Patterns of common illness and injury of readymade garment workers and a review of safety practices in Bangladesh

Abstract

BACKGROUND:

Readymade garment workers globally experience distinctive vulnerabilities at the workplace. The situation is worse in many developing countries. However, there is a lack of scientific evidence about the health and safety of garment workers in the workplace.

OBJECTIVE:

The objective of this study was to examine the patterns of illness and injury of garment workers, factory level health safety policies and programs, and views and perception of management staff at factories in Bangladesh.

METHODS:

This mixed-method study was conducted among garment workers and management level staff between January 2018 and April 2019. We extracted 4000 health records of the workers who attended primary health care centers of the factories and conducted 11 key informant interviews using qualitative method from different management-level staff.

RESULTS:

Half of the workers (51.0%) were working in the sewing section following 12.8% in quality control and 12.3% in the laundry section. A review of the medical records showed that peptic ulcer diseases (PUDs) (19.2%), fever (11.7%), loose motion (10.3%), and headache (9.4%). Needle injury was uncommon for taking medical care. Occupational safety and health management, safe drinking water, access to maternity leave and other facilities were better in large and medium factories compared with those in small factories.

CONCLUSIONS:

Although the readymade garments sector is one of the largest sources of foreign currency revenue earnings in Bangladesh, occupational health and safety issues of workers remain a big concern. Thus, support from the government needs more focus on the health and safety of workers.

Keywords

Readymade garment workers illness and injury health safety quantitative and qualitative data Bangladesh

1 Introduction

Globally, readymade garment workers are vulnerable at their workplace [1, 2]. An unhealthy working environment, an intense work-schedule, low-wages, and low-food intake and sexual-harassment, are very common in the factory [3, 4]. However, South and Southeast Asian countries’ workers are suffering a lot due to unhealthy environment in the workplace [3], specifically health related problems are the most significant problem facing by workers [5]. A study conducted by Padmini and Venmathi categorized these problems into five groups: (a) ergonomic hazards, (b) physical hazards, (c) psychological hazards, (d) mechanical hazards, and (e) chemical hazards [6].

In 2015, Bangladesh was the third leading manufacturer and exporter of garment and textile products worldwide [7], and in recent years it has become the second largest industry with 7,000 estimated exporting factories employing 6 million workers [8]. Unfortunately, a big accident at Tazreen Fashions, a ready-made garment factory in Dhaka occurred in 2012, causing 112 deaths [9]. A few months later, the largest incident occurred in history, in another factory, the Rana Plaza building, that collapsed on 24 April 2013, causing the death of 1,129 mainly female garment workers and injuring more than thousands [10, 11]. Most of the injured workers’ lives became very difficult later on.

In low-middle-income countries (LMICs), factory workers are vulnerable to arbitrary conditions set by their local employers, work pressure from buyers and local challenges including monitoring by the government for their basic rights as citizens. Most of the factory workers have limited access to healthcare due to long working hours and low-wages [12]. As a result, 85% of female workers in Bangladesh showed suffering from malnutrition, reproductive health problems, and other diseases [12]. The International Labour Organization (ILO) reported that excessive working hours and inadequate periods of rest might damage workers’ health conditions and increase the risk of workplace accidents [13].

Bangladesh is one of the major readymade garment (RMG) items exporters to the world community because of cheap labour (i.e. low-wages) and available work forces [14]. This job is available as no technology/prior skills are needed for this job, and there is a lack of alternative job options, particularly for women. However, RMG industries in Bangladesh are playing the main role of nation’s economic development and income opportunities for women [14]. These benefits come at a considerable cost to the women. A recent study conducted in Bangladesh showed that 77–80% of female RMG workers are anemic [15] and suffer a lot in their later life. Working conditions in garment factories and the impact on the health of garment workers is a pressing concern within the garment industry. However, there is a lack of information about the health and safety of garment workers in the workplace. Therefore, this study aimed 1) to describe garment workers’ illness and injury profile at the workplace, 2) to identify prevalent health and safety hazards at the workplace, 3) to learn about the perception of factory management staff on existing safety and health hazards at their factories, and 4) to document existing factory level policies and programs on health and safety.

