Fabiha Tasnim, Imon Rahman*, Monica Sharfin Rahman and Ridwan Islam
Department of Pharmacy, BRAC University, Dhaka, Bangladesh
Received date: February 17, 2016; Accepted date: March 21, 2016; Published date: March 25, 2016
Citation: Tasnim F, Rahman I, Rahman MS, Islam R (2016) A Review on Occupational Health Safety in Bangladesh with Respect to Asian Continent. Int J Pub health safe 1:102. doi:10.4172/ijphs.1000102
Copyright: © 2016 Tasnim F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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In the recent scenario, occupational health hazard has been the reason of great concern for a long period of time in this industrialized and digital generation. It is obviously because their significant impacts in terms of human, social and economic sufferings both on national and international arena, but mostly on Asian region. However, there were attempts to take measures and strategies to prevent, control, reduce or eliminate these hazards; they were not adequate to eliminate this issue completely. As a result, occupational hazards are still continued to be significantly disastrous in developing countries like Bangladesh. In Bangladesh it is estimated that 11.7 thousand workers suffer from fatal accidents and a further 24.5 thousand die from work related diseases across all sectors each year which lead the victims spend an average of US $4 on each injury where 17.6% of the population lives below the lower poverty line. Therefore, in order to raise required concern this article will provide a brief overview of occupational hazard exposures, accidents and their hazardous impacts on human health, keeping in concern the most hazardous occupational sectors in a developing country of Asia with a close comparison with other developed and developing countries of the world. And at the end, it will also provide possible recommendations among industrialists, researchers and policy makers.
Occupational health hazard; Occupational safety; Occupational health; Diseases; Pesticides; Garment industries; Tanneries
BBS: Bangladesh Bureau of Statistics; BEF: Bangladesh Employers’ Federation; BILS: Bangladesh Institute of Labour Studies; BTA: Bangladesh Tanners Association; COPD: Chronic Obstructive Pulmonary Disease; DOE: Department of Environment; EPB: Export Promotion Bureau; GDP: Gross Domestic Product; ILO: International Labor Organization; NCCWE: National Coordination Committee for Workers Education; NCLS: National Child Labour Survey; NGO: Non-Governmental Organization; NIPSOM: National Institute of Preventive and Social Medicine; OSD: Occupational Skin Diseases; OSH: Occupational Safety and Health; OSHE: Occupational Safety; Health and Environment Foundation; PAN: Pesticide Action Network; USA: United States of America; U. S. EPA: United States Environmental Protection Agency; WHO: World Health Organization
At the present scenario occupational hazard lies as the hazardous genesis of almost all fatalities in this digital and industrialized generation. The reason behind this statement came from the statistics estimated by the International Labor Organization (ILO) according to which, from over the 2.3 million fatalities that take place annually, over 2 million fatalities are caused by work related diseases . This burning issue has made a huge impact in different sectors (Human, Social and Economic) because of their contribution to significant losses both on the national and international arena, but especially on the Asian arena.
The fatalities of occupational hazards (occupational accidents, injuries, diseases and major industrial disasters) which had caused human, social and economic costs have raised concern in all levels of people starting from the working individuals, employers, to the national and international skeleton, mostly in Asian region. However, to keep pace with technological and economic changes, measures and strategies are designed, developed and applied to prevent, control, reduce or eliminate these occupational hazards and risks over the years, particularly, when it is compared with the ancestral period. But despite these consistent slow improvements, considering the human suffering and economic burden, occupational accidents and diseases are still too frequent and still continuing to be significantly disastrous in Asia .
Asia is the largest and most populous continent of the Earth. The vast demographic, cultural, political and economic differences among the countries of Asia have often been the basis for a lively engagement of this continent with the world. While diversity is a universal feature, Asia represents an extreme form of it comprising some of the highly performing sub groups of economics. It contains some of the developed countries as well as those that have performed relatively poorly, commonly characterized as developing countries . Therefore, this article will provide a brief overview of health risk due to occupational hazard and will also provide recommendations for Asian region with a close comparison with other developed and developing countries of the world.
Occupational health hazards usually refer to the materials and processes that have the potential to cause harm to the workers. Thus, the evaluation, control and entailing the identification of these hazards must be the inaugural actions to ensure occupational safety. Occupational safety and health is key element in achieving sustained decent working conditions and strong preventive safety cultures. As a result, since the creation of organization in 1919, it has continued till today . It is generally illustrated as the science of anticipation, recognition, evaluation and control of hazards arising in or from the workplace that could impair the health and wellbeing of workers. In addition, it may also take account the possible impacts on the surrounding communities and the general environment .
