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The utilisation of three-dimensional limit equilibrium in evaluating open pit slope stability is becoming increasingly common in the industry. Implementation of this assessment approach requires developing new assessment workflows associated with the model inputs to ensure confidence in the modelling outcomes and leveraging the full benefits of the approach. Several challenges also exist in terms of understanding data reliability and software capability; a particular limitation identified was the practical application of the disturbance zone behind the slope. This paper provides a workflow adopted to ensure high confidence in the modelling outcomes and communication of the assessment results using a case study and highlights the software developments to address limitations.

Exploration, resource definition, and active mining operations can be located in terrains that contain geohazards such as rockfalls or landslides from natural slopes. To mitigate risks associated with working within these environments, controls such as hazard rating sheets have been developed for use by field personnel that enable escalation of assessment and implementation of mitigation measures as may be required to manage the risk. Where these risks are present in active mining operations, assessment of the natural geohazards must be integrated with ground control management tools such as ground awareness training, trigger action response plans, and geotechnical hazard plans. This paper provides an example of a site-specific framework for natural slope hazard management in the Pilbara and how GIS-based susceptibility mapping and rockfall hazard rating field assessment sheets are integrated into the operations ground control management system.

Closure planning is a fundamental requirement for all existing and planned future mines. However, there are no accepted industry guidelines for how to geotechnically and hydrogeologically assess options for open pit and waste dump closure or for advancement of the closure plan in parallel stages with overall project development and operation. Ideally, closure planning needs to consider the site setting, develop the “big-picture” strategy, and work downward from there, balancing the objectives of the operator, regulator and community. At present, too much binding detail is being included in “early-stage” closure plans that, when approved, become committed. This paper outlines the “State-of-Practice” geotechnical and hydrogeological guidelines for closure planning and implementation being developed by the Large Open Pit (LOP) project research group. The new Guidelines are intended for use by geotechnical and hydrogeological mining professionals addressing closure design criteria, risk management, detailed planning and implementation. Benchmarks are provided for stakeholders, including regulators and the community, to judge whether adequate investigations and planning have been completed for appropriate stages of overall project development. Three case studies are provided to illustrate how changes of closure approach produced a substantially better outcome

Rising concerns around antimicrobial resistance (AMR) have led to a renewed push to rationalise antibiotic prescribing in low- and middle-income countries (LMICs). There is increasing unease in conceptualising antibiotic use as individuals behaving '(ir)rationally' and recognition that rising use is emergent of and contributing to wider economic and political challenges. But in between these individual and societal 'drivers' of antibiotic use is an everyday articulation of care through these substances, written-in to the scripts, delivery chains and pedagogics of global healthcare. This article focuses on this everyday 'architecture' that over time and across spaces has knitted-in antibiotics and rhetorics of control that inform current responses to AMR. Based on historically informed ethnographic research in Zimbabwe, we examine points of continuity and change between 20th Century rational drug use (RDU) discourses and contemporary socio-political formations around AMR and antimicrobial stewardship (AMS), paying particular attention to their co-evolution with the process of pharmaceuticalisation. We illustrate how the framework and techniques of RDU were embedded within programmes to increase access to essential medicines and as such complemented the building of one of Africa's strongest postcolonial health systems in Zimbabwe. Whilst 20th Century RDU was focused on securing the health and safety of patients and affordability for systems, AMS programmes aim to secure medicines. Continuous through both RDU and AMS programmes is the persistent rhetoric of 'irrational use'. Health workers in Harare, attuned to the values and language of these programmes, enact in their everyday practice an architecture in which antibiotics have been designed-in. This research illustrates the struggle to optimise antibiotic use within current framings for action. We propose a reconfiguring of the architecture of global health such that frontline prescribers are able to provide 'good' care without necessarily turning to antibiotics. To design-out antibiotic reliance would require attention beyond '(ir)rationality', to the redrafting of blueprints that inscribe practice.

BackgroundAs concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.DesignThis article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.ResultsThe most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.ConclusionsOur findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.