2 Materials and methods

A cross-sectional (both quantitative and qualitative) design was employed for this study. The data were collected from three categories (small, medium, and large) of garment factories purposively selected from the different industrial areas in and around the Dhaka City of Bangladesh. Specifically, one garment was inside the Dhaka North City Corporation located in Mirpur area. The other two garment factories were in the industrial zone area close to Dhaka city named Gazipur District in Bangladesh. However, all garment factories were involved in the same activities and the same types of workers work there.

2.1 Study participants and data collection

All three (one from a small category, one from a medium category and one from a large category) factories have a primary healthcare center run by the management. If workers become sick, they can visit the healthcare center and receive the primary healthcare free of charge. After the primary healthcare support, if further treatment is needed then the management of the factory sends them to the private or government run hospitals for secondary health care services. Some garment factories have referral systems in place to some tertiary hospitals. Most of the garment factories provide common drugs free of charge during the working hours. The details of the categories of the garment factories for this study are described below.

Small category factories: This category has less than 2000 workers including common production sections. Here, the primary healthcare center is run by a nurse or a paramedic with two other junior nurses for healthcare services. In most cases, the health care center is located in a single room where workers can come to get the primary healthcare. They have a blood pressure (BP) measurement machine and other basic tools including a first aid kit.

Medium category factories: This category has between 2000 to 4500 workers and much better health care facilities compared with small category factories. Their primary health care center is run by a medical doctor who comes twice a week but a senior nurse provides full time services with the support from other healthcare staff. They maintain their activities in a systematic way, such as keeping record of symptoms and more common medicine for the primary healthcare. They also have a referral system with the secondary or tertiary hospitals.

Large category factories: This category has more than 4500 workers and the health center is led by two full-time medical doctors including a female doctor. In addition, they have two full-time nurses and one health technologist. They are more equipped and connected with more referral hospitals for the secondary healthcare of the workers. In addition, they have transport services for sending severe cases to referral hospitals. They can prescribe more essential drugs as the management team keep in the dispensary for the workers.

Participants of this study were selected from three categories of garment factories. Figure 1 shows the number of workers working in the three categories of a garment factory and we included those workers into our study who visited the respective staff clinic/healthcare center for any kind of illness or injury during the study period. In the small category of garment factories we included in this study, about 67.1% of the workers visited the primary healthcare center, whereas this was 72.1% from medium and 30.1% from large factories.

Fig. 1

Participants of the different categories of garment factories in this study.

Our trained research assistant visited each category of the factories mentioned above. The small category factory had 1,050 workers where we obtained health records of 705 (67.1%) workers who sought medical care. We included one-time visit health records within 16 months. Out of the total workers in the small category of the factory, 35% were male and 65% female. In the medium category factory, we obtained data of 72.1% workers and in the large factory category 30.1% workers who visited their respective health care center for healthcare services.

2.2 Quantitative data collection

After the selection of garment factories based on the above mentioned criteria, our trained research staff visited the garment factories for collecting the medical records. The health clinic visit records from January 2018 to April 2019 of the workers were collected from the register books kept by those factories. The trained research staff took photocopies and photos of the records from the register book between May and October 2019. The information included age, sex, working section, symptoms during illness, and category of the workers. From the photocopies of the record, our trained research staff entered the data into a database using SPSS Software, and then cleaned and coded as needed for the analyses. Both quantitative and qualitative data collection communication with factories was supported through a personal connection as sometimes factories do not allow data collection from inside of the factory.