However, assurance of the occupational safety and health may be achieved by a multidisciplinary act, which aims at the protection and promotion of the health of the workers. It may work by preventing and controlling occupational diseases and accidents and by eliminating the occupational factors and conditions that are hazardous to health and safety of the workers at the working place. It may also include the development and promotion of healthy and safe work, working environment and working organizations. Thus, occupational health will be gradually developed from a risk oriented activity to a comprehensive approach that may consider an individual’s physical, mental and social well-being with general health and personal development .
Effects of occupational hazards/occupational diseases
Before ensuring occupational safety, one should be very much clear about occupational diseases. Occupational diseases are the adverse health conditions of human being, occurrence or severity of which is related to the exposure to hazardous health factors in the job or in the working environment. However, in most of the time, occupational cause of these diseases is overlooked by the health care providers and professionals. This is because of the several special characteristics of occupational and work related diseases that may obscure their actual occupational origins. Again, the clinical and pathological presentation of most of the occupational diseases is identical to that of nonoccupational diseases. For example, in the occupational sector, most of the workers suffer asthma which is caused by the excessive narrowing of the airways of the lungs due to airborne exposure to toluene diisocyanate. But often the disease is clinically indistinguishable from asthma which is caused by some other non-occupational reasons.
Occupational disease may also occur long after being exposed to an occupational hazardous factor. An extreme example would be asbestos related mesothelioma which is a canceraffecting the lungs and abdomen. The disease may occur from about 30 to 40 years after being exposed to it while working in an industry. It is one of the occupational factors which can act in combination with other non-occupational factors to produce disease. For example, exposure to asbestos alone increases the risk of lung cancer five-fold, whereas long term smoking of cigarettes increases the risk of lung cancer in somewhere between 50 and 70 fold . Again, in many occupations, workers are exposed to numerous combinations of various potential hazards which might be chemical, physical, biological, ergonomic or psychological but all of which ultimately result in occupational diseases. It was estimated in one study that more than about 13 million workers in the United States are potentially exposed to chemicals which can be absorbed through skin. Several observations have also indicated us that dermal exposure to hazardous agents like dusts, fumes, mists, aerosols, fibers, toxic gases, catastrophic chemicals can result in a variety of occupational diseases and disorders. It might also include occupational skin diseases (OSD) as well as systemic toxicity which may follow some different mechanisms . However, it is observed from studies that in industries, poisoning with metals usually takes chronic form and results usually from the absorption of small amounts of them over long periods of time. Acute poisoning may also occur from the accidental intake of large doses of toxic compounds like arsenicals. Nevertheless, metals and their compounds with most physical hazards may also gain access into the body by inhalation, ingestion and in a few cases through the skin.
Apart from these, homogenous organic solvents or chemicals produce similar hazards as organic liquids in which other substances can also be dissolved without changing their chemical composition or not. These chemicals are used in the extraction of oils and fats in food industry, chemical industry, paint, varnishes, enamel, degreasing process, dry cleaning, printing and dying in the textile and rayon industries and can contribute to the occupational hazards. All these compounds have a risk to be absorbed mainly through the lungs, via the gastrointestinal tract if taken by mouth and for many of them via the intact skin  and cause adverse effects. Some of the effects are discussed below:
• Nervous system: Any poisoning to the nervous system may cause dizziness, peripheral neuritis, affected vision, insomnia, headache, easy fatigue, unconsciousness and even death. This type of poisoning works faster when the hazardous agent is absorbed through the respiratory system than via the other routes. This is because of the numerous blood vessels of the lungs which make possible for the inhaled disastrous nerve agent to be rapidly diffused into the blood circulation and thereby reach the target organs. In case of skin nerve agents, they are more or less fat-soluble and have to penetrate the outer layers of the skin, thus, they take time before reaching the deeper blood vessels. However, the toxic effects of these nerve agents depends on their ability to be bound with the enzyme, acetyl cholinesterase and thereby inhibiting this vital enzyme’s normal biological activity in the cholinergic nervous system. This is quite alarming since it becomes extremely disastrous for the workers anyway long after the time of exposure to these agents .
