganj coalfields. Dust monitoring studies (Ghose & Majee, 2000; Mukherjee et al., 2003) confirm high concentrations in underground and opencast mines, frequently exceeding DGMS standards. Kurmi et al. (2014) found increased respiratory morbidity and reduced lung function in coal miners compared with non-miners in the same region. NIOH surveillance reports indicate that CWP remains underdiagnosed because routine radiography using the ILO classification is inconsistently applied across mining companies.
The link between silica exposure and tuberculosis is one of the most important findings repeatedly confirmed in Indian literature. Sharma et al. (2016), writing in the Bulletin of the WHO, emphasize that silica severely impairs immune defense, making exposed workers far more susceptible to TB infection and reactivation. Earlier studies by Jindal et al. (2012) and NIOH field reports concur, showing high rates of TB in silicosis patients, often exceeding 10–15% in high-exposure regions. Coexisting COPD, chronic bronchitis and restrictive lung disease are commonly documented in silica and coal-exposed workers (Krishnan et al., 2019; Pandey et al., 2011). Misdiagnosis remains common, with many silicosis cases incorrectly treated as TB, delaying compensation and appropriate care.
Air monitoring studies reveal extremely high dust levels in Indian mining and stone-processing environments. Majumdar and Rao (2014) documented respirable dust concentrations several times above DGMS limits in stone-crushing units. Similar findings were reported by Ghose and Majee (2000) in coal mines, where both respirable dust and free silica percentages were high. Bhagia (2012) noted significant environmental exposure in communities living near stone-crushing units, implying that risk extends beyond occupational settings.
India’s regulatory framework includes DGMS dust-control mandates, ILO classification for diagnosis, and state-level silicosis compensation schemes (e.g., Rajasthan's policy). However, implementation remains fragmented. Murlidhar and Kanhere (2015) emphasize that absence of surveillance in the informal sector allows widespread undetected silicosis. Even in coal mines, where regulation is relatively stronger, enforcement gaps remain, as highlighted by Chakraborty et al. (2010). The National Programme for Elimination of Silicosis, supported by ILO, has improved documentation, but field-level implementation is insufficient due to lack of trained personnel and inadequate monitoring infrastructure.
The evidence clearly shows that India faces a dual challenge: extremely high silicosis prevalence in informal stone-processing sectors and persistent CWP in coal mining regions. Silicosis remains far more common due to the sheer number of workers exposed to silica dust in unregulated environments. The disease disproportionately affects poor, migrant and marginalized groups, who often lack access to healthcare and compensation. International evidence confirms that silicosis is completely preventable through dust control, yet Indian industries continue to rely on dry cutting, open processing and outdated machinery. Adoption of wet-drilling technology, local exhaust ventilation and enclosed crushing systems remains minimal. Personal protective equipment, even when available, is rarely used due to discomfort, lack of training and absence of enforcement. CWP, while numerically less prevalent, continues due to inadequate dust suppression, non-compliance with DGMS guidelines and inconsistent dust monitoring in older coal mines. The strong association between silica exposure and TB exacerbates India’s already heavy TB burden, making integrated screening crucial. Policy measures such as Rajasthan’s silicosis compensation scheme and the national elimination programme represent positive steps, but require nationwide scaling. More robust surveillance using ILO-classified radiographs and digital imaging, regular dust monitoring, strengthened labour inspections and employer accountability are essential.
Silicosis and CWP continue to impose substantial health and socioeconomic burdens in India, despite being fully preventable. Real, verifiable studies spanning three decades consistently document severe silicosis prevalence in Rajasthan, Gujarat and Madhya Pradesh, and significant CWP in coalfields. Addressing these diseases requires a comprehensive strategy involving strict dust control implementation, standardized diagnostic protocols, integration with TB programmes, improved compensation systems and targeted interventions for informal workers. Eliminating pneumoconiosis in India is achievable but demands political will, regulatory enforcement and sustained public health commitment.
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