2.3 Qualitative data collection

For qualitative data collection, we conducted a total 11 (four from the large factory, four from the medium factory, and three from the small factory) key informant interviews (KIIs) with the management level staff of the factories who were directly involved with the health care and safety issues. We tried to cover all tiers of management level staff including Executive Admin and HR Manager, Clinic-in-Charge, Staff Nurse, Welfare Officer, HR and Compliance Officer, Fire Safety Officer, and others. The KIIs of the management level personnel were conducted using a structured questionnaire by the trained researchers having experience with qualitative methods. Each interview was conducted in a quiet place and at a convenient time for the respondents. All interviews were recorded by taking extensive notes during data collection. Right after the data collection, each interview was written out, reviewed, edited, re-reviewed and finally summarized by the researchers. Further, the data were reviewed and coded by the trained qualitative researcher. Thematic content analysis was followed for the qualitative part. The study also followed both method triangulation and data source triangulation. The method triangulation includes KIIs and field records. Data source triangulation involves the collection of data from the different management-levels of staff of the garment factories. As an example of data source triangulation, we collected data from Executive Admin and HR Manager, Clinic-in-Charge, Staff Nurse, Welfare Officer, HR and Compliance Officer, and Fire Safety Officer. Besides, we collected both quantitative and qualitative data in different time periods.

2.4 Policy review

Bangladesh has developed and revised several policies for the safety of garment workers. To identify the gap on prevalent health and safety hazards at the workplace, we visited the respective authorities and collected available policies both hard and soft copies. Then we reviewed existing available policies for the workers.

Ethical approval

The main protocol named “GEOHealth Hub protocol” including this study was reviewed and approved by the Research Review Committee and the Ethical Review Committee of the International Centre for Diarrhoeal Disease Research, Bangladesh. Written informed consent was obtained from the management level staff for qualitative data collection.

2.5 Data analysis

Quantitative analysis: We conducted a basic analysis including Pearson chi-square based on the characteristics of the data and objectives of this study. We ran the chi-square tests to examine the differences of the variables between genders of the participants. We performed statistical analysis using SPSS Software, version 25 (IBM Corp., Armonk, NY, USA).

Qualitative analysis: We conducted thematic content analysis for qualitative data. Firstly, we checked the written interviews for errors and compared with field notes following the method triangulation. The researchers reviewed the hand written interviews multiple times for familiarization of data. Secondly, a list of a priori codes was developed initially from the interviews. The data was arranged in cluster per code. The researchers then re-visited the interviews to identify the key themes generated from the interviews. Information extracted from the interviews that provided evidence for each theme and categories extracted. Finally, a report was outlined including each theme and sub-theme for the qualitative part.

3 Results

Out of the total participants in the medium category of the factory, males were 20–55 years old whereas females were 18–50 years old. About 72.1% (1595/2213) workers visited the healthcare center from the medium category of garment factories. However, in the large category of the garment, 35% are males between 18–65 years old and 65% females are between 18–50 years old. In the large category, only 30.1% visited the healthcare center.

Table 1 shows almost 71.0% of the workers who visited in the health care center of the garment factories were female. 99.3% of the workers were full-time workers. More than two-fifths (42.5%) of the workers were working in the high facility-level (large) factory in the Dhaka city, of which more than half (56.9%) were between 25–35 years old. The participants who sought primary health care from the health center run by the respective garment factory in the workplace were 67.0% working as operator and 11.9% were quality inspectors. Out of the total participants, more than half (50.9%) were working in the sewing section, 12.8% were in the quality control section, and 12.3% were in the laundry section.

Table 1
Basic characteristics of the workers participated in this study (N = 4,000)

Variables Frequency Percentage

(%)

