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Adhikari TB, Sigsgaard T, Kallestrup P, Kurmi O. Reshaping the fabric of health: a call for improving the respiratory health of textile workers in low- and middle-income countries. Eur Respir J 2024; 63:2301803. [PMID: 38238001 DOI: 10.1183/13993003.01803-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/17/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Tara Ballav Adhikari
- Research Unit for Environmental and Occupational Medicine, Department of Public Health, Aarhus University, Aarhus, Denmark
- Nepal Health Frontiers, Kathmandu, Nepal
- Nepal Development Society, Chitwan, Nepal
| | - Torben Sigsgaard
- Research Unit for Environmental and Occupational Medicine, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Per Kallestrup
- Research Unit for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Om Kurmi
- Faculty Centre for Healthcare Research and Communities, Coventry University, Coventry, UK
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Nexus Institute of Research and Innovation, Lalitpur, Nepal
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Nafees AA, Allana A, Kadir MM, Potts J, Minelli C, Semple S, De Matteis S, Burney P, Cullinan P. A cluster randomised controlled trial to reduce respiratory effects of cotton dust exposure among textile workers: the MultiTex RCT study. Eur Respir J 2024; 63:2301028. [PMID: 37857425 DOI: 10.1183/13993003.01028-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND We determined the effectiveness of an intervention to reduce cotton dust-related respiratory symptoms and improve lung function of textile workers. METHODS We undertook a cluster randomised controlled trial at 38 textile mills in Karachi, Pakistan. The intervention comprised: training in occupational health for workers and managers, formation of workplace committees to promote a health and safety plan that included wet mopping and safe disposal of cotton dust, provision of simple face masks, and further publicity about the risks from cotton dust. Participating mills were randomised following baseline data collection. The impact of the intervention was measured through surveys at 3, 12 and 18 months using questionnaires, spirometry and dust measurements. The primary outcomes were 1) changes in prevalence of a composite respiratory symptom variable, 2) changes in post-bronchodilator percentage predicted forced expiratory volume in 1 s (FEV1) and 3) changes in cotton dust levels. These were assessed using two-level mixed effects linear and logistic regression. RESULTS Of 2031 participants recruited at baseline, 807 (40%) were available at the third follow-up. At that point, workers in the intervention arm were more likely to report an improvement in respiratory symptoms (OR 1.58, 95% CI 1.06-2.36) and lung function (FEV1 % pred: β 1.31%, 95% CI 0.04-2.57%). Personal dust levels decreased, more so in intervention mills, although we did not observe this in adjusted models due to the small number of samples. CONCLUSION We found the intervention to be effective in improving the respiratory health of textile workers and recommend scaling-up of such simple and feasible interventions in low- and middle-income countries.
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Affiliation(s)
- Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Genomic and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Asad Allana
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - James Potts
- Genomic and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Cosetta Minelli
- Genomic and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sara De Matteis
- Genomic and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Peter Burney
- Genomic and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Paul Cullinan
- Genomic and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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Khan M, Muhmood K, Noureen S, Mahmood HZ, Amir-Ud-Din R. Epidemiology of respiratory diseases and associated factors among female textile workers in Pakistan. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 28:184-198. [PMID: 32602797 DOI: 10.1080/10803548.2020.1751973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective. The study aimed to estimate the prevalence of byssinosis and other respiratory symptoms among women textile workers and the associated risk factors in 18 spinning mills of Faisalabad and Lahore districts of Punjab, Pakistan. Method. In this case-control study of 1054 female workers, we used the dose-response function to measure the association between dust level and respiratory disorders in cotton textile workers. Results. Working overtime and long working hours per week are significantly associated with self-reported symptoms of byssinosis. Women's age, marital status and wages were significantly associated with mitigating actions (seeing the doctor), while the education of the women was significantly associated with averting action (use of a mask). Conclusion. Regulating working hours and ensuring employees' compliance with the safety standards are expected to mitigate the health problems of female workers.
