Industrial hygiene, occupational safety and respiratory symptoms in the Pakistani cotton industry

Respiratory symptoms and pulmonary function impairment among textile industry workers in Alexandria, Egypt

Occupational exposure to cotton dust is still an important cause of respiratory problems in textile workers particularly in less developed countries like Egypt. Evaluate respiratory symptoms and diseases, and pulmonary function pattern among Egyptian textile workers. Cross sectional comparative study was conducted from December 2019 to September 2020 in a textile factory in Egypt; 364 male workers (184 cotton dust exposed workers, and 180 unexposed workers) were included. Participants were subjected to an interviewing questionnaire, British Medical Research Council questionnaire, anthropometric measurements, pulmonary function tests, and byssinosis grading format. Descriptive and analytic statistics were conducted. Chronic cough, phlegm production, and shortness of breath grade I, II and III were more reported in cotton dust exposed workers than unexposed workers (P#x003C;0.01, P#x003C;0.01, and P=0.02, respectively). Prevalence of chronic bronchitis was significantly higher among cotton dust exposed workers (12%) than unexposed workers (3.9%) (P#x003C;0.01). The mean percent predicted values of lung function indices reflecting large-1irway function (VC, FVC, FEV1, FEV1%, PEFR, and FEF75) were significantly lower in cotton dust exposed workers (P#x003C;0.01). Prevalence of byssinosis was 22.8%. Workers with byssinosis had significantly higher prevalence of respiratory symptoms, chronic bronchitis, cross-shift reduction in PEFR and significant decrease in mean percent predicted values of FVC, FEV1, PEFR, FEF75, and FEF50 than workers without byssinosis. This study revealed a substantial association between cotton dust exposure at work and respiratory symptoms and morbidity. Regular measurement of cross shift change in PEFR is recommended among exposed workers for early diagnosis of byssinosis.

Work-related disease symptoms and occupational injuries among coffee processing industry workers in Bench-Sheko and Kaffa Zones Southwest, Ethiopia: A mixed-method study

Background

Occupational injuries have become one of the most critical rooting causes paying to infirmities and life-threatening conditions in developed and developing countries. Workers in the coffee industry face some occupational health and safety issues. However, there is limited evidence on this important public health issue. Hence, this research was conducted to assess work-related disease symptoms and occupational injuries among coffee processing workers in Southwest, Ethiopia.

Methods

A cross-sectional study supplemented with a qualitative method was done. A total of 721 workers were involved in the study for quantitative information. In addition, we performed a total of 22 in-depth and five key informant interviews for generating qualitative evidence. Quantitative data was collected by an interview-based questionnaire which is adapted from similar studies. We conducted descriptive, binary logistic, and multivariable regression analysis as necessary, to ascertain the factors affecting occupational injuries. We collected qualitative data guided by an interview guide, transcribed verbatim, and analyzed using ATLAS ti version-8 by applying a content analysis approach. Finally, quotes from participants that had exemplary ideas were triangulated along with quantitative findings.

Result

The overall prevalence rate of work-related symptoms and occupational injuries among coffee processing workers were 21.7 and 13.4% respectively. Age group 30-39 and 40-49 (Adjusted odds ratio (AOR) 1.95, 95% CI 1.37, 2.79, (AOR 3.28, 95% CI 1.89, 5.69, respectively, income level (AOR 0.24, 95% CI 0.16, 0.36, p = 0.000), experience (AOR 1.64, 95% CI 1.04, 2.60, p = 0.034), and smoking cigarette (AOR 5.59, 95% CI 2.78, 11.26, p = 0.000) were significantly associated with the work-related symptom. In addition, training related to the job (AOR 11.88, 95% CI1.34, 105.57, p = 0.026) was significantly associated with occupational injuries among coffee processing industry workers.

Conclusion

The prevalence of work-related symptoms and occupational injuries was high among coffee processing industry workers in southwest Ethiopia. Therefore, there is a need for regulations for both government and industry owners to advance the occupational conditions and ergonomic structure of coffee processing industries.

