Comparing lung function of textile workers with the healthy Pakistani population

Background: The purpose of this study was to compare lung function of textile workers with healthy Pakistani population, compare predicted values based on the European Respiratory Society (ERS) equations with those based on the Pakistani equations, and to develop predictor equations for textile workers in Pakistan.Methods: This was a secondary analysis of data from two previous surveys where lung function of textile workers was compared with healthy Pakistani men. Spirometry was performed according to the American Thoracic Society guidelines. Independent sample t-test was used to compare the lung function parameters and multivariate linear regression was used to develop predictor equations.Results: There were significant differences in lung function of textile workers (FVC: 4.1 L, FEV1: 3.3 L and FEV1/FVC: 0.8) compared to healthy Pakistani men (FVC: 3.9 L, FEV1: 4.1 L and FEV1/FVC: 1.04). ERS reference equations tended to under-diagnose abnormal lung function, 16.9% versus 25.3% (p\u3c0.01). Predictor equations for Pakistani textile workers were also developed.Conclusion: Lung function of textile workers was significantly reduced compared to healthy population. Use of ERS reference equations for Pakistani textile workers may not provide appropriate interpretation

Available interventions for prevention of cotton dust-associated lung diseases among textile workers

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources (PubMed, Cochrane Library, Google and Google Scholar) were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment (PPE). Ten relevant articles were shortlisted, five related to engineering controls (pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures). Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is a dearth of literature regarding field-based assessment of interventions for control of cotton dust associated respiratory diseases and the available studies primarily focus on pre-processing of cotton. This review highlights the uncertainties that remain; and recommends several areas for future research on respiratory health of textile workers

Stewardship in health policy and its relevance to Pakistan

Since the concept of stewardship in health care first appeared in World Health Report 2000 there has been very limited discussion in the academia about its implications. In the present paper we revisit this concept and review the literature that has been written about it. We have particularly focused on the role of stewardship in health policy of Pakistan. We also highlight the improvement that stewardship can bring about in the health policy of Pakistan and the possible constraints that might be faced during its implementation phase. The literature available is on the concept of stewardship in health policy. The search was done through the database of PubMed with key words including; stewardship, health policy, governance, and role of state. A total of 22 articles were shortlisted and included in the review. The concept of stewardship has a lot of potential to reinterpret and reinvigorate the role of the state in Public Health of nations across the globe, including Pakistan

Knowledge, attitude and practices regarding respiratory symptoms among textile workers of Karachi, Pakistan: A cross-sectional survey

Objectives: To determine the prevalence and predictors of good knowledge, appropriate attitude and appropriate protective practices regarding respiratory symptoms among textile workers, and to determine the association of knowledge, attitude and practices with respiratory symptoms.Methods: The cross-sectional study was conducted in 2009 and comprised male workers from 15 textile mills in and around Karachi. A structured and pre-tested questionnaire was used which included questions to explore the knowledge, attitude and practices regarding respiratory symptoms. SPSS 19 was used for statistical analysis.Results: The study had a sample size of 372 and found prevalence of good knowledge to be in 182 (48.9%) workers and appropriate attitude in 302 (81%), while only 80 (21%) were practising these measures appropriately. Being educated and older than 38 years of age, belonging to Sindhi ethnicity, and working in the weaving section were significant (p0.05).Conclusions: There was low prevalence of appropriate practices, high prevalence of good knowledge and attitude, indicating an interplay of several other social and environmental factors which need to be explored

Validation of respiratory questionnaire for lung function assessment among an occupational group of textile workers in Pakistan

Objective: To determine the association of spirometric lung pattern with respiratory symptoms and to validate the American Thoracic Society respiratory questionnaire for lung function assessment among textile workers.Methods: This cross-sectional survey was conducted from August to December 2009 among adult textile workers of Karachi. Data was collected through the American Thoracic Society Division of Lung Disease respiratory questionnaire and the lung function was assessed by using a spirometer. Results of three acceptable readings of spirogram were recorded and the best of the three readings was used for analysis. SPSS 19 was used for data analysis.Results: There were 372 participants in the study with an overall mean age of 27±8.5 years. In linear regression analysis, forced expiratory volume in one second for workers who had chronic cough was -829.1 (confidence interval: -1273.1, -385.2), chronic wheeze -168.8 (confidence interval: -319.3, -18.2) and shortness of breath grade 2 -215.6 (confidence interval: -387.8, -43.4). In logistic regression model, after adjusting for covariates, odds of reduced percentage predicted forced expiratory volume in one second for workers who had chronic cough was 3.09 (confidence interval: 1.26, 7.56), chronic wheeze 1.98 (confidence interval: 1.05, 3.71) and shortness of breath grade 2 2.07 (confidence interval: 1.05, 4.07), while odds of reduced percentage predicted forced vital capacity for shortness of breath grade 2 was 2.35 (confidence interval: 1.05, 5.21). In logistic regression model 2, for assessing the effect of different combinations of chronic respiratory symptoms, the odds of reduced percentage predicted forced expiratory volume in one second for the combination of cough and wheeze was 2.08 (confidence interval: 1.05, 4.10), cough and shortness of breath grade 2 2.47 (confidence interval: 1.18, 5.18), phlegm and shortness of breath grade 2 2.59 (confidence interval: 1.23, 5.43), cough, wheeze and shortness of breath grade 2 4.64 (confidence interval: 1.97, 10.93)and cough, phlegm, wheeze and shortness of breath grade 2 4.18 (confidence interval: 1.68, 10.37).Conclusions: A combination of chronic respiratory symptoms was best associated with decrements in lung function

