Research by AKU highlights the effectiveness of interventions to improve the health of textile workers in Pakistan

A multi-faceted study conducted by Dr Asaad Nafees, Assistant Professor, Department of Community Health Sciences at the Aga Khan University (AKU) is the largest of its kind to determine the effectiveness of a simple intervention in reducing cotton dust-related respiratory health effects on textile workers in Pakistan. The study titled MultiTex RCT, in collaboration with the National Heart and Lung Institute (NHLI) and Imperial College London, marked a crucial step towards revolutionizing occupational health interventions for textile workers in Pakistan and other Low- and Middle-Income Countries (LMICs).

Persistent cotton dust exposure leads to the development of a disease called byssinosis, a disease prevalent among textile workers in LMICs due to limited access to occupational health and safety measures. With an initial cohort of 2031 workers from 38 textile mills in Karachi, the study tested a low-cost intervention package to ascertain if it would mitigate the adverse respiratory effects experienced by these workers. The interventions comprised training in occupational health for all workers and managers, regular refresher sessions, formation of workplace committees to enforce a health and safety plan including wet mopping and safe disposal of cotton dust, and provision of face masks. The results showed clear improvements in respiratory symptoms and lung function of the textile workers.

Funded by the Wellcome Trust for a period of three years, the findings of this important research can be applied to the larger textile landscape helping workers in Pakistan and elsewhere stay safe and minimize their disease burden. Discussing the study outcomes, Prof Paul Cullinan, formerly of Imperial College London, involved in the study said, "Studies of this caliber on occupational health interventions are extremely rare and this work has promise for large-scale uptake since the multifaceted intervention was designed to fit the local context in Pakistan. There is no obvious reason why it could not be rolled out more widely, nationally, and internationally. In the 200 years we have been faced with byssinosis, this work represents a landmark in its control". He underlined the importance of these simple yet transformative interventions, advocating for their widespread adoption for the benefit the workers.

Dr Asaad Nafees, the Principal Investigator, explained that “this trial was a parallel, cluster-randomized controlled study with textile mills as the unit of randomization. It can be replicated across the region to potentially impact respiratory health of all relevant workers, and potentially result in a healthier, more productive workforce.”

Key findings were recently presented at a seminar, where Engineer Sibtain Mughal, Joint Director Labour (OSH), Government of Sindh, committed the government’s support to the implementation of the health measures recommended by the study. "Workers deserve a high level of care and attention since their health holds significant importance for the industrial productivity and economy of the country."

Several manuscripts have been published in high-impact occupational health journals. The study was also recently accepted for publication in the European Respiratory Journal.