Use of Low-Cost Particle Counters for Cotton Dust Exposure Assessment in Textile Mills in Low- and Middle-Income Countries

OBJECTIVE

There is a lack of consensus on methods for cotton dust measurement in the textile industry, and techniques vary between countries-relying mostly on cumbersome, traditional approaches. We undertook comparisons of standard, gravimetric methods with low-cost optical particle counters for personal and area dust measurements in textile mills in Pakistan.

METHODS

We included male textile workers from the weaving sections of seven cotton mills in Karachi. We used the Institute of Occupational Medicine (IOM) sampler with a Casella Apex 2 standard pump and the Purple Air (PA-II-SD) for measuring personal exposures to inhalable airborne particles (n = 31). We used the Dylos DC1700 particle counter, in addition to the two above, for area-level measurements (n = 29).

RESULTS

There were no significant correlations between the IOM and PA for personal dust measurements using the original (r = -0.15, P = 0.4) or log-transformed data (r = -0.32, P = 0.07). Similarly, there were no significant correlations when comparing the IOM with either of the particle counters (PA and Dylos) for area dust measurements, using the original (r = -0.07, P = 0.7; r = 0.10, P = 0.6) or log-transformed data (r = -0.09, P = 0.6; r = 0.07, P = 0.7).

CONCLUSION

Our findings show a lack of correlation between the gravimetric method and the use of particle counters in both personal and area measurements of cotton dust, precluding their use for measuring occupational exposures to airborne dust in textile mills. There continues to be a need to develop low-cost instruments to help textile industries in low- and middle-income countries to perform cotton dust exposure assessment.

Epidemiology of respiratory diseases and associated factors among female textile workers in Pakistan

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.

Contemporary Prevalence of Byssinosis in Low- and Middle-Income Countries: A Systematic Review

We aimed to identify the contemporary prevalence of byssinosis through a systematic review. We used Medline, Web of Science, Embase, and Global Health databases to identify studies published in any language between 2000 and 2019, reporting primary data on byssinosis among adults. We used the Joanna Briggs Institute checklist to estimate the risk of bias in studies and undertook a qualitative, narrative data analysis. The review considered the prevalence of byssinosis, chest tightness, and airflow obstruction in textile workers in low- and middle-income countries (LMICs). We found 26 relevant studies that included 6930 workers across 12 countries. Most of the studies (n = 19) were from Asia, and 7 from African countries. Twenty-five studies were cross-sectional surveys while 1 was a cohort study. The prevalence of byssinosis was reported by 18 studies, and ranged from 8% to 38%, without any clear associations, at the group level, between the prevalence of byssinosis and durations of workers’ exposures. Prevalence of chest tightness ranged between 4% and 58% and that of airflow obstruction between 10% and 30%. We found a strong correlation ( r = 0.72) between prevalence of byssinosis and cotton dust levels. Our findings indicate that byssinosis remains a significant, contemporary problem in some parts of the textile sector in LMICs.

Registered health problems and demographic profile of integrated textile factory workers in Ethiopia: a cross-sectional study

BACKGROUND

Textile and garment factories are growing in low and middle-income countries as worldwide demand for inexpensive clothing increases each year. These integrated textile and garment production factories are often built-in areas with few workplaces and environmental regulations, and employees can be regularly exposed to workplace hazards with little regulatory oversight. Consequently, workers' health may be significantly affected due to long term exposure to hazards. This study describes registered health problems and their association to work-related and personal factors among workers in integrated textile factories in Ethiopia.

METHODS

Institution-based cross-sectional study design was employed for this analysis. A one-year recording of worker's clinical diagnoses (between March 2016 and February 2017) was gathered from the factory clinics of three integrated textile factories. Clinical diagnosis data was obtained as factory workers visited the clinics if feeling unwell. Sociodemographic characteristics and work-related information were obtained from the factory's human resource departments. The sociodemographic and clinical diagnosis statuses of 7992 workers were analyzed. The association between the registered diagnoses and workplace factors (work in textile production, garment production and support process) and personal factors (age, sex and educational status) were studied using logistic regression analysis.

RESULTS

The average employee age and years of service were 40 years and 11 years respectively. 60% of workers were females, comprising of 4778 women. 66% of all workers (5276) had 27,320 clinical diagnoses. In total, this caused 16,993 absent working days due to sick leave. Respiratory diseases (34%) and musculoskeletal disorders (29%) were the most prevalent diagnoses, while bodily injuries were the cause of most work absences. Work department, sex and educational status are variables that were most significantly associated with higher prevalence of disease groups.

