Discussion: Tuberculosis in Garment Factory Workers

Located in Southeast Asia, the People’s Republic of Bangladesh with a population of 164,669,751 million (2017 est.) remains one of the least developed and poorest countries in the world. The populace of Bangladesh is principally homogenous, with 98 percent being ethnic Bangla (Bengali), the remaining two percent is comprised of 27 different minority groups and the indigenous tribes (Aliprandini, 2017). Regarding matters of faith and belief, the majority of the Bangladeshi population is Muslim followed by Hindus, Buddhist, and Christians. Notably, Bangladesh and its indigenous tribes share a “rich and diverse culture which is reflected in the architecture, culture, literature, music, painting, and clothing” (National Tourism Organization, 2017, para. 3). Although rich and diverse, both religious and cultural beliefs to some degree factor into the health disparities witnessed among the Bangladeshi population.

Demographic Profile

According to the World Bank (2017), Bangladesh’s population density stands at 1,251.8 persons per square kilometer of land area, which is comprised of the following age and sex distribution. Also, the dependency ratio is included here as a means to showcase the imbalance between working and non-working persons.

Age/Sex Structure

· 34.3 percent of the population under 15 – males 28,477,712 / females 27,676,239

· 61.1 percent of the population aged 15 and 64 – males 47,501,643 / females 52,602,227

· 4.7 percent of the population 65 and older – males 3,738,570 / females 3,905,749 (Country Meters, 2017).

Age Dependency Ratio/Life Expectancy

With a total dependency ratio of 63.7 percent (56.1% under 15 and 7.6% for those 65 and older), it places a tremendous burden on the productive population to cover the expenditures for both children and aged individuals. Total life expectancy at birth (both sexes) for Bangladeshi’s is 69.8 percent (males 67.9 years/females 71.7 years) falls just short of the global population average of 71 years (Country Meters, 2017).

Overcrowding, Poverty, and Disease

As previously stated, the population of Bangladesh stands at 164,669,751 million; thus, ranking the eighth most populous country in the world. Interestingly, only 34 percent of the Bangladeshi populous live in urban areas; thus, an astonishing 66 percent of this country’s population reside in urban locals (World Meters, 2017). Notwithstanding the significant difference between urban and rural population rates, there remains little escape from overcrowding, as well as the ease in which disease(s) can spread within congested populations.

Additionally, poverty is a pressing concern when considering 24.3 percent of the population (37.9 million people) lives below the national poverty line of which 12.9 percent (4.9 million people) live in extreme poverty (World Bank, 2017). Collectively, population density and poverty have further strained Bangladesh’s already inadequate and struggling health care system. The latter stems from a significant shortage of hospitals and health care workers in urban locals and near extinct palliative care services available to rural inhabitants (Aliprandini, 2017). Consequently, theses untied forces leave Bangladesh ill-equipped to combat the major burdens of diseases threatening its people.

Communicable and Non-Communicable Diseases

Although Bangladesh has witnessed substantial progress in disease prevention, new and old communicable diseases, like malaria, acquired immunodeficiency syndrome (AIDS), and tuberculosis (TB) will persist as a significant health burden for the foreseeable future. The latter results from migration, urbanization, trade, and travel. Of notable concern is microbial evolution, which often strengths said diseases. Equally concerning, is the emergence of drug-resistant TB and Malaria, which increases this population’s risk (World Health Organization, 2017). Noteworthy non-communicable diseases as a source of substantial death and disability among adults include cancer, heart disease, diabetes, and mental disorders, whereas malnutrition is the leading cause of death and disability among children. Estimates suggest 75 percent of a child’s life is consumed by illness because of malnutrition-related infections and disability (WHO, 2017). Notwithstanding the personal and economic impact resulting from the aforementioned burdens of disease, TB is particularly concerning.

Tuberculosis Burden

Compared to Malaria and HIV/AIDS, TB is by far the most predominant communicable disease in Bangladesh. According to the World Health Organization (2017), “in 2014, there were 187,005 new cases of TB in Bangladesh and it was the leading cause of death, accounting for 81,000 fatalities” (para. 1). Estimates for 2016, indicate improvements in TB prevention with a rate of 221 new infections per 100,000 people or 361,000 new cases (males 232,000 / females 129,000). Markedly, years of healthy life lost due to TB (both sexes) is 481.0 per 100,000 people and the mortality rate rests at 40 per 100,00 people the equivalent of 65,868 lives lost per year (WHO, 2017). Given the population of Bangladeshi’s is witnessing new, resurgent, and drug-resistant TB incidences, it indicates the country has entered the third epidemiological transition (Mahmood, Ali, & Islam, 2013). Although improved, these statistics remain alarming, yet for those working in the garment industry, the picture is much bleaker.