Category of the garment factory

Small facility 705 17.6

Medium facility 1595 39.9

Large facility 1700 42.5

Sex

Male 1177 29.4

Female 2823 70.6

Staff category

Full time 3973 99.3

Part-time 27 0.7

Age

18–24 years 1196 29.9

25–35 years 2277 56.9

36–46 years 483 12.1

47–60 years 44 1.1

Designation of the garment workers

Helper 318 8.0

Operator 2681 67.0

Supervisor 152 3.8

Over than supervisor 53 1.3

Quality inspector 475 11.9

Others 321 8.0

Working section

Sewing 2036 50.9

Cutting 332 8.3

Quality 513 12.8

Laundry 67 1.7

Finishing 493 12.3

Others 559 14.0

Variables	Frequency	Percentage
Category of the garment factory
Small facility	705	17.6
Medium facility	1595	39.9
Large facility	1700	42.5
Sex
Male	1177	29.4
Female	2823	70.6
Staff category
Full time	3973	99.3
Part-time	27	0.7
Age
18–24 years	1196	29.9
25–35 years	2277	56.9
36–46 years	483	12.1
47–60 years	44	1.1
Designation of the garment workers
Helper	318	8.0
Operator	2681	67.0
Supervisor	152	3.8
Over than supervisor	53	1.3
Quality inspector	475	11.9
Others	321	8.0
Working section
Sewing	2036	50.9
Cutting	332	8.3
Quality	513	12.8
Laundry	67	1.7
Finishing	493	12.3
Others	559	14.0

Table 2 shows symptoms and diseases of the participants. Participants who visited the healthcare center, their symptoms and diseases were peptic ulcer diseases (PUDs) (19.2%), fever (11.7%), loose motion (10.3%), headache (9.4%), weakness (9.2%), and others.

Table 2

Symptoms and diseases of the participants (N = 4,000)

Symptoms/diseases	Frequency	Percentage
		(%)
Abdominal pain	13	0.3
Abscess	19	0.5
Allergy	40	1.0
Back pain	33	0.8
Body ache	144	3.6
Chest pain	19	0.5
Common cold	211	5.3
Cough	12	0.3
Dysentery	12	0.3
Dysmenorrhea	59	1.5
Dysphagia	13	0.3
Eye problem	34	0.9
Fever	469	11.7
Hand pain	50	1.3
Headache	375	9.4
Hypertension	36	0.9
Itching	13	0.3
Lower abdominal pain (LAP)	61	1.5
Low back pain (LBP)	34	0.9
Loose motion	413	10.3
Leg Pain	84	2.1
Neck pain	110	2.8
Needle injury	6	0.1
Pain	132	3.3
Pregnancy	39	1.0
Peptic ulcer diseases (PUDs)	768	19.2
Road traffic accident (RTA)	41	1.0
Sore throat	42	1.1
Tonsillitis	14	0.4
Tooth pain	37	0.9
Vertigo	64	1.6
Vomiting	147	3.7
Weakness	368	9.2
Others	88	2.3

In Table 3, during the sex differences analysis, age category, category of the garment factories, position of the workers in the factories and working sections showed significant differences between males and females. Interestingly, tonsillitis and toothache were more common in females compared with male participants. Among the participants, fever was higher among females (12.1%) compared with males (10.8%), however, common cold was higher in male (7.1%) compared with females (4.5%). We found only 6 cases of needle injury from this data. Pain-related problems higher more in females (4.0%) compared with males (1.5%).

Table 3

Association between sex and age, category of garment factory, designation and working sections of the workers

Variables	Male	Female	p-value
Age
18–24 years	349	847	<0.001
25–35 years	640	1637
36–46 years	157	326
47–60 years	31	13
Category of the garment factory
Small facility	94	611	<0.001
Medium facility	581	1014
Large facility	502	1198
Designation of the garment workers
Helper	67	251	<0.001
Operator	588	2093
Supervisor	120	32
Over than supervisor	48	5
Quality inspector	190	285
Others	164	157
Working section of the workers
Sewing	348	1688
Cutting	136	196	<0.001
Quality	222	291
Laundry	27	40
Finishing	160	333
Others	284	275
Symptoms during illness
Abdominal pain	3	10
Abscess	6	13
Allergy	8	32
Back pain	5	28	<0.001
Body ache	50	94
Chest pain	6	13
Common cold	84	127
Cough	3	9
Dysentery	6	6
Dysmenorrhea	2	57
Dysphagia	4	9
Eye problem	8	26
Fever	127	342
Hand pain	14	36
Headache	132	243
Hypertension	10	26
Itching	3	10
Lower abdominal pain (LAP)	15	46
Low back pain (LBP)	11	23
Loose motion	101	312
Leg Pain	30	54
Neck pain	32	78
Needle injury	1	5
Pain	18	114
Pregnancy	0	39
Peptic ulcer diseases (PUDs)	274	494
Road traffic accident (RTA)	15	26
Sore throat	11	31
Tonsillitis	1	13
Tooth pain	5	32
Vertigo	12	52
Vomiting	23	124
Weakness	130	238
Others	29	59