CONCLUSIONS

About two-thirds of the integrated textile factory workers were diagnosed with different types of disease. The textile and garment production department workers were affected at a greater rate than the support process workers, indicating that some diseases may be related to workplace exposure. Further study should investigate rare chronic diseases such as cancer, heart diseases, renal diseases and diabetes.

Occupational Conditions in Brazilian Modern Rural Slave Labour

Work in rural properties in conditions similar to slavery remains a reality in many countries, including Brazil. The Brazilian State characterises contemporary slave labour as a condition of freedom restriction for paying off debt, served by intensive working hours or inadequate working conditions related to Occupational Safety and Health. This study highlights the working conditions in rural slavery in Brazil, based on the Occupational Safety and Health perspective. The study was carried out based on a sample of Inspection Reports of the Governmental Authority to Combat Modern Slavery. A random sample of 42 reports was collected and analysed, describing the working conditions of 392 rural workers characterised as labour analogous to slavery. The analysis strategy was carried out from an Occupational Safety and Health standpoint. Data sets were identified and selected, grouped into five categories: Work routine; General health conditions; Manual machines and tools; Environmental conditions. Widespread exposure of Neo-enslaved workers to stressful working hours was found, in addition to severe Occupational Safety and Health problems. The occurrence of all these characteristics simultaneously was the most observed phenomenon among the sample, which demonstrates that it is possible to identify cases of modern slavery from an Occupational Safety and Health perspective.

Respiratory symptoms and their association with exposure to respiratory dust among indigo-dyed cotton workers

Indigo-dyed cotton weavers are exposed to various dust particles that may contain chemical contaminants from indigo fermentation process and can be related to respiratory symptoms. This cross-sectional study thus investigates the prevalence of respiratory symptoms and their association with respiratory dust (RD) exposure among workers in northeastern Thailand. It recruited 146 indigo-dyed cotton weavers. The prevalence of respiratory symptoms was collected by a self-report questionnaire included cough, phlegm, chest tightness, wheezing, and dyspnea. The average RD was 47.9 ± 28.3 μg/m³. Logistic regression models revealed a strong association between RD exposure and respiratory symptoms after adjustment. An exposure to RD ≥50 µg/m³ was associated with 5.05-, 3.58-, 2.88-, and 3.30-fold increased odds ratio of cough, phlegm, chest tightness, and dyspnea, respectively. The study results reveal that RD exposure may contribute to respiratory symptoms among indigo-dyed cotton weavers.

Dyspnea has an association with lifestyle: differences between Swedish and Finnish speaking persons in Western Finland

Background Difference in dyspnea mMRC ≥2 between Finnish speaking and Swedish-speaking populations in Finland has not been previously studied.

Methods In February 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20–69 years in western Finland with a response rate of 52.3%. The registered native language of each subject determined whether questionnaire in Finnish or Swedish was applied. Multiple logistic regression was performed to calculate Odds Ratios (OR) with 95% CI for the simultaneous effects of independent variables on dyspnea mMRC ≥2.

Results Of all participants, 2780 (71.9%) were Finnish speakers and 1084 (28.1%) were Swedish speakers. Finnish speakers had a higher prevalence of dyspnea mMRC ≥2 (11.1% vs 6.5% p < 0.001) when compared to Swedish speakers. Finnish speakers smoked more often, had higher BMI, spent less time moving during the day, had more often occupational exposure to vapours, gases, dusts or fumes (VGDF), and had lower socioeconomic status based on occupation. Significant risk factors for dyspnea mMRC ≥2 were COPD (OR = 10.94), BMI >35 (OR = 9.74), asthma (OR = 4.78), female gender (OR = 2.38), older age (OR = 2.20), current smoking (OR = 1.59), and occupational exposure to VGDF (OR = 1.47).

Conclusions Swedish speakers had less dyspnea mMRC ≥2 which is explained by a healthier lifestyle. Smoking, obesity, and occupational exposures should be in focus to improve respiratory health.