• Gastrointestinal system: Exposure to different chemicals through foods or inhalation may cause dyspepsia, anorexia, nausea and maybe secondary effect to the liver affection .
Toxins and microorganisms that are able to breach the single layer of epithelial cells have unimpeded access to the systemic circulation and cause these symptoms . For example, alcohol can impair the function of muscles by separating the esophagus from stomach, which may favor the occurrence of heartburn, even in some cases may lead to the stomach cancer .
• Respiratory tract: Effect of hazardous chemicals and other toxins may show upper respiratory irritation in some cases . In chemical plants, workers who are producing pesticides are frequently experiencing chronic bronchitis and disturbed pulmonary ventilation . A significant fraction of hazardous particles that are inhaled by a worker can deposit within the respiratory tract such as in the lung airways during the inspiratory phase of a tidal breath which can cause harm to the respiratory system and result in respiratory tract infection to various diseases .
• Urinary system: A considerable amount of epidemiological data supports the casual relationship of occupational exposures with bladder cancer but the precise contributions of workplace exposures to kidney failure and kidney cancer are difficult to estimate. In a recent report, it was estimated that up to 10% of end stage renal disease could be attributed to workplace exposures. But this result is difficult to validate because of changing environmental and chemical hazards, variations in diagnostic criteria and the often long latency period between exposure and disease. It is predicted from study that function of two-thirds of the nephrons of both kidneys may be lost before renal damage is clinically evident. However, evidence is mounting that what were previously thought to be socioeconomic or ethnic causes of nephrotoxicity may in fact be environmental, adding validity to the role of toxicants in disease development .
• Skin: The growth of industry, agriculture, mining and manufacturing has been paralleled by the development of occupational diseases of the skin. The earliest reported harmful effects were ulcerations of the skin from metal salts in mining. As populations and cultures have expanded, the uses of new materials, new skills and new processes have emerged. Such technological advances brought changes to the working environment and during each period some aspect of the technical change has impaired workers’ health. Fifty years ago in the United States occupational diseases of the skin accounted for no less than 65-70% of all reported occupational diseases . Though recently statistics collected by the United States Department of Labor indicate a drop in frequency to approximately 34%. But still many people are in conditions which are conducive to the occupational diseases like cement dermatitis, chrome holes, chloracne, fiberglass itch, oil bumps, rubber rash etc. . Therefore, exposure to toxic components to skin may show contact dermatitis or acne to skin cancer depending on the exposure intensity .
In the context of occupational health hazards, sleep problems may be a relevant risk factor for occupational injuries due to the sleep deprivation caused from overtime work or work stress. Insufficient sleep may not have led the news in reporting on serious occupational accidents in recent decades, but that doesn't mean fatigue and inattention due to sleep loss did not play a role in occupational health disasters. For instance, investigators have interpreted that sleep deprivation was a significant factor in the 1979 nuclear accident at Three Mile Island Nuclear Plant, USA as well as the 1986 nuclear meltdown at Chernobyl Nuclear Plant, Ukraine . Since sleep is essential for the functioning of the human body, disrupted sleep has numerous negative consequences, including increased mortality , diabetes, obesity, burnout, and poor performance Recent reviews have indicated that 10% to 40% of the population suffer from insomnia, 2% to 10% suffer from obstructive sleep apnea, 4% to 29% suffer from restless legs syndrome, and about 25% suffer from non-specific sleep-related problems. Furthermore, approximately 13% of work injuries are due to sleep problems and the risk for sleep related work injuries has increased by a factor of 1.62 .
1. The review is about to give a brief demonstration about the profound health consequences of the world especially in emerging economic countries like Bangladesh if occupational health hazard is not tackled.
2. To identify the effects of different occupational exposures and accidents on human health taking Bangladesh as a developing country.
3. To raise a concern though a possible recommendation among industrialist, researcher and policy makers.
Data collection process
The review is based upon the information collected from articles that are especially written in English language with English abstracts. For relevance, studies were justified on the abstracts. A systemic search of international peer-reviewed literature was carried out on occupational hazard and its impact on global and Bangladeshi sectors. Using generic search engines like Google, yahoo etc., grey literature such abstracts, presentation, technical reports were identified on these topics. The search terms used were occupational hazard, impact on human health due to occupational hazard in global arena, impact on Bangladesh due to occupational hazard etc.
The data’s were analyzed by the search result individually to find potentially eligible studies. The publications were sorted by titles and abstract and only eligible studies were selected for full text review. During this stage all the irrelevant studies were excluded.
A concern on Bangladesh as a developing country
In many rapidly developing countries, industrialization bring a radical alteration with it in the lives of the countries. But if industries are not well designed and appropriate safety measures are not adequately adopted, serious adverse health consequences can ensue . For example, in country like Bangladesh, agricultural profession as well as fishing or forestry can make people face substantial risks due to their occupational and geographical setting . According to the ILO, it is estimated that 11.7 thousand workers suffer fatal accidents and a further 24.5 thousand die from work related diseases across all sectors each year in Bangladesh  whereas work related diseases result in approximately over 2 million fatalities from over the 2.3 million fatalities that are caused throughout the whole world annually . It was also observed that a further 8 million workers suffer injuries at work–many of which will result in permanent disability. Although little research has taken place in Bangladesh, it is internationally recognized that most of the occupational deaths and injuries are entirely preventable, and could also be avoided if organization provide proper environment with all kinds of safety facilities and employers and workers took simple initiatives to reduce hazards and risks at the workplace .
Considering the statistical scenario, latest labor force survey of Bangladesh published in 2009 (Table 1), about 51 million people are in the occupational sector in Bangladesh, of whom 22.2 million are involved in agriculture, forestry and fisheries sector, 7.8 million in trade, hotel and restaurant service occupations, about 7 million in manufacturing, 2 million in construction sector, and about 4.2 million people are involved in transport, storage and communication sector (Figures 1 and 2) [16,17]. But the alarming news is most of these employees operate under poor working conditions and also quite terrifyingly, in absence of occupational health and safety standards .
Table 1: Bangladesh labor force characteristics, 2009.
A study conducted in Bangladesh revealed that about 79.52% of the injured (by occupational injuries) workers were in between 40–59 age group and about 73.26% of the accidents that caused injury to hands, feet, torso, arms and eyes result in different forms of disability . It was also observed from a study conducted by Mohammad Muhsin Aziz Khan, Zaheed Ibne Halim and Mohammad Iqbal which was published in the International Journal of Occupational Safety and Ergonomics (JOSE) that of all the respondents suffered from occupational hazards, 75.24% of total injured workers faced hand, feet, arm, eye, face and head injury, among which 27.72, 18.81, 7.92 and 5.94% of the total injury occurred in hands, feet, eyes and head respectively and the rest (24.76%) of the injured workers suffered injury in other parts of the body . However, that type of injury pattern was seen due to the ignorance of workers for not using precautionary measures such as gloves, helmets, eye shields, etc., during their working hours. The illustrates the number and percentages of the risk susceptibility of the different organs of the workers obtained from the above mentioned study (Figure 3).
The real scenario of occupational health hazard in Bangladesh can be inferred if the regular media reports concerning workplace accidents and injuries are taken into account. A media scan report of 2007 showed that almost half of all worker deaths took place in the construction sector, with 164 separate incidents which ultimately results in a combined total of 222 deaths [19,16], whereas in Thailand which is another developing country there were 189,621 cases of occupational injuries in 2001 . It is also observed that in spite of being one of the most developed countries, a preliminary total of 4,405 fatal work injuries were also recorded in the United States in 2013 . Therefore Bangladesh is not only the hazardous prey of occupational health injuries but it has been estimated that at least, in the developed world, they have taken drastic measures to discard the fatalities caused by occupational hazards. As in USA there were fewer fatalities in 2013, lower than the revised count of 4,628 fatal work injuries in 2012 . On the contrary statistics from the Bangladesh Occupational Safety, Health and Environment Foundation (OSHE) revealed that 1,310 workers were killed and 899 others were injured during the first six months of 2010 [22,23] and some 622 workers were killed and 395 others injured in various work related incidents across the country in the first six months of 2011 which are much higher than the number of fatalities caused in the previous years . List of casualties caused from occupational incidents in the year 2012 and 2013 in Bangladesh is mentioned in the (Table 2).
|24-Nov-12 A fire at Tazreen Fashions at Ashulia district on the outskirts of Bangladesh which used to produce T-shirts, polo shirts and jackets for various companies and organizations leads resulted in the deaths of 112 workers.|
|26-Jan-13 A fire at Smart Exports Garments in the Mohammadpur suburb of Dhaka resulted in the deaths of seven workers.|
|24-Apr-13 The Rana Plaza building which was an eight story commercial building in Savar, a sub district in the greater Dhaka area collapsed leading to the loss of 1,135 lives. Most of the victims were workers from the ready-made garment factories housed in the building.|
|8-Oct-13 A fire at Aswad Composite Mills resulted in the deaths of seven workers.|
Table 2: List of incidents and casualties in Bangladesh in the year 2012 and 2013 .