Table 4

Qualitative data collected from the management level staff of garment factories (N = 11)

Particulars/Items	Small category factories	Medium category factories	Large category factories
Item 1: Hospitalization/clinical and medicine support to the employees	1. No hospitalization facility 2. No medicine shop in the factory premises	1. No hospitalization facility 2. There is a small medicine shop near factory premises	1. On emergency, a care center for few hours2. There is a medicine shop in the factory premises
Item 2: Maternal leave and healthcare services	1. 90 days maternity leave2. Have a trained female nurse	1. 112-120 days maternity leave 2. Have a female doctor3. Provides some sort of ANC care	1.112-120 days maternity leave. 2. Have female doctor for full time of services and provides full ANC care
Item 3: Cancer screening program and other healthcare services such as physiotherapy	1. Do not have any services related to cancer screening and physiotherapy	1. Don’t have any services related to cancer screening and physiotherapy	1. Don’t have any services related to cancer screening and physiotherapy
Item 4: Day-care center for the children of the workers	1. No day care center	1. A day care center is available in premises	1. A day care center is available in premises
Health awareness and vaccination program	2. No health awareness program 3. No vaccination program	2. No health awareness program 3. No vaccination program	2. Have health awareness program 3. No vaccination program
Item 5: Transportation in case of emergency illness	1. No transportation facility for the workers in case of emergency illness	1. Have a transportation facility for the workers in case of emergency illness	1. Have a transportation facility for the workers in case of emergency illness
Item 6: Safe drinking water and toilets for the workers	1. Have separate toilet for male and female workers 2. Using filtered water for drinking	1. Have separate toilet for male and female workers 2. Using a deep tube-well water for drinking	1. Have separate toilet for male and female workers 2. Using a deep tube-well water for drinking
Item 7: Perception of overall working environment and safety for the workers	1. Provide safety training for the workers	1. Provide safety training for the workers	1. Provide safety training for the workers2. Had a proper ventilation and fire equipment
Item 8: Compliance for code of conduct	1. Follow the code of conduct for the compliance	1. Follow the code of conduct for the compliance	1. Follow the code of conduct for the compliance
Item 9: Fire warning and evacuation system in the factories	1. No fire safety officer in the factory 2. Not enough firefighting equipment 3. No heat detector equipment	1. A Fire safety officer is in the factory 2. Most of the firefighting equipment are in the factory3. No heat detector equipment	1. A Fire safety officer is in the factory 2. Most of the firefighting equipment are in the factory3. No heat detector equipment

General facilities and rights: In our study, we found that workers in both large and medium factories had options to earn 10 days leave and 14 days sick leave. Most of the large and medium factory workers perceived that they had a hygienic working environment and they were following the existing guidelines of the Bangladesh Garments Manufacturer and Exporter Association (BGMEA) regarding maintenance of hygiene in the factory. Besides, all big and medium factories had a policy of sexual harassment and a plan to introduce health schemes for the workers.

The qualitative data showed that most of the management-level staff informed that their garment factories had Accord Standard compliance level facilities where doctor and nurses were available. In this regard, BGMEA, the government of Bangladesh and international buyers’ brand were in an agreement to improve the overall health and safety condition of the RMG sector. Besides, their opinion was that the health and safety condition and rules have been changing dramatically after the Rana Plaza disaster in 2013. They also mentioned that they were regularly providing health and safety education to the staff. However, most of the KIIs mentioned that they had limitations on ANC care, vaccination, and women’s cancer screening, and others advanced health care facilities for the workers. They also added that they need to improve fire safety and other safety issues as per occupational safety and health convention, known as ILO convention 1981 No. 155.