Personal inhalable dust and endotoxin exposure among workers in an integrated textile factory

The aim of this study was to determine personal exposure to inhalable dust and endotoxin levels among workers in an integrated cotton-processing textile factory and exposure variability across the different work sections. Full shift measurements were carried out using inhalable conical samplers with 37 mm glass-fiber filters. Personal inhalable dust was determined gravimetrically, and endotoxin levels were analyzed by kinetic chromogenic Limulus Amebocytes Lysate assay. The geometric means of personal dust and endotoxin concentrations were 0.75 mg·m^-3 and 831 EU·m^-3, respectively. The highest dust and endotoxin concentrations were observed in carding section (1.34 mg·m^-3 and 6,381 EU·m^-3, respectively). Altogether, 11% of dust and 89% of endotoxin samples exceeded workplace exposure limits. This study showed a moderate correlation between inhalable dust and endotoxin (r = 0.450, p < 0.001). Our findings indicate that low dust exposure does not guarantee a low exposure to endotoxin.

Dose-response of Cotton Dust Exposure with Lung Function among Textile Workers: MultiTex Study in Karachi, Pakistan

BACKGROUND

Cotton dust exposure among textile mill workers lead to impaired lung function. However, only few studies have investigated the dose-response relationship between cotton dust and lung function.

OBJECTIVE

To determine the dose-response relationship between cotton dust exposure and lung function among textile workers.

METHODS

This cross-sectional survey was conducted from January to March 2016 and included 303 adult male textile workers from spinning and weaving sections of 5 mills in Karachi, Pakistan. We collected data through a translated version of the American Thoracic Society respiratory questionnaire (ATS-DLD-78A) and using spirometry. Mill-level airborne cotton dust was measured over an 8-12-hour shift through UCB-PATS (University of California, Berkeley-Particle, and Temperature Monitoring System). Multiple linear regression was used to determine the association between cotton dust exposure and lung function assessed through the 3 indices: forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and their ratio (FEV1/FVC).

RESULTS

The mean age of the workers was 32.5 (SD 10.5) years. The mean spirometry indices expressed in percent predicted values were FEV1 82.6 (SD 14.0); FVC 90.3 (14.7), and FEV1/FVC 94.9 (10.5). The median cotton dust concentration was 0.61 (IQR 0.2 to 1.3) mg/m3. The frequency of respiratory symptoms was 15% for cough, 20% for phlegm, and 20% for wheezing. After adjustment for covariates, every mg/m3 increase in dust concentration was associated with 5.4% decline in FEV1.

CONCLUSION

This study quantifies the exposure-dependent relationship between cotton dust and lung function; which has implications for regulations and standards in the textile industry in Pakistan and similar cotton-processing countries.

Cotton dust exposure and self-reported respiratory symptoms among textile factory workers in Northwest Ethiopia: a comparative cross-sectional study

Background

Cotton dust induced respiratory disorders are dramatically increased over the globe, especially the problem is serious in developing countries. Respiratory symptoms, such as cough, phlegm, wheezing, shortness of breath, chest tightness, chronic bronchitis, and byssinosis are common among workers exposed to cotton dust. However, in Ethiopia, the magnitude of the problem is not well known and information is limited about the risk factors. Therefore, this study was aimed to assess the prevalence of respiratory symptoms and associated factors.

Methods

A Comparative cross-sectional study design was employed. A total of 413 (276 exposed and 137 unexposed) participants were included in the study. Stratified and simple random sampling techniques were used to select exposed and unexposed groups to cotton dust respectively. Multivariable binary logistic regression analyses was performed to identify variables associated with respiratory symptoms and adjusted odds ratio (AOR) was used to determine the strength of associations. Significance level was obtained at 95% confidence interval (CI) and p-value ≤0.05.