Since 1985, expert committee, clinical and epidemiological research teams have provided a great deal of new evidences on the relationship of work to diseases. The attribution by work varies widely depending on diseases and type of work, as well as on local working conditions and health conditions of the community. A substantial part of work-related morbidity has been associated with common non-communicable and communicable diseases prevalent among populations, such as cardiovascular disorders, respiratory disorders and musculoskeletal disorders . It is observed that adults as well as children working in hazardous jobs are subjected more to acute or chronic physical illness, and this number of population is not at all insignificant . The National Child Labour Survey (NCLS) 2002-2003 conducted in Bangladesh found that about 7.9 million children who are working are between the ages of 5 and 17 and 8 percent of these children are hurt or become sick due to work. These child workers were often found to work long hours in a variety of hazardous occupations and sectors that have the potential to seriously damage their health (e.g., in bidi factories, manufacturing, construction, tanneries, and the seafood and garments industries) . Even in the developed countries like USA it has been found that younger workers who are in between 15 to 24 age group represent 14% labor force. This labor force face high risk for injury when on the job during the period 1998- 2007 but there is a moderate decline in the number of fatalities by year unlike Bangladesh . The following illustrates the percentages of various illness related to different employment sectors (Table 3).
|By health conditions||Injury/Illness||Tiredness/ Exhaustion||Body injuries||Backache||Other health problems|
Table 3: Percentages of health conditions by sectors of employment (NCLS data 2002) .
Occupational hazard and agro-based sector
Bangladesh is an agro-dominant country where about 62% of the population is involved directly or indirectly in agricultural sector . Bangladesh economy draws its main strength from agriculture sector. The sector contributes about 19.10% to the GDP (at current prices) and employs approximately for about 50.28% of the labor force . The most alarming concern about the farmers regarding their occupational safety is the indiscriminate use of pesticides due to their ease of availability, relatively cheap cost and ease of application [28,30]. Even though occupational health hazard can be found in most agricultural workers among the developing countries including Bangladesh, not many studies have been performed in this sector. The reason may be it is not quite an alarming issue in the developed world because of their less dependency on agriculture due to their industrialized technological advancement.
Yet in 1990, WHO estimated that about one million unintentional acute pesticide poisonings occurred worldwide annually and the estimated number of people who died worldwide as a result of poisonings was 20,000 in the respective year . However, since 2008, more current statistics have become available, among them, according to WHO data, 346,000 people die annually worldwide as a result of pesticide poisonings and two-third of them are in the developing countries which includes Bangladesh as well [32,33]. Nevertheless, it should be strongly mentioned that occupational health hazard have always been a serious issue in the agricultural communities since the ancient ages .
In 1983, a study was investigated on the extent of acute pesticide poisoning and their contributing factors in selected agricultural communities alike Bangladesh such as Indonesia, Malaysia, Sri Lanka and Thailand. The study confirmed the existence of this problem, which was found to be due to inadequate knowledge of the safe practices in the use of pesticides among users and to the lack of suitable protective clothing for use by agricultural workers in hot and humid climates, which is still observed among the Bangladeshi agricultural workers. The result of the study reflecting the pesticide users perception of a pesticide-related acute illness, revealed that in Sri Lanka and Malaysia, 7.1% and 7.3%, respectively, of the workers had suffered an episode of poisoning during the previous year, compared with only 0.3% in Indonesia . In all of the four countries, spraying, mixing and diluting of pesticides were the most frequently identified activities associated with poisoning; unfortunately, these activities are still included in the traditional agricultural system of Bangladesh .
