545647 research-article2014
APHXXX10.1177/1010539514545647Asia-Pacific Journal of Public HealthChumchai et al
Article
Prevalence and Risk Factors of Respiratory Symptoms Among Home-Based Garment Workers in Bangkok, Thailand
Asia-Pacific Journal of Public Health 2015, Vol. 27(4) 461–468 © 2014 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539514545647 aph.sagepub.com
Pornlert Chumchai, BNS, MSc1, Pimpan Silapasuwan, EdD1, Chukiat Wiwatwongkasem, PhD1, Sara Arphorn, DrBiolHum1, and Plernpit Suwan-ampai, PhD2
Abstract This study aimed to determine the prevalence and risk factors associated with respiratory symptoms. A cross-sectional study with random sampling method was employed and 300 home-based garment workers (HBGWs) were recruited. Risk factors, including personal factors; knowledge, health preventive behaviors, and skill of self-health surveillance, working condition, and respiratory symptoms were assessed. Data were collected using self-reported questionnaires. Prevalence of respiratory symptom was 22.3%. Majority of participants were female (78%). Mean age and working experience were 37.38 years (SD = 10.70) and 13.58 years (SD = 8.71), respectively. Allergic respiratory symptoms (odds ratio [OR] = 16.5; 95% confidence interval [CI] = 8.61-31.7) and garment dust exposure (OR = 12.3; 95% CI = 6.4923.3) were significantly associated with respiratory symptoms (P < .001). Logistic regression analysis indicated history of allergic predicted the respiratory symptoms (OR = 12.96; 95% CI = 4.24-39.55). HBGWs who had serious allergic symptoms and high exposure to dust were at risk of respiratory symptoms. Therefore, preventive program for garment dust exposure among HBGWs is needed. Keywords prevalence, risk factors, respiratory symptoms, home-based garment workers (HBGWS), occupational health
Introduction Cotton workers are commonly at high risk of byssinosis, chronic bronchitis, chronic cough, and other occupational lung disease.1-4 The prevalence of respiratory symptoms among garment
1Mahidol 2Ministry
University, Bangkok, Thailand of Public Health, Bangkok, Thailand
Corresponding Author: Pimpan Silapasuwan, Department of Public Health Nursing, Faculty of Public Health, Mahidol University, 420/1 Rachavithi Road, Rachathavee District, Bangkok 10400, Thailand. Email: [email protected]
Downloaded from aph.sagepub.com at Oakland University on June 4, 2016
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Asia-Pacific Journal of Public Health 27(4)
workers has been reported in several countries, including European countries1 (27.8%), and Asian countries such as China5 (23%), India (22.3%),3,4 and Thailand6 with similar rates. The Thai government had proposed the implementation of health surveillance measures to sustain the well-being in the workplace of workers in the informal sector. Garment processing in a home workplace is considered hazardous to workers’ health because of exposure to garment dust in inappropriate workspaces with poor ventilation.7 HBGWs are prone to respiratory symptoms, including cough, phlegm production, chest tightness, nasal congestion, and wheezing.8-11 The inhalation of small particles of fabric dust results in the development of respiratory symptoms, and reductions in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Abnormal pulmonary function among garment workers in the informal sector is relatively common at the workplace.12-18 Respiratory symptoms have a variety of impacts on physical and mental health, and on the economy through lost productively. Lung function is directly affected, including breathing difficulties, dyspnea, and the development of chronic lung disease. Moreover, it affects workers’ ability to produce high-quality products.19,20 Factors related to respiratory symptoms include duration of fabric dust exposure smoking, ineffective and inadequate use of personal preventive equipment, poor working ventilation,9,21 and individual health literacy, such as knowledge of occupational disease, dust preventive behaviors, and occupational health surveillance skills namely workflow process analysis, health risk assessment, and walk-through survey skills. Several studies have focused on health risks garment workers in factory settings. Home-based garment workers (HBGWs), who are informal workers, who work at home, remain underreported. Therefore, this study aims to determine the prevalence and risk factors associated with respiratory symptoms among HBGWs in Bangkok community.