Results

The prevalence of self-reported respiratory symptoms was 47.8% (95% CI: 41.3, 53.7%) and 15.3% (95% CI: 9.6, 22.3%) among exposed and control groups respectively. Sex (AOR = 2.1, 95% CI: 1.29, 3.45), service year (AOR = 2.38, 95% CI: 1.19, 4.71) and ventilation (AOR = 2.4, 95% CI: 1.17, 4.91) were factors significantly associated with respiratory symptoms. Furthermore, working department such as; ginning (AOR = 5.1, 95% CI: 2.13, 12.16), spinning (AOR = 4.96, 95% CI: 2.18, 11.29), weaving (AOR = 5.9, 95% CI: 2.46, 14.27) and blowing working departments (AOR = 5.14, 95% CI: 1.4, 18.94) were significantly associated with respiratory disorders.

Conclusions

The prevalence of self-reported respiratory symptoms was higher among workers exposed to cotton dust than unexposed workers. Sex, service year, working department and work unit ventilation were predictor variables for respiratory symptoms. Thus, reducing exposure to dust, adequate ventilation and improving the hygiene of working departments are needed to reduce respiratory symptoms.

Occupational lung diseases: from old and novel exposures to effective preventive strategies

Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.

Respiratory symptoms increase health care consumption and affect everyday life - a cross-sectional population-based study from Finland, Estonia, and Sweden

BACKGROUND

Even though respiratory symptoms are common in the adult population, there is limited research describing their impact on everyday life and association with health care consumption.

AIM

The main objective of this population-based study was to estimate and compare the prevalence of respiratory symptoms among adults in Finland, Estonia, and Sweden in relation to health care consumption and to identify factors influencing health care consumption. A secondary aim was to assess to which extent the presence of respiratory symptoms affect everyday life.

METHOD

In the population-based FinEsS studies consisting of random samples of subjects aged 20 to 69 years from Finland (n=1,337), Estonia (n=1,346), and Sweden (n=1,953), data on demographics, respiratory health, and health care consumption were collected by structured interviews. Prevalence was compared and multiple logistic regression analyses were performed.

RESULTS

Respiratory symptoms were significantly more common in Finland (66.0%) and Estonia (65.2%) than in Sweden (54.1%). Among subjects with respiratory symptoms, the proportion reporting outpatient care during the past year was fairly similar in the three countries, while specialist consultations were more common in Finland (19.1%), and hospitalisations more common in Estonia (15.0%). Finnish and Estonian residency, female sex, and BMI>25 increased the risk for outpatient care consumption. Wheeze and attacks of shortness of breath in the past 12 months, recurrent sputum production, and cough were associated with an increased risk for health care consumption. Increasing number of respiratory symptoms increased the risk for consuming health care. A larger proportion of subjects in Estonia and Sweden experienced their everyday life being affected by respiratory symptoms compared with subjects in Finland.

CONCLUSION

Respiratory symptoms are common in Finland, Estonia, and Sweden and contribute to a negative impact on everyday life as well as increased health care consumption. The observed differences in health care consumption between countries are probably related to national differences in health care structure.

Diminished pulmonary function in long-term workers exposed to cotton dust determined in a cross-sectional study in small Pakistani enterprises

PURPOSE

While large cotton industry plants producing for the foreign market have undergone improvements of occupational hygiene lately, working conditions in power looms producing mainly for the local market are still poor. The respiratory health in workers of power looms has not been studied so far.

METHODS

In a cross-sectional study, 51 male cotton workers from power looms, 58 from large cotton factories and 52 controls were investigated by spirometry and a symptoms questionnaire. Spirometric measurements and respiratory symptoms were related to exposure duration in large and small factories by multivariate linear regression and logistic regression, respectively, with smoking, age and anthropometric parameters considered as confounders.

RESULTS

Work duration in power looms was associated with declines in forced expiratory volume in 1 s, peak flow, maximum midexpiratory flow and forced expiratory flow 75 and an increased risk of obstruction (OR 1.09/year; 95% CI: 1.002 to 1.18) by applying the Global Lung Initiative equations. Except cough that was only associated with smoking, all respiratory symptoms (chest tightness, shortness of breath, fever) increased as a function of duration of exposure in power looms but not in large factories.

CONCLUSIONS

Despite limitations inherent in the cross-sectional approach, there is evidence for workers in small weaving factories to face an increased risk of pulmonary function loss and respiratory symptoms. Industrial hygiene measures in these small enterprises should be encouraged. Failure to detect adverse respiratory outcomes from occupation in large factories could be due to a 'survivor' (healthy worker) effect.