Asbestos risk assessment in Pakistan: Current scenario and way forward

[No abstract available

Correlation of respiratory symptoms and spirometric lung patterns in a rural community setting, Sindh, Pakistan: A cross sectional survey

Background: Symptom-based questionnaires can be a cost effective tool enabling identification and diagnosis of patients with respiratory illnesses in resource limited setting. This study aimed to determine the correlation of respiratory symptoms and spirometric lung patterns and validity of ATS respiratory questionnaire in a rural community setting.Methods: This cross sectional survey was conducted between January - March 2009 on a sample of 200 adults selected from two villages of district Khairpur, Sindh, Pakistan. A modified version of the American thoracic society division of lung disease questionnaire was used to record the presence of respiratory symptoms. Predicted lung volumes i.e. forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and their ratio (FEV1/FVC) were recorded using portable spirometer.Results: In the study sample there were 91 (45.5%) males and 109 (54.5%) females with overall mean age of 34 years (±11.69). Predominant respiratory symptom was phlegm (19%) followed by cough (17.5%), wheeze (14%) and dyspnea (10.5%). Prevalence of physician diagnosed and self-reported asthma was 5.5% and 9.5% respectively. Frequency of obstructive pattern on spirometry was 28.72% and that of restrictive pattern was 19.68%. After adjustment for age, gender, socioeconomic status, spoken dialect, education, smoking status, height, weight and arsenic in drinking water, FVC was significantly reduced for phlegm (OR 3.01; 95% CI: 1.14 - 7.94), wheeze (OR 7.22; 95% CI: 2.52 - 20.67) and shortness of breath (OR 4.91; 95% CI: 1.57 - 15.36); and FEV1 was significantly reduced for cough (OR 2.69; 95% CI: 1.12 - 6.43), phlegm (OR 3.01; 95% CI: 1.26 - 7.16) and wheeze (OR 10.77; 95% CI: 3.45 - 33.6). Presence of respiratory symptoms was significantly associated with restrictive and/or obstructive patterns after controlling for confounders. Similar findings were observed through linear regression where respiratory symptoms were found to be significantly associated with decrements in lung volumes. Specificity and positive predictive values were found to be higher for all the symptoms compared to sensitivity and negative predictive values.Conclusion: Symptoms based respiratory questionnaires are a valuable tool for screening of respiratory symptoms in resource poor, rural community setting

Violence and abuse among working children in urban and suburban areas of lower Sindh, Pakistan

Background: Child labourers are exposed to an insecure environment and higher risk of violence. Violence among child labourers is an under-studied phenomenon which requires contextual assessment.Aims: We applied Bronfenbrenner\u27s ecological model (micro-, exo- and macro-system) to understand the interplay of individual, community, societal and policy context fuelling violence.Methods: Focus group discussions and family ethnographies of child-labourers working in common occupational sectors of suburban areas of Sindh were carried out to gain in-depth understanding of their immediate environment and abuse (micro-system). Frequency of emotional, physical and sexual violence (5-14 years; n = 634) was also determined. Indepth interviews with employers (exo-system, n = 4) and key-informant-interviews of prominent stakeholders in Pakistan (macro-system, n = 4) working against labour/violence were carried out Thematic-content analysis was performed using MAXQDA, version 8.0.Results: We estimated that 21%, 19% and 9% of children suffered from emotional, physical and sexual violence respectively. Child labourers\u27 interviews indicated the existence of all forms of abuse at home and in the workplace; sexual violence by grandfathers was highlighted (micro-system). Children reported frequent scolding and insults in the workplace along with physical violence that could be fatal (exo-system). The legal environment of violence in Pakistan was considered deficient as it did not address the hidden forms (touching, kissing, etc.; macro-system).Conclusion: We documented that all forms of violence were rampant among the child labourers, and improved efforts and comprehensive legislation is direly needed to alleviate the situation

Situation analysis of child labour in Karachi, Pakistan: A qualitative study

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal advice and advocacy; those generating statistics; and those that are providing interventions. Discussion with children showed that irrespective of the immediate cause, the underlying determinant for child labour was poverty. The best practices identified included evening schools and drop-in centers for working children with provision for skill-based education and basic health facilities. There is need to have more such centres

Chronic bronchitis and chronic obstructive pulmonary disease (COPD) among textile workers in Karachi, Pakistan

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan.Study design: Cross-sectional survey.Place and duration of study: Karachi, Pakistan, from October to December 2009.Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire (ATS-DLD-78-a) and spirometry.Results: Out of 372 participants, 29 (7.8%) workers had chronic bronchitis (4, 9.1% aged ≥40 years) and 25 (6.7%) had COPD (12, 27.2% aged ≥40 years). Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, ≥ 10 pack years of smoking, uneducated, longer duration of work (≥11 years), and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work (AOR = 7.4; 95% CI: 1.9, 28.0), family history of respiratory illness/symptoms (AOR = 4.8; 95% CI: 1.1, 20.9) and lack of education (AOR = 4.2; 95% CI: 1.1, 16.9) were significant predictors of chronic bronchitis. Duration of work ≥11 years (AOR = 5.5; 95% CI: 1.5, 19.7) and pack years of smoking ≥10 years (AOR = 3.5; 95% CI: 1.1, 11.7) were strong predictors for COPD.Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified