Inequitable morbidity and injuries burden among informal sector workers in an urban area in Dhaka: a retrospective analysis of Médecins Sans Frontières occupational health clinics, Bangladesh, 2014–2023

INTRODUCTION

In Bangladesh, 85% of the workforce is employed in the informal sector, characterised by unsafe working conditions, low wages, and a lack of social and labour protections. Evidence on the health and occupational injuries faced by informal sector workers is limited. This study assessed the health status of informal sector workers in Dhaka’s Kamrangirchar area, where Médecins Sans Frontières (MSF) has provided occupational health (OH) services and provides evidence to inform policy.

METHODS

We conducted a retrospective analysis using OH data from two MSF clinics, covering patients aged ≥ 18 years from February 2014 to December 2023. We performed a descriptive analysis, stratified by sex, using chi-squared tests to identify differences in health status by key characteristics, including patient demographics such as age and sex, factory type, work-related morbidity, injuries, nutritional status, and mental health. The analysis was limited to new consultations.

RESULTS

Between 2014 and 2023, 64,467 OH consultations occurred among adults aged ≥ 18 years, of which 23,874 were new consultations with sex data available (self-reported); 38.6% were women. Women were more likely to work in plastics (35.7% vs. 24.4%) and garment (28.8% vs. 18.9%) factories, whereas men were predominated in leather factories (17.5% vs. 7.8%). Machinery operation was reported by 92.8% of men and 91.5% of women. Work-related conditions accounted for 90.5% of all visits. The most common diagnoses for both sexes were musculoskeletal disorders (30.3%) and gastrointestinal conditions (22.7%). Injuries represented 4.3% of new consultations, with a higher proportion in men (6.0% vs. 1.8%), and 60% of injuries occurred in metal factories. Malnutrition affected 16.7% of men and 12.5% of women. Among 561 patients with mental health outcomes, mood disorders were more frequent in women (92% vs. 84%).

CONCLUSIONS

This study highlights the significant work-related health burden faced by urban informal sector workers operating in hazardous environments, with gender-based differences. Urgent gender-sensitive workspace safety, social and mental health, and nutritional initiatives are needed. Ratifying the International Labour Organization Conventions C189 and C190, which aim to provide informal workers with the same protection as those in the formal sector, would be a crucial step toward safeguarding workers’ rights and well-being.