Methods A cross-sectional study, using a random sampling method, was conducted among HBGWs in Bangkok-Noi and Din-Deang district, Bangkok, Thailand. Three hundred HBGWs were randomly recruited from homes and all fulfilled the following inclusion criteria: working on garments at home, producing garment product for at least 1 year, and age range from 14 to 70 years. The sample size was calculated by estimating the proportion of the respiratory symptoms among garment workers. The minimum sample size was calculated as 288 plus a 10% nonresponse rate, yielding a sample size of 316. The formula of calculating sample size22 was n= n=
Z α2 / 2 × π(1 − π) d2
(1.96) 2 × 0.25(0.75) = 288 (0.05) 2
2 where n = sample size, Z α/ 2 = confidence interval, π = the estimated proportion of prevalence of respiratory symptoms, and d = error (precision) of estimation. Sixteen questionnaires were deleted because information was missing from them. Data were collected using a self-reported questionnaire derived from the literature review; it consisted of 5 parts: (a) personal data included gender, age, smoke, and allergic reaction (5 items); (b) knowledge of occupational health on lung disease (10 items), which had 2 choices as answers and were categorized into high (mean >7.59) and low score (mean 7.40] and low score [mean 8.82] and low score [mean < 8.82]), working condition and work environment in the workplace were used as the walk-through survey assessment tool (5 items—garment dust exposure, process of garment, working hours, working experience, and fabric dust exposure); and (e) respiratory symptoms questionnaire from the American Thoracic Society’s Division of Lung Diseases,23 which was classified into dichotomous outcome variables, including normal and abnormal respiratory symptoms. Pulmonary function was measured using the Sprirolab II model and performed by trained nurse practitioners. The questionnaire response rate was 98.03%. The content validity of the questionnaire was examined by 5 experts and validated for reliability, yielding Cronbach’s alphas for garment dust prevention behaviors of .78 and occupational self-health surveillance skills of .81. In addition, the knowledge of occupational lung disease questionnaire tested by Kuder-Richardson (KR-20), yielded a reliability of .82. This study was approved by the Ethical Committee on Human Research, Faculty of Public Health, Mahidol University (Ref. No. MUPH 2012-173). Participants provided informed consent for all studies conducted during the period January to April, 2012. SPSS version 11.5 for Windows24 was used for the analysis. Descriptive statistics were analyzed to describe the subject characteristics and the study variables. Odds ratios (ORs) with 95% confidence intervals (CIs) for bivariate variables were determined by cross-tabulation. Stepwise logistic regression analysis was used to identify risk factors associated with the respiratory symptoms among HBGWs.
Results Participant Characteristics Participant characteristics are reported in the Table 1. The majority of the participants were female (78.0%), age ranged from 14 to 69 years (mean = 37.38 years, SD = 10.70), most were married (79.3%), and places of birth were northeastern region (56.0%) and central region (24.3%). The main garment process was sewing (89.7%), working hours were more than 8 hours a day (98.7%) and working experience ranged from 1 to 44 years. Of the participants, 25.3% had allergic symptoms, and 10.7% smoked. Respiratory symptoms included cough (5%), phlegm (4%), cough with sputum (1.7%), chest tightness (0.03%), nasal congestion (17.3%), itchiness (4.7%), and abnormal lung function (29.3%). For knowledge of occupational health disease, behavior of use of personal protective equipment and risk assessment skill levels were low. The mean knowledge of occupational lung disease score was 7.59 (SD = 0.89), fabric dust prevention behavior was 7.40 (SD = 1.98), and occupational self-health surveillance skills was 8.82 (SD = 3.43). Table 2 shows the association between personal factors and respiratory symptoms among the HBGWs. The prevalence of respiratory symptoms among HBGWs was 22.3%. Bivariate analysis found that allergic symptoms and garment dust exposure were significantly associated with the respiratory symptoms among HBGWs, at P < .001: OR = 16.5, 95% CI = 8.61-31.7 and OR = 12.3, 95% CI = 6.49-23.3, respectively. In this study, variables found significant by univariate analysis were entered into the multiple logistic regression models to determine the predictive values of respiratory symptoms among the HBGWs. The results showed that the history of respiratory allergy was statistically significantly predictive of respiratory symptoms among HBGWs, at P < .001: OR = 12.96, 95% CI = 4.24-39.55.