Policies and laws

Amendment of Labour Law: In Bangladesh, there are several major national policies linked to labour law [16]. However, after the Rana Plaza collapsed in 2013, the Bangladesh Labour Act, 2006 was amended on 16th July 2013 to ensure workers’ safety, welfare and rights and promote trade unionism for mutual bargaining with the factory owners [13]. This amendment brings about certain improvements in freedom of association, collective bargaining, and safety in the workplace. More specifically, trade union registration has been made easier and more accountability.

Minimum wages of garment workers in Bangladesh: The government has negotiated with the association of garment owners and declared the minimum wages for the workers, with an increase of 77% from previous wages [17]. This has been implemented since 1^st December 2013. Now the minimum wage for garment workers is Tk 5300/- which is about US$68 [17].

4 Discussion

This study revealed common illness or illness-related symptoms recorded while garment workers sought primary health care from the respective Primary Health Care clinic of the garment factories in Bangladesh. Most common illnesses or symptoms or diseases were PUDs (19.2%), fever (11.7%), common cold (5.3%), headache (9.4%), and loose motion (10.3%). In this study, the garment workers were suffering from PUDs (19.2%), which was higher than the prevalence of PUDs (15%) among the general population in Bangladesh, whereas PUDs among developed countries’ population is only 1.5% [18]. This indicates that garment workers are doing their work in a stressful situation, with low-nutrition and other consequences. There should be counseling services in the factory on disease prevention and workplace safety. Individual garment factories must take necessary steps for health checkup of the workers on a regular basis. For the healthcare support of the workers, group insurance can be introduced under the universal health care scheme through buyers of the products.

In this study, we found that 11.7% of the participants had fever and 5.3% had common cold, which are consistent with other studies conducted in low-and-middle income countries (LMICs) [5 , 20]. However, respiratory problems among garment workers are very common. A recent review article showed that respiratory problems are common among garment workers due to common cold, fever, and headache [21]. In our study, we also categorized the patients based on their symptoms such as fever, common cold, cough, loose motions and others. However, in the study by Ahmed and Raihan, 82.0% of garment workers had experienced persistent fever and 79% had high cold [5]. Our study included review of a large number of health records of garment workers who attended health centers and symptoms-based diagnoses of illnesses were performed by medical health professionals of the respective garment factories. The face-to-face interview is difficult sometimes for the garment workers. Thus, in this study we collected data from the clinical records kept by the health professionals in the garment factories. After the Rana Plaza disaster, owners of garment factories ensured a good workplace environment more suitable for the workers. In addition, this will in the future reduce the disease burden and will make a good product which will earn more foreign currency for the country.

Musculoskeletal problems including headache, body ache, back pain, LAP, LBP and neck pain were very common among garment workers. These may be due to long working hours, sound pollution in the factory, and others. A study conducted in Ethiopia found that musculoskeletal elbow and wrist disorders among sewing machine operators [22]. Findings from our study also showed that more than half (50.9%) of the workers are working in the sewing section and many of them are suffering from musculoskeletal problems. It might gradually become severe with a longer duration of working in this section. Further follow-up studies are needed to assess such problems. In addition, designing an awareness program involving health professionals, NGOs, and a team from the respective garment factory to provide information and counseling for reducing and avoiding musculoskeletal problems.

In recent years, non-communicable diseases (NCDs) are increasing among garment workers. However, in our study, we found that only about 1.0% of garment workers had hypertension. This low percentage of hypertension among participants of this study might be due to the younger age of the workers as 87.0% of them were between 18–35 years old. The other study conducted in Dhaka city showed that 4.8% of workers had been suffering from hypertension, where only 145 participants were interviewed [23]. However, there is lack of data as many of the workers are unwilling to go for the test, care, and treatment due to related costs. There might be chances the cases are underreported. Thus, factory-based screening on NCDs is a high priority which can prevent NCD-related diseases and premature death among a vulnerable group of workers. Early screening can not only save their lives but also provide a more productive life in the future.