However, when it is compared to the past a much recent study in 2004 showed that in 2001, of the 3035 cases of reported occupational diseases in a study of Thailand, 87.4% were caused by pesticide poisoning and 3.4% were by petro-chemical poisoning . It is also observed that as a result of frequently problematic handling of pesticides in developing countries like Thailand, Bangladesh, 70% of all pesticide poisonings and 99% of resulting deaths occur in these countries, despite the fact that of all pesticides used globally, only 25% are applied there . It also reveals that in the countries including Bangladesh as well having traditional agricultural occupation still have the most significant occupational health effects among the workers. On the contrary, though in USA, more than 18,000 products are licensed for use and each year more than 2 billion pounds of pesticides are applied to crops, gardens, in homes etc.  it is seen that they are able to overcome these losses and adverse effects caused by pesticides. This is because of their technological, economic and medical advancement which make them capable of spending 1.1 billion dollars per year to overcome the losses due to the application of pesticides which is quite difficult for any developing countries resembling Bangladesh to implement [38,39].
The activities identified by the pesticide users which resulted in poisoning may include spraying using knapsack spray equipment, mixing and diluting pesticides and repairing or cleaning of spray equipment etc. . Since exposure to pesticides can lead to unspecific adverse health effects, this exposure may be referred to here as poisonings. The adverse health effects of insecticides may range from damage of nerve impulses transmission, inhibition of blood clotting to paralysis of the respiratory and circulatory centers. The typical symptoms of poisoning in humans that are relatively easy to diagnose as acute pesticide poisoning are fatigue, headaches and body aches, skin discomfort, skin rashes, poor concentration, feelings of weakness, circulatory problems, dizziness, nausea, vomiting, excessive sweating, impaired vision, tremors, panic attacks, cramps, etc., and in severe cases coma and death [40,41]. Besides causing acute poisoning, pesticides can also cause chronic illnesses if they are incorporated over a longer period, even if the amounts taken up are relatively small. Symptoms are often diffuse or do not become apparent for a long time, which then may lead to late effects. Although the results of various epidemiological studies are inconsistent, some findings leave no doubt that agricultural workers exposed to pesticides have a significant risk of contracting non-Hodgkin lymphomas and leukaemia . Other studies have also revealed a correlation between pesticide use and sarcomas, multiple myelomas, cancer of the prostate, pancreas, lungs, ovaries, the breasts, testicles, liver, kidneys, and intestines as well as brain tumors [40-44].
Occupational safety in garment sector
In Bangladesh, garment sector plays an important role in the overall economic development. The sector is providing employment to approximately 20 lakh workers (among which 80% is female) of the country . But it is unfortunate that working condition of these industries is also putting at risk the health of these workers.
From a study conducted with 90 random correspondents in three garment factories of Bangladesh, it was found that working condition of those three garment factories severely affected worker’s health, because of their confinement in a closed environment during working hours . In the study the particular nature of work created various types of health hazards among the selected respondents such as sleep deprivation, headache, malnutrition, musculoskeletal pain, eye strain, less appetite, chest pain, fainting, diarrheal disease, hepatitis (jaundice), food poisoning, asthma, fungal infection, helminthiasis and dermatitis. Results of the study also showed that at most 95.6 percent of the workers were experiencing headache. In total 90, 58.89 percent respondents implied that their extent of headache was severe. About 52.22 percent of the respondents opined that they suffered from severe malnutrition, followed by 78.89 percent by musculoskeletal pain, 72.22 percent by eye strain, 68.89 percent by less severe malnutrition, respectively . The following illustrates the patterns of diseases and illness among the respondents (Figure 4).
It is also observed from the study that, 45.56 percent respondents mentioned that they had severe diarrheal diseases and 36.67 percent replied that they had not affected by diarrheal diseases yet. The study also showed that amount of absenteeism of diarrheal diseases was high on those who were involved in the garments sector less than two years. This is may be due to the transmission of diarrheal diseases by faecooral route and its relation to poor sanitation and poor socioeconomic status .
Apart from these, asthma, a Chronic Obstructive Pulmonary Disease (COPD) is also commonly found in the garment workers due to the production of excessive dust like, cotton during preparation and handling of garments product in the working place. The disease progresses very slowly over many years and commonly occurs due to inhalation of dust particle which ultimately causes chronic irritation of lungs. From the table it is clear that 41.11 percent of the garment workers experienced severe asthma severity of which was related to the duration of work. The explanation of their relation to duration of work is also similar to fungal infection, helminthiasis and dermatitis. It is predicted from different observation that those who had less work experience the existence of these disease was absent in them, on the contrary who are involved in the garments sector for over a long time the existence of these diseases was severe .