Discussion The results of this study revealed that the prevalence of respiratory symptoms among this sample was 22.3%, which is similar to the rates in other countries. The prevalence rate of cotton workers Downloaded from aph.sagepub.com at Oakland University on June 4, 2016
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Table 1. Participants’ Characteristics (N = 300). Variable
n (%)
Gender Female Male Age in years, mean ± SD (range) Work experience in years, mean ± SD (range) Marital status Single Married Place of birth Central North South Northeastern Working hours 8 hours a day Process of garment Cutting Sewing Allergy Yes No Smoking Yes No Knowledge of occupational lung disease, mean ± SD (range) Behavior of fabric dust prevention, mean ± SD (range) Skill of occupational self-health surveillance, mean ± SD (range) Respiratory symptoms No Yes Cough Phlegm Cough with phlegm Chest tightness Nasal congestion Pulmonary function No Yes
232 (78.0) 66 (22.0) 37.38 ± 10.70 (14-69) 13.58 ± 8.71 (1-44) 62 (20.7) 238 (79.3) 73 (24.3) 7 (2.3) 52 (17.4) 168 (56.0) 4 (1.3) 296 (98.7) 31 (10.3) 269 (89.7) 76 (25.3) 224 (74.7) 32 (10.7) 268 (89.3) 7.59 ± 0.89 (3-9) 7.40 ± 1.98 (4-15) 8.82 ± 3.43 (4-21) 233 (77.7) 67 (22.3) 15 (5.0) 12 (4.0) 5 (1.7) 1 (0.03) 52 (17.3) 212 (70.7) 88 (29.3)
ranged from 20.0% to 41.8%, as reported in other studies.1,2,4,9 Mbenrikunashe et al2 studied textile manufacturing company workers in Zimbabwe and found that the prevalence of severe respiratory obstruction was 27.8%. Respiratory symptoms frequently occurred in garment processing workplace, both factory and home-based areas. Moreover, garment workers suffered from the common cold (22.5%) and respiratory tract infections (15.1%).19 Garment processing in home workplace is more likely to increase respiratory disorders because the structure of homes is inappropriate, with unsupported space and poor ventilation.7 In
Downloaded from aph.sagepub.com at Oakland University on June 4, 2016
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Chumchai et al Table 2. Factors Associated With Respiratory Symptoms in Home-Based Garment Workers in Bangkok, Thailand. Respiratory Symptoms, n (%) Variables
Yes
Age (years) >40 29 (21.1) 8 hours a day 1 (25.0) 10 40 (21.8)
APHXXX10.1177/1010539514545647Asia-Pacific Journal of Public HealthChumchai et al
Article
Prevalence and Risk Factors of Respiratory Symptoms Among Home-Based Garment Workers in Bangkok, Thailand
Asia-Pacific Journal of Public Health 2015, Vol. 27(4) 461–468 © 2014 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539514545647 aph.sagepub.com
Pornlert Chumchai, BNS, MSc1, Pimpan Silapasuwan, EdD1, Chukiat Wiwatwongkasem, PhD1, Sara Arphorn, DrBiolHum1, and Plernpit Suwan-ampai, PhD2
Abstract This study aimed to determine the prevalence and risk factors associated with respiratory symptoms. A cross-sectional study with random sampling method was employed and 300 home-based garment workers (HBGWs) were recruited. Risk factors, including personal factors; knowledge, health preventive behaviors, and skill of self-health surveillance, working condition, and respiratory symptoms were assessed. Data were collected using self-reported questionnaires. Prevalence of respiratory symptom was 22.3%. Majority of participants were female (78%). Mean age and working experience were 37.38 years (SD = 10.70) and 13.58 years (SD = 8.71), respectively. Allergic respiratory symptoms (odds ratio [OR] = 16.5; 95% confidence interval [CI] = 8.61-31.7) and garment dust exposure (OR = 12.3; 95% CI = 6.4923.3) were significantly associated with respiratory symptoms (P < .001). Logistic regression analysis indicated history of allergic predicted the respiratory symptoms (OR = 12.96; 95% CI = 4.24-39.55). HBGWs who had serious allergic symptoms and high exposure to dust were at risk of respiratory symptoms. Therefore, preventive program for garment dust exposure among HBGWs is needed. Keywords prevalence, risk factors, respiratory symptoms, home-based garment workers (HBGWS), occupational health
Introduction Cotton workers are commonly at high risk of byssinosis, chronic bronchitis, chronic cough, and other occupational lung disease.1-4 The prevalence of respiratory symptoms among garment
1Mahidol 2Ministry
University, Bangkok, Thailand of Public Health, Bangkok, Thailand
Corresponding Author: Pimpan Silapasuwan, Department of Public Health Nursing, Faculty of Public Health, Mahidol University, 420/1 Rachavithi Road, Rachathavee District, Bangkok 10400, Thailand. Email: [email protected]
Downloaded from aph.sagepub.com at Oakland University on June 4, 2016
462
Asia-Pacific Journal of Public Health 27(4)