Rising concerns about antimicrobial resistance have sparked a renewed push to rationalise and ration the use of medicines. This article explores the case of the Integrated Management of Childhood Illness (IMCI) guideline, a periodically updated ‘global’ algorithm that shapes and normalises the centrality of medicines to care in low- and middle-income countries and, increasingly, the imperative to ration them. Using ‘classification work’ as analytic frame, we firstly consider the IMCI algorithm as a blueprint for global health that classifies illnesses, patients, and care in particular ways relative to available medicines. Zooming in on this blueprint, we then offer a classificatory reading of ‘fever’ over time, tracing ‘nonmalarial fever’ from being malaria’s residual ‘other’ category to becoming increasingly legible through attention to diagnostics and antibiotic (over)use. Our reading suggests that an apparent refinement of the ‘fever’ category may concurrently entail the closing down of medicine options. This raises the possibility that an increasingly high-tech but ‘empty’ form of pharmaceuticalised care is being incidentally worked into the infrastructure of weak health systems.

Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category ‘antibiotic’ does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a ‘Drug Bag’ method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. We illustrate the kinds of qualitative and quantitative data the method can produce, comparing and contrasting our experiences in different settings. The Drug Bag method can produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples’ everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.

Background Overuse of antibiotics is one of the main drivers for antimicrobial resistance (AMR). Globally, most antibiotics are prescribed in the outpatient setting. This survey aimed to explore attitudes and practices with regards to microbiology tests, AMR and antibiotic prescribing among healthcare providers at public primary health clinics in Harare, Zimbabwe. Methods This cross-sectional survey was conducted in nine primary health clinics located in low-income suburbs of Harare between October and December 2020. In Zimbabwe, primary health clinics provide nurse-led outpatient care for acute and chronic illnesses. Healthcare providers who independently prescribe antibiotics and order diagnostic tests were invited to participate. The survey used self-administered questionnaires. A five-point Likert scale was used to determined attitudes and beliefs. Results A total of 91 healthcare providers agreed to participate in the survey. The majority of participants (62/91, 68%) had more than 10 years of work experience. Most participants reported that they consider AMR as a global (75/91, 82%) and/or national (81/91, 89%) problem, while 52/91 (57%) considered AMR to be a problem in their healthcare facilities. A fifth of participants (20/91, 22%) were unsure if AMR was a problem in their clinics. Participants felt that availability of national guidelines (89/89, 100%), training sessions on antibiotic prescribing (89/89, 100%) and regular audit and feedback on prescribing (82/88, 93%) were helpful interventions to improve prescribing. Conclusions These findings support the need for increased availability of data on AMR and antibiotic use in primary care. Educational interventions, regular audit and feedback, and access to practice guidelines may be useful to limit overuse of antibiotics.

Although access to healthcare has improved since South Africa’s democratic transition, neoliberal reforms have had detrimental effects on clinic-community and nurse-patient relationships, undermining efforts to control tuberculosis (TB). This article focuses upon the work of nurses in three public health clinics in the Western Cape, South Africa. We explore how they experienced, made sense of and grappled with the challenges of TB control, especially patients “defaulting” on medication. Paying particular attention to confrontations between nurses and patients, we build upon previous qualitative studies that have contested popular constructions of nurses as “rude” and “uncaring.” We argue that patient blaming and scolding need to be understood in light of nurses having to tread a fine line between compassion and assertiveness, individual and public good against the backdrop of a dissonance between the theory and reality of TB control. Nurses’ confrontational approaches are responses to the messy reality of TB control on the ground, solutions to which require attention to the socioeconomic and historical context of nursing and primary healthcare. In the absence of such attention, animosities between clinics and communities could continue being cyclically reproduced.

Much of the current social science literature on the clinical trials industry focuses on the profit-seeking practices adopted by pharmaceutical companies and the contract research organisations they employ to enable the mass production and distribution of their products. However, what the current literature demands is further ethnographic engagement with the particularities of the diseases being investigated, the local contexts and histories in which they are entwined, and how these impact the affective relationships between clinical research organisations and their participants. On the basis of ethnographic research with a nonprofit clinical research organisation specialising in TB vaccinations in South Africa, I argue that the complexities of TB mean that research into it necessitates frequent and often intimate interactions with research participants. These were perceived by researchers to yield opportunities to take an interest in the physical and psychosocial wellbeing of research participants which went beyond and sometimes ran into conflict with the requirements of protocol. The aim of this paper is to advocate more finely tuned attention to the challenges posed by the clinical trials industry today, an attention sensitive to the particularities of the contexts of clinical trials.