The participants’ age and category of garment factory showed significant differences between the male and female participants. This may be due to younger participants working at the average quality of the factory. In most cases, experienced workers tend to work in a high-quality factory. In Bangladesh, garment workers start their work as helpers and, in the next stage, start as operators in the factory. Back pain and pain symptoms during illness showed mostly among females compared with males. This might cause extra working hours or no movement during work.

During qualitative data collection, we asked about the workplace safety and working environment issues. This is crucial because they stay and work 8–10 hours a day in this environment. If the environment of the factory, such as ventilation, space and proper working equipment, is not organized in a sagacious way, the health condition of the workers will be execrable. The KIIs revealed that owners of the garment factories are now following rules and regulations of workers’ safety instructed by the government and buyers. They arranged fire drills every 3 months as well as other safety training as mentioned by most of the members. However, every garment factory has the necessary firefighting equipment and train workers what they should do during an emergency. Most of the management members mentioned that almost every garment factory follows the International Labor Organization (ILO) convention 155(1981) on occupational safety and Health. Regarding the general facilities and workers’ rights issue, they state that most of the time they follow the BGMEA rules.

The management staff of these factories recommended specialized hospitals and special physiotherapy centers for garment workers.

This study has several limitations. Firstly, we were not able to conduct face-to-face interviews. However, we used healthcare data that was recorded by the primary healthcare center of the garment factories. We took photos of the health records and analyzed them to examine the illness profiles of the workers. In this analysis we were not able to make categories of the diseases using the ICD-code as we do not confirm on diseases through records. Further studies need to be conducted through face-to-face data collection focusing on NCDs and use the diseases code. Secondly, it was not possible to take measurements of participants’ health, which could have been valuable for the health profile of the workers. Thirdly, we were not able to collect any information on preventive health measures from the participants. Finally, our study is cross-sectional; hence, we could not investigate the causality. However, we received some information from interviewing the management level staff of those garment factories.

This study has several strengths too. First, the sample size was large enough to represent the real-life scenario of symptoms-based illness patterns of garment workers in the workplace. Secondly, we conducted key informative interviews with the management level staff of the selected garment factories to obtain their opinion on workers’ health and safety plans and support for the future.

5 Conclusions

Even though the RMG sector is bringing the second highest revenue income in Bangladesh, occupational health and safety showed a big gap among the garment workers. This study revealed that garment workers are suffering from different types of illness, lack of getting care at the workplace including health screening, unavailability of medicines at garment compounds, and other healthcare-related facilities. This is the time to urgently focus on the healthcare of workers to prevent diseases through a proper surveillance system and maintaining a good database of the workers. In addition, safe care, safe drinking water, maternity leave and other facilities are needed for better health of the workers. Policymakers and garment owners need to take urgent actions for future healthcare policy for workers to be workable and healthy. Ultimately, a standard healthcare policy for the workers can bring good well-being and strong wealth to the country.

Ethical approval

The GEOHealth Hub protocol including the pilot study was reviewed and approved by the institutional review board (IRB) consisting of the Research Review Committee and Ethical Review Committee of the International Centre for Diarrhoeal Disease Research, Banglades. The protocol number is PR-15111 and the IRB number is IRB00001822.

Informed consent

Written informed consent was obtained from the management level staff for qualitative data collection.

Conflict of interest

None of the authors have any conflict of interest to declare.

Footnotes

Acknowledgments

We acknowledge the support with data collection of a local NGO named Green Foundation (Sobujher Ovijan Foundation) with 14 years of working experience on garment workers’ health and safety issues in Bangladesh, and respective factories and staff.

Funding

This study was performed under a project funded by the Fogarty International Center of the National Institutes of Health (NIH) under Award Number U01TW010120.

Author contributions

All authors contributed to the design of the study. Study implementation was managed by SEH, TI, HEM M E, SA and MY. The analyses were performed by SEH, BKD, and RA. The first draft was completed by SEH, BKD, RA and MY. All authors critically reviewed the manuscript and approved the final draft for the publication.

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