workers has been reported in several countries, including European countries1 (27.8%), and Asian countries such as China5 (23%), India (22.3%),3,4 and Thailand6 with similar rates. The Thai government had proposed the implementation of health surveillance measures to sustain the well-being in the workplace of workers in the informal sector. Garment processing in a home workplace is considered hazardous to workers’ health because of exposure to garment dust in inappropriate workspaces with poor ventilation.7 HBGWs are prone to respiratory symptoms, including cough, phlegm production, chest tightness, nasal congestion, and wheezing.8-11 The inhalation of small particles of fabric dust results in the development of respiratory symptoms, and reductions in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Abnormal pulmonary function among garment workers in the informal sector is relatively common at the workplace.12-18 Respiratory symptoms have a variety of impacts on physical and mental health, and on the economy through lost productively. Lung function is directly affected, including breathing difficulties, dyspnea, and the development of chronic lung disease. Moreover, it affects workers’ ability to produce high-quality products.19,20 Factors related to respiratory symptoms include duration of fabric dust exposure smoking, ineffective and inadequate use of personal preventive equipment, poor working ventilation,9,21 and individual health literacy, such as knowledge of occupational disease, dust preventive behaviors, and occupational health surveillance skills namely workflow process analysis, health risk assessment, and walk-through survey skills. Several studies have focused on health risks garment workers in factory settings. Home-based garment workers (HBGWs), who are informal workers, who work at home, remain underreported. Therefore, this study aims to determine the prevalence and risk factors associated with respiratory symptoms among HBGWs in Bangkok community.
Methods A cross-sectional study, using a random sampling method, was conducted among HBGWs in Bangkok-Noi and Din-Deang district, Bangkok, Thailand. Three hundred HBGWs were randomly recruited from homes and all fulfilled the following inclusion criteria: working on garments at home, producing garment product for at least 1 year, and age range from 14 to 70 years. The sample size was calculated by estimating the proportion of the respiratory symptoms among garment workers. The minimum sample size was calculated as 288 plus a 10% nonresponse rate, yielding a sample size of 316. The formula of calculating sample size22 was n= n=
Z α2 / 2 × π(1 − π) d2
(1.96) 2 × 0.25(0.75) = 288 (0.05) 2
2 where n = sample size, Z α/ 2 = confidence interval, π = the estimated proportion of prevalence of respiratory symptoms, and d = error (precision) of estimation. Sixteen questionnaires were deleted because information was missing from them. Data were collected using a self-reported questionnaire derived from the literature review; it consisted of 5 parts: (a) personal data included gender, age, smoke, and allergic reaction (5 items); (b) knowledge of occupational health on lung disease (10 items), which had 2 choices as answers and were categorized into high (mean >7.59) and low score (mean 7.40] and low score [mean 8.82] and low score [mean < 8.82]), working condition and work environment in the workplace were used as the walk-through survey assessment tool (5 items—garment dust exposure, process of garment, working hours, working experience, and fabric dust exposure); and (e) respiratory symptoms questionnaire from the American Thoracic Society’s Division of Lung Diseases,23 which was classified into dichotomous outcome variables, including normal and abnormal respiratory symptoms. Pulmonary function was measured using the Sprirolab II model and performed by trained nurse practitioners. The questionnaire response rate was 98.03%. The content validity of the questionnaire was examined by 5 experts and validated for reliability, yielding Cronbach’s alphas for garment dust prevention behaviors of .78 and occupational self-health surveillance skills of .81. In addition, the knowledge of occupational lung disease questionnaire tested by Kuder-Richardson (KR-20), yielded a reliability of .82. This study was approved by the Ethical Committee on Human Research, Faculty of Public Health, Mahidol University (Ref. No. MUPH 2012-173). Participants provided informed consent for all studies conducted during the period January to April, 2012. SPSS version 11.5 for Windows24 was used for the analysis. Descriptive statistics were analyzed to describe the subject characteristics and the study variables. Odds ratios (ORs) with 95% confidence intervals (CIs) for bivariate variables were determined by cross-tabulation. Stepwise logistic regression analysis was used to identify risk factors associated with the respiratory symptoms among HBGWs.