However, although there has been a number of evidences of these severe diseases among garment workers of Bangladesh, the most heartrending fact of the fate of the garment workers is being injured or dead in the consecutive accidents being occurred in the industries. Table 2 reveals the deadliest recent accidents occurred in four industries of Bangladesh among which three are garment industries . Unlike
Bangladesh the garment workers of the developed world are safer and no recent fatal incident could be found among them, except some news reports which mentioned the workers turning violent due to the recent harassments abuses and death of some workers in India . It obviously explains the lack of righteous, secured work environment among garment workers not only in Bangladesh but also in other countries.
Hazardous practices that are observed in tanneries
Tanneries are probably the oldest sectors which have been playing a significant role in the national economy of Bangladesh. As the sector is fully privatized since 2010 at present, Bangladesh has approximately more than 1750 big, small and medium size tanneries which are providing employment to approximately 0.5 million people . However, it is also observed from the report of Human Right Watch (2012) that 58% of these tannery workers in Bangladesh suffer from gastrointestinal disease, 31% from skin diseases, 12% from hypertension and 19% from jaundice (DOE, 2011) [49,50].
However, though illness among these tannery factory workers is quite a serious issue, there is still no monitoring and action taken by the law enforcements of Bangladesh . Moreover, Human Right Watch reported hazardous child labor practices in these tanneries . It is observed that a range of health conditions including prematurely aged, discolored, itchy, peeling, acid-burned, and rash-covered skin, fingers corroded to stumps, aches, dizziness and nausea and disfigured or amputated limbs have been displayed by the past and present tannery workers . These health problems may arise from repeated exposure to a hazardous cocktail of chemicals while measuring and mixing them, adding them to hides in drums, or manipulating hides saturated in them and in several other situation. However, some of these chemicals can be injurious to health in the short term such as sulfuric acid and sodium sulfide which can burn tissue, eye membrane, skin and the respiratory tract. On the contrary, some chemicals like formaldehyde, azocolorants and pentachlorophenol which are confirmed or potential human carcinogens show symptoms or health effects years after exposure to them .
Considering the geographical aspects, Occupational Health hazards among the workers of tannery industries are not only a matter of concern in developing country like Bangladesh but also in western countries as well. Studies of leather-tannery workers in Sweden and Italy found cancer risks between 20% and 50% of the workers which is above expectation in case of their developed and safer health conditions of their inhabitants . Moreover according to a survey conducted recently by Bangladesh Occupational Safety, Health and Environment Foundation (OSHE), at least 21 people die in Bangladesh due to toxic chemicals each month and as per an International Labour Organisation (ILO) report, about two million people die annually across the world due to chemical related diseases while about 160 million people are affected by such diseases . Therefore the occupational hazard among tannery workers which is a matter of distress Bangladesh is also an alarming issue throughout the world.
A study revealed that irrespective of the severity of injuries, victims in rural Bangladesh spent an average of US $4 on each injury although this is a country where 17.6% of the population lives below the lower poverty line . With a poor public health care system, insufficient health insurance and social safety nets, injured and sick victims and their families are forced to cover the cost of treatment through their own means . Therefore, though work-related diseases are amenable to prevention through recognition, evaluation and control of the hazards in an ideal world, effective practice of occupational health and safety is yet to be fully developed in the developing countries like Bangladesh.
Considering the economic situation of the world, Bangladesh is still lying in the developing stage. So, it is predicted that by far the occupational health and safety service in Bangladesh is in the developing situation. The current state of law and regulation system of the country refers to the extreme need for more workers, industries or new manufacturing process as the current condition does not at all completely cover all the occupational sectors of the country (Figure 2). In addition, the laws that are run by the country to cover up the health impacts due to occupation hazards, are lacking I standard values, in fact they are not specific, rather general in nature. However, from 2009, significant initiatives have been taken against these occupational health hazards in Bangladesh such as TVET Reform Project. The project was jointly funded by the Bangladesh Government, the European Commission and the International Labour Organization (ILO). The project arranged a day long workshop on “Occupational Safety and Health” (OSH) to raise awareness among the industry stakeholders . In addition, the amendments of Bangladesh Labour Act 2006, adopted on 15 July 2013, were supposed to be the first step towards fulfilling the Government’s obligation to the fundamental rights of freedom of association. The amendments were also adopted to address the critical need of bolstering the occupational safety and health . The conformity of the amended legislation with international labour standards ratified by Bangladesh was reviewed by the ILO supervisory machinery later in that year. An initial review by International Labour Organization suggested that the amendments did address some of the ILO’s specific concerns, while fall short of several important steps for which the organization requested the country to bring them into conformity with ratified international labour standards . Though several provisions to improve workplace safety have now been included in the law, the disastrous incidences caused by occupational health hazards are yet to be reduced. Since Bangladesh has ratified category only or sector specific Conventions on OSH which are not directly related to the Labour Act, the specific steps taken in this area detailed below can only be welcomed. However the country is encouraged to ratify the key international labour standards on OSH policy, namely Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187) and Occupational Safety and Health Convention, 1981 (No. 155) . But even in this bigger platform no such organization or agencies have developed which could be a referral center for different standard or occupational permissible limit. Moreover, it is also important to raise concern among out country workers because the labor law in Bangladesh has been framed which requires employers to undertake corrective measures on occupational safety and health. Lack of awareness, training program of the OSH standards by the employers made this area vulnerable to the workers.