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Affiliation(s)
- Muhammad Khan
- Department of Economics, COMSATS University Islamabad, Pakistan
| | - Kashif Muhmood
- Department of Economics, COMSATS University Islamabad, Pakistan
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Nafees AA, De Matteis S, Kadir MM, Burney P, Coggon D, Semple S, Cullinan P. MultiTex RCT - a multifaceted intervention package for protection against cotton dust exposure among textile workers - a cluster randomized controlled trial in Pakistan: study protocol. Trials 2019; 20:722. [PMID: 31842937 PMCID: PMC6913022 DOI: 10.1186/s13063-019-3743-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/23/2019] [Indexed: 12/04/2022] Open
Abstract
Background In the Pakistani textile industry the prevalence of workplace respiratory illnesses, including byssinosis, is high. The MultiTex RCT study aims to determine the effectiveness of a multifaceted intervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory symptoms among cotton textile workers, and improving their lung function. Methods/design We will conduct a cluster-randomized controlled trial at 28 textile mills in Karachi. The intervention will comprise: training in occupational health for all workers and managers reinforced by regular refresher sessions; the formation of workplace committees to draw up, agree and promote a health and safety plan that includes wet mopping, safe disposal of cotton dust, and the use of simple face-masks, as well as further publicity about the risks from cotton dust; and provision of adequate supplies of face-masks to support the health and safety plan. Participating mills will be randomized to intervention and control arms following a baseline survey. The impact of the intervention will be determined through follow-up surveys conducted at 3, 12 and 18 months. Data collection in the surveys will include spirometry, questionnaire-based interviews and cotton-dust measurements. Discussion If successful, the study may pave the way for simple, low-cost interventions that can help reduce cotton-dust levels in textile mills, and improve the respiratory health of textile workers in developing countries such as Pakistan. Trial registration ClinicalTrials.gov, ID: NCT03738202. Registered on 12 November 2018.
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Affiliation(s)
- Asaad Ahmed Nafees
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan. .,Population Health and Occupational Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
| | - Sara De Matteis
- Population Health and Occupational Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Muhammad Masood Kadir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Peter Burney
- Population Health and Occupational Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sean Semple
- Institute for Social Marketing and Health Research, University of Stirling, Stirling, Scotland, UK
| | - Paul Cullinan
- Population Health and Occupational Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, UK
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Abstract
PURPOSE OF REVIEW Although, in the industrialized world, there is a significant decline in the prevalence of cotton dust lung diseases, studies show an increasing incidence in the developing world. With rapid industrialization of the developing world, cotton dust-induced lung diseases are poised to become a global health problem. Discovery of other vegetable dusts causing similar conditions and appreciation of a wider variety of clinical features also make this an opportune time to review this topic. RECENT FINDINGS In addition to chronic exposure-related byssinosis and less common forms of acute byssinosis, recent reports describe the rare occurrence of cotton dust-induced pulmonary fibrosis. New data also relate long-term cotton dust exposure to symptoms and physiologic changes of chronic obstructive pulmonary disease. There have also been new developments relating the pathogenesis of cotton dust airway disease to endotoxin lipopolysaccharide found in cotton dust and bract extracts. SUMMARY Establishment of an association between prolonged exposure to cotton and other vegetable dusts and symptoms of chronic obstructive pulmonary disease widens the clinical implication of cotton dust exposure. In addition, accumulating knowledge of endotoxins will bring about promising new developments reshaping industrial safety standards and measures to prevent cotton dust exposure.
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Affiliation(s)
- Ahmed J Khan
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Lane SR, Sewell RDE. The bacterial profile of cotton lint from worldwide origins, and links with occupational lung disease. Am J Ind Med 2007; 50:42-7. [PMID: 17154404 DOI: 10.1002/ajim.20412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Byssinosis, the cotton worker's lung disease persists today in many countries. Several agents have been investigated with respect to causality; among these are Gram-negative bacteria. These organisms are a source of lipopolysaccharide toxins, which are potentially hazardous to the respiratory tract. Despite byssinosis being most prevalent in countries where adequate preventive procedures are lacking, the majority of past studies have been conducted on cotton from the United States. METHODS The current investigation, involved the identification of Gram-negative bacteria from cotton lint samples originating in 12 world regions. RESULTS The current investigation, involved the identification of Gram-negative bacteria from cotton lint samples originating in 12 world regions. CONCLUSIONS Building a bacterial profile of cotton samples with worldwide origins will be useful in isolating sources of these organisms, assessing the risk posed to industry, workers and ultimately assisting the prevention of byssinosis and related conditions.
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Affiliation(s)
- Samantha R Lane
- School of Science and the Environment, Bath Spa University, Bath, UK
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