Results Participant Characteristics Participant characteristics are reported in the Table 1. The majority of the participants were female (78.0%), age ranged from 14 to 69 years (mean = 37.38 years, SD = 10.70), most were married (79.3%), and places of birth were northeastern region (56.0%) and central region (24.3%). The main garment process was sewing (89.7%), working hours were more than 8 hours a day (98.7%) and working experience ranged from 1 to 44 years. Of the participants, 25.3% had allergic symptoms, and 10.7% smoked. Respiratory symptoms included cough (5%), phlegm (4%), cough with sputum (1.7%), chest tightness (0.03%), nasal congestion (17.3%), itchiness (4.7%), and abnormal lung function (29.3%). For knowledge of occupational health disease, behavior of use of personal protective equipment and risk assessment skill levels were low. The mean knowledge of occupational lung disease score was 7.59 (SD = 0.89), fabric dust prevention behavior was 7.40 (SD = 1.98), and occupational self-health surveillance skills was 8.82 (SD = 3.43). Table 2 shows the association between personal factors and respiratory symptoms among the HBGWs. The prevalence of respiratory symptoms among HBGWs was 22.3%. Bivariate analysis found that allergic symptoms and garment dust exposure were significantly associated with the respiratory symptoms among HBGWs, at P < .001: OR = 16.5, 95% CI = 8.61-31.7 and OR = 12.3, 95% CI = 6.49-23.3, respectively. In this study, variables found significant by univariate analysis were entered into the multiple logistic regression models to determine the predictive values of respiratory symptoms among the HBGWs. The results showed that the history of respiratory allergy was statistically significantly predictive of respiratory symptoms among HBGWs, at P < .001: OR = 12.96, 95% CI = 4.24-39.55.
Discussion The results of this study revealed that the prevalence of respiratory symptoms among this sample was 22.3%, which is similar to the rates in other countries. The prevalence rate of cotton workers Downloaded from aph.sagepub.com at Oakland University on June 4, 2016
464
Asia-Pacific Journal of Public Health 27(4)
Table 1. Participants’ Characteristics (N = 300). Variable
n (%)
Gender Female Male Age in years, mean ± SD (range) Work experience in years, mean ± SD (range) Marital status Single Married Place of birth Central North South Northeastern Working hours 8 hours a day Process of garment Cutting Sewing Allergy Yes No Smoking Yes No Knowledge of occupational lung disease, mean ± SD (range) Behavior of fabric dust prevention, mean ± SD (range) Skill of occupational self-health surveillance, mean ± SD (range) Respiratory symptoms No Yes Cough Phlegm Cough with phlegm Chest tightness Nasal congestion Pulmonary function No Yes
232 (78.0) 66 (22.0) 37.38 ± 10.70 (14-69) 13.58 ± 8.71 (1-44) 62 (20.7) 238 (79.3) 73 (24.3) 7 (2.3) 52 (17.4) 168 (56.0) 4 (1.3) 296 (98.7) 31 (10.3) 269 (89.7) 76 (25.3) 224 (74.7) 32 (10.7) 268 (89.3) 7.59 ± 0.89 (3-9) 7.40 ± 1.98 (4-15) 8.82 ± 3.43 (4-21) 233 (77.7) 67 (22.3) 15 (5.0) 12 (4.0) 5 (1.7) 1 (0.03) 52 (17.3) 212 (70.7) 88 (29.3)
ranged from 20.0% to 41.8%, as reported in other studies.1,2,4,9 Mbenrikunashe et al2 studied textile manufacturing company workers in Zimbabwe and found that the prevalence of severe respiratory obstruction was 27.8%. Respiratory symptoms frequently occurred in garment processing workplace, both factory and home-based areas. Moreover, garment workers suffered from the common cold (22.5%) and respiratory tract infections (15.1%).19 Garment processing in home workplace is more likely to increase respiratory disorders because the structure of homes is inappropriate, with unsupported space and poor ventilation.7 In
Downloaded from aph.sagepub.com at Oakland University on June 4, 2016
465
Chumchai et al Table 2. Factors Associated With Respiratory Symptoms in Home-Based Garment Workers in Bangkok, Thailand. Respiratory Symptoms, n (%) Variables
Yes
Age (years) >40 29 (21.1) 8 hours a day 1 (25.0) 10 40 (21.8)