The ILO Country Office for Bangladesh in cooperation with the Ministry of Labour and Employment, Bangladesh Employers’ Federation (BEF), National Coordination Committee for Workers Education (NCCWE), social partners such as the Occupational Safety and Health and Environment (OSHE) Foundation and the Bangladesh Institute of Labour Studies (BILS), are working to foster a preventative safety and health culture by strengthening national occupational safety and health (OSH) systems  which includes:
• Development of a National OSH policy, National OSH profile (2002) update;
• Promotion on ratification of the Occupational Safety and Health Convention, 1981, as well as Occupational Health Services Convention, 1985 (No. 161) and Private Employment Agencies Convention, 1997 (No. 181);
• Capacity building of the key OSH stakeholders;
Promotion of safe and environmentally friendly ship recycling; and Promotion of better working conditions in the garment industry .
Even in these acts, there is no legal requirement for safety committee and employment of the safety officers. The provisions of medical care are nonspecific and vague. The inspectorate of factories and establishment, the enforcing agency for different legislation are under-staffed and unequipped both in terms of training and technology, in fact they are unable to execute the enforcing activities adequately. The NGO activity of the OSH is limited even. Only a few conducts awareness, training and research activities regarding OSH issues. Training and education facilities on OSH are inadequate and limited mainly in governmental undertakings.
Considering the data management systems, OSH is inadequate since it gathers information mainly from the secondary sources and has no primary data collection system in place. So there is an increasing number of events that are under reported or miss reported. Moreover, while the data for occupational injuries and accidents are available from the department of inspection, the data for occupational illness are not found from these departments of inspectorate as they are not normally reported. Nevertheless, in the studies conducted by NIPSOM, a number of occupational diseases have been found to be prevailing in various industries.
All these gaps are needed to be minimized by government, NGO and private sectors by incorporating proper initiatives. It is also necessary to give specific ideas to the policy makers to revise our legislation process so that they can reduce these OSH problems. OSH management and framing of national occupational safety and health policy should also be incorporated to the national policy. Training awareness and motivating workers regarding the safety and health in their working place are needed to be undertaken by their owners and it should be forced by the government agency. Development of and strengthen of institutional capacity to provide education and training related to the OSH in all sectors has now become an urgent need. Thus, qualified OSH personnel-occupational physicians, occupational nurse and industry hygienist and safety officers etc. are needed in each company as well as all occupational sector to share their strength of knowledge to disseminate their OSH information and its vulnerability. Occupational health care facilities for employees must be ensured in all the workplaces. Considering the business perspective, interim incentives for adoption and implementation of OSH program can be encouraged. Apart from them, researchers and academicians are also needed to come forward with their research ideas to go through this problem. Moreover, national statistics has to be developed by active data collection system by establishing occupational disease surveillance and national and regional accidents and occupational disease database system.
Conclusively, based on the present review study, OSH has a became a problem that needs to be addressed both in developed and developing countries, but particularly in the countries where there is a high density of industries producing or using manpower as their main strength. This review shows that occupational health hazard can be extremely harmful to the humans’ health to make any kind impact that can’t be measured. All these factors point at a single conclusion that we must take immediate steps to protect our country through proper rules, regulation and implementation. Otherwise, we cannot ascertain a healthy and safe life for those who are yet to see a healthy family beside them.