Managing heat stress among Bangladesh ready-made garment workers in Bangladesh

The global rise in temperatures due to climate change has increased the prevalence of heat stress, particularly affecting vulnerable populations such as workers in sectors that have high heat exposures and high work intensities (e.g. Outdoor workers) or indoor workers in resource constrained settings with insufficient cooling. This thesis investigates the implications of occupational heat stress on health and productivity within the Ready-Made Garment (RMG) sector in Bangladesh and explores feasible interventions to mitigate these effects. Heat stress not only affects health but also reduces worker productivity. Studies indicate that as temperatures rise, the capacity to work decreases, leading to significant economic losses. The productivity of workers in the RMG industry is particularly impacted due to long working hours in hot, poorly ventilated environments. This sector is crucial for Bangladesh's economy, making the need for effective heat stress management to ensure worker health and productivity even more urgent. Various strategies have proven effective to mitigate the effects of heat stress, including environmental manipulation (modifying the surroundings to reduce heat exposure and improve comfort), external and internal cooling methods, and hydration strategies. However, some of these interventions are not as feasible in low-resource settings like Bangladesh and are challenging in workplaces where piecemeal work exists. Despite the recognition of heat stress as a significant issue, there is limited research on the specific impact of heat on indoor factory workers in Bangladesh. Moreover, the feasibility of implementing various heat mitigation strategies in the RMG sector remains underexplored. This research seeks to provide an increased understanding of the challenges posed by heat stress in the RMG industry and recommend practical solutions that can enhance worker health and productivity. The findings can contribute to the development of targeted interventions that are both economically and environmentally sustainable, ultimately improving the working conditions and economic outcomes in Bangladesh's RMG sector. This thesis incorporates three research studies designated to address the overall research aim and questions. The study employs a mixed-methods approach, combining qualitative data from interviews and focus group discussions with quantitative data from biological markers of kidney impact (e.g., serum creatinine levels and estimated glomerular filtration rate) to assess the health impacts of heat stress. Study 1 is a qualitative exploration with workers and key stakeholders to understand the effects of heat on the health and productivity of production-line workers in the economically vital Bangladesh RMG industry. Findings from this study indicate that workers self-reported symptoms such as headaches, dizziness, fatigue, and nausea attributed to heat, and these were confirmed by factory health professionals. Additionally, factory health professionals noted cardiovascular strain in workers, including altered blood pressure responses during the summer. Key informants (KIs) also observed increased absenteeism during hotter months. The study identified how heat significantly affects overall productivity via a number of pathways including heat-related illnesses, workplace injuries, diminished work capacity, and absenteeism. and despite awareness of hydration among workers as a key heat health risk mitigation strategy, quota pressures in factories hinder its effectiveness. In Study 2 a prospective cohort study was conducted where participants were screened based on health criteria, excluding those with pre-existing kidney conditions. Physiological measurements such as blood pressure, height, weight, and blood and urine samples were collected pre- and post-shift to assess kidney function and hydration status. The study identified notable variations in urine pH and estimated glomerular filtration rate (eGFR) between different seasons and shift periods, indicating a possible but not statistically significant link between heat exposure and the risk of acute kidney injury (AKI) among RMG workers in the sample. The observed differences in urine pH between summer and winter, as well as pre- and post-shift conditions, suggest that working under heat stress may contribute to the development of AKI, underscoring the impact of heat on kidney function. Additionally, this small study demonstrated the feasibility and need to conduct a larger-scale study across multiple garment factories in Bangladesh. Study 3 was a qualitative exploration of heat mitigation with stakeholders and workers of the RMG sector. Workers from two RMG factories were interviewed, along with key informants (KIs) from three additional factories to enhance factory representation. Findings revealed that while many cooling solutions remain challenging to implement because of high costs and cultural barriers, other options such as increased ventilation, low-cost cooling devices, and mandatory breaks for rest and hydration could be implemented without major disruptions. Effective cooling requires regular maintenance and proper operational guidance, and this was identified as problematic. Health advice often emphasises hydration and cooler clothing, but clothing recommendations are not enforceable, and cultural norms typically favour heavier, more layered garments, especially for women. Research on culturally sensitive clothing options to reduce heat risk is needed. Although there is awareness of the importance of hydration among factory staff and some workers, production quotas often discourage adequate hydration and taking breaks. Therefore, it is essential for management to enforce regular hydration and rest breaks, particularly during the hottest periods, by integrating work-rest- hydration protocols into daily schedules. The key findings from the three interrelated studies are thematically categorised into three areas: health and productivity impacts, biological insights into heat stress, and feasibility and barriers to heat mitigation. Heat stress significantly affects RMG workers' health (e.g., fatigue, abnormal blood pressure, urinary tract infections) and productivity (e.g., workplace injuries, absenteeism), emphasising the need for heat mitigation strategies. Biological findings reveal a link between heat exposure and acute kidney injury risks, including declines in eGFR, changes in biomarkers like uric acid and electrolytes, and potential early signs of dehydration or renal strain. Socio-cultural, economic, and operational barriers (e.g., costs, workload pressures, limited awareness) can hinder effective heat mitigation strategies. These interconnected findings underscore the need for a comprehensive approach to manage heat stress, addressing health, productivity, and systemic barriers to ensure the sustainability of the RMG sector under global warming. The key findings from this research include recognising the impact of heat stress on RMG workers' health and productivity, implementing systematic reporting and assessment mechanisms, enhancing workplace infrastructure and protocols, and promoting policy and cultural shifts to prioritise worker well-being. Education and training programs are essential to raise awareness and equip workers, managers, and health professionals with strategies to manage heat stress. Additionally, industry-wide heat mitigation systems, such as heat-trigger mechanisms and adaptive operational hours, should be developed to optimise responses and reduce costs. Finally, further research is needed to understand the long-term impacts of heat-related kidney injuries and develop sustainable, climate-adaptive solutions for the sector.