MultiTex RCT - a multifaceted intervention package for protection against cotton dust exposure among textile workers - a cluster randomized controlled trial in Pakistan: study protocol

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.

Byssinosis and tuberculosis amongst "home-based" powerloom workers in Madhya Pradesh State, India

BACKGROUND

Byssinosis is an occupational lung disease observed among workers exposed to cotton, flax, and hemp dust. The severity and extent of Byssinosis are well recognised in the high-income countries and control measures have been implemented to prevent the disease. In India, there are conflicting evidence on burden estimation of the disease, followed by inadequate prevention and control of Byssinosis.

DESIGN/METHODS

We did a cross-sectional study to assess the prevalence of Byssinosis in "home-based" power-loom workers in Mominpura, an administrative ward of Burhanpur Municipality with 2800 population in the state of Madhya Pradesh, India. 290 adults working from "home-based" power loom units were randomly selected, profiled and screened for Byssinosis like symptoms with the help of a semi-structured questionnaire and simple hand-held peak expiratory flow monitor. For epidemiological purposes the symptoms were classified based on Schilling's classification. Chest x-rays were done for selected subjects. Sputum smear microscopy for detecting TB was done for those who had Byssinosis like symptoms.

RESULTS

Prevalence of Byssinosis among "home based" powerloom workers was found to be 98% [n = 283, 95 CI (95.65-98.96)]. Peak expiratory flow rate (PEFR) was reduced in 44% (n = 124), of which 81 (29%) had more than 50% PEFR reduction, and of these, 69 (29%) were in early stage of Byssinosis (Grade 0.5). 11% of study participants who had Byssinosis like symptoms, also had TB.

CONCLUSIONS

Byssinosis is highly prevalent in "home-based" power loom units in Madhya Pradesh. Adequate advocacy on awareness and prevention; prompt diagnosis and linkages to treatment services in "home-based" power loom units are urgently required to address Byssinosis at an early disease stage.

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.

Respiratory Symptoms and Lung Function among Greek Cotton Industry Workers: A Cross-Sectional Study

Background:

Workers in cotton industry are occupationally exposed to various dust-related hazards. The nature of these agents and the respective exposure levels depend on the cotton industry specific sector. These exposures could be associated with respiratory symptoms and changes in lung function parameters.

Objective:

To evaluate associations between occupational exposure and respiratory function as well as reported symptoms in several groups of workers at different stages of the cotton industry in a vertical approach that covers all the major sectors—from cotton ginning to weaving and fabric production.

Methods:

A questionnaire on respiratory symptoms and individual as well as workplace characteristics was completed by 256 workers at the cotton industry and 148 office workers (control group). Both groups underwent spirometry.

Results:

Workers in cotton industry reported a higher prevalence of severe dyspnea (p=0.002) and wheezing (p=0.004) compared to the control group. Also they were found to have a lower predicted FEV1% (p<0.029) and lower FEV1/FVC (p<0.001) values. In addition, a higher prevalence of FEV1% <80% (p<0.001) and FEV1/FVC <70% (p=0.041) were found among textile workers. Similar results were found for non-smoker textile workers compared to non-smoker control group workers. Those working in cotton ginning mills recorded the highest decrease of spirometric values. Duration of employment in cotton industry and smoking use were found to be predictors of lung function decline for cotton industry workers.

Conclusion:

Occupational exposure to cotton dust was associated with increased prevalence of respiratory symptoms and obstructive pattern in pulmonary function test.

Pulmonary effects of intermittent, seasonal exposure to high concentrations of cotton dust

AIM: To quantify the exposure levels and to assess pulmonary reactions associated with exposure to cotton dust and its biological contaminants.

METHODS: All employees (51 male workers) of a ginning industry as well as 51 referent unexposed subjects from clerical staff of an educational center were investigated. Atmospheric concentrations of cotton dust and bioaerosols were measured. Furthermore, bacterial and fungal genera and species were identified by an expert microbiologist and an experienced mycologist. A standard respiratory symptom questionnaire was filled out for the subjects and they underwent multiple spirometry tests, at the beginning and at the end of work season as well as prior to (pre-exposure base line values) and at end of the first shift of workweek (post exposure).

RESULTS: Gram negative bacteria including Enterobacter agglomerans and Pseudomonas spp. were found to be the dominant bacterial species and genera, respectively. Similarly, dominant fungi were identified to be Mucor sp. Rhizopus sp. and Aspergillus niger. Mean atmospheric concentrations of cotton dust in ginning and outdoor areas were found to be 35.2 and 6.8 mg/m³, respectively. The prevalence rates of cough, phlegm, wheezing, dyspenea and grade 1/2 byssinosis among the exposed subjects were significantly higher than their corresponding values for the unexposed employees (P < 0.05). Additionally, significant differences were noted in the mean baseline value (preshift) of vital capacity, forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity ratio of the exposed subjects when compared with those of their referent counterparts. Similarly, significant cross shift decrements were noted in most parameters of pulmonary function of the exposed subjects.

CONCLUSION: Seasonal exposure to cotton dust induces both acute, partially reversible, and chronic irreversible decrements in the lungs’ functional capacities as well as increased prevalence of respiratory symptoms.

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

OBJECTIVES

In the cotton industry of Pakistan, 15 million people are employed and exposed to cotton dust, toxic chemicals, noise and physical hazards. The aim of this study was to determine the prevalence of health symptoms, particularly respiratory symptoms, and to measure cotton dust and endotoxin levels in different textile factories of Faisalabad, Pakistan.

METHODS

A cross-sectional investigation was performed in a representative sample of 47 cotton factories in the Faisalabad region in Punjab, Pakistan. Respiratory symptoms of 800 workers were documented by questionnaire. Occupational safety in the factories was assessed by a trained expert following a checklist, and dust and endotoxin levels in different work areas were measured.

RESULTS

Prevalence of respiratory disease symptoms (fever, shortness of breath, chest tightness and cough) was generally high and highest in the weaving section of the cotton industry (20-40% depending on symptoms). This section also displayed the poorest occupational safety ratings and the highest levels of inhalable cotton dust (mean±SD 4.6±2.5 vs 0.95±0.65 mg/m(3) in compact units). In contrast, endotoxin levels were highest in the spinning section (median 1521 EU/m(3)), where high humidity is maintained.

CONCLUSIONS

There are still poor working conditions in the cotton industry in Pakistan where workers are exposed to different occupational hazards. More health symptoms were reported from small weaving factories (power looms). There is a dire need for improvements in occupational health and safety in this industrial sector with particular focus on power looms.