Factory Garment Workers and Tuberculosis

The more than 5,600 garment factories in Bangladesh employ an estimated 4.2 million people, of which women and young girls account for 85 percent of the workforce (Ghosh, 2014). Important to note, TB outbreaks are closely linked to overcrowding, poor ventilation, poor working conditions, malnutrition, and an imbalanced healthy workforce, all of which are prevalent issues in Bangladesh garment factories. Thus, when taking into account that “TB is spread through the air when people who have an active TB infection, cough, sneeze, or otherwise transmit respiratory fluids through the air, garment factories provide an environment ripe for the spread of (Bangladesh Garment Manufacturers and Exporters Association, 2015, para. 3).

With that said, “a study among 2281 workers from 30 garment factories in Dhaka city, the prevalence of TB was found to be higher (960 per 100,000) than in the general population” (Islam, Akramul Islam, Islam, Ahmed, & Islam, 2015, p. 2). Thus, when compared to the general population, garment factory workers are 2.4 times more likely to develop active TB. As such, “TB patients lose 3-4 months of work time, resulting in an average lost potential earning of 20% to 30% of annual household income” (21st Century Academic Forum, 2017, 12:46). However, there’s a significant gender disparity in “TB detection and diagnosis, with a female: male ratio of 0.38 compared with 0.51 in South-East Asia and 0.71 worldwide” (21st Century Academic Forum, 2017, 12:46). Markedly, young women as the driving force of the garment industry belong to low-income families; thus, suffer from malnutrition, which increases their risk for TB. Subsequently, these statistics suggest the importance of continuing TB control programs in garment factories, as well as TB education directed toward the workforce.

Tuberculosis Prevention

As is often the case with most communicable diseases’ awareness, education, and access to health services are pivotal to reducing incidences of the disease, which in this case is TB. Bangladesh’s National Strategic Plan for TB Control (2015-2020) is one program that’s proving successful. Under the program, as of 2016, they have achieved a treatment success rate of 93 percent among all new and relapsed cases, as well as a multi-drug resistant TB treatment with a success rate of 73 percent. Contributing to this success is the increased number of automated diagnostic machines that from a small sample can detect TB infection (WHO, 2017). While the efforts of the National Strategic Plan for TB Control have proven fruitful much work remains. The latter is especially true if Bangladesh hopes to achieve the Sustainable Development Goals set forth by the World Health Organization, which is a “95% reduction in deaths and a 90% reduction in TB incidence by 2035 (WHO, 2017, para.1). Although successful, it’s fundamentally important to bring TB awareness and education to the extremely vulnerable population of garment factory works. In doing so, it will not only improve the health of the workforce, it also increases production rates and profits, which could help to increase garment factory workers wages.

References

Aliprandini, M. (2017). Our world Bangladesh. Retrieved from doi:10.3331/our_world_481_250188

Bangladesh Garment Manufacturers and Exporters Association. (2015, March 15). Garment workers being infected with tuberculosis. News Bangladesh. Retrieved from http://www.newsbangladesh.com/english/details/598

Ghosh, P. (2014). Despite low Pay, poor work conditions, garment factories empowering millions of Bangladeshi women. Retrieved from http://www.ibtimes.com/despite-low-pay-poor-work-conditions-garment-factories-empowering-millions-bangladeshi-women-1563419

Health Grove. (2016). Tuberculosis: Impact in Asia. Retrieved from http://global-diseases.healthgrove.com/l/4/Tuberculosis

Islam, Q. S., Akramul Islam, M., Islam, S., Ahmed, S. M., & Islam, M. A. (2015). Prevention and control of tuberculosis in workplaces: how knowledgeable are the workers in Bangladesh. BMC Public Health, 15(1), 1-10. doi:10.1186/s12889-015-2622-4

Mahmood, S.A., Ali, S., & Islam, R. (2013). Shifting from infectious diseases to non-communicable diseases: A double burden of disease in Bangladesh. Journal of public health and epidemiology, 5(11), 424-434. Retrieved from doi:10.1186/s40249-017-0310-6

National Tourism Organization. Visit Bangladesh. Retrieved from http://visitbangladesh.gov.bd/about-bangladesh/culture-religion-language/

World Bank. (2017). Bangladesh: Country profile. Retrieved from http://databank.worldbank.org/data/Views/Reports/ReportWidgetCustom.aspx?Report_Name=CountryProfile&Id=b450fd57&tbar=y&dd=y&inf=n&zm=n&country=B

World Health Organization. (2017). Health profile of Bangladesh. Retrieved from http://www.whoban.org/country_health_profile.html

World Health Organization. (2017). WORLD TB DAY 2016: Bangladesh continues its battle against the disease. Retrieved from http://www.searo.who.int/bangladesh/world-tb-day-2016/en/

World Meters. (2017). Countries in the world by population (2017). Retrieved from http://www.worldometers.info/world-population/population-by-country/

21st Century Academic Forum. (2017, March 12). Gender Disparity in Management of Tuberculosis Patients among Garments Workers [Video File]. Retrieved from https://www.youtube.com/watch?v=qHXwz3jvKK8