BACKGROUND
Bangladesh has the second highest burden of child labour in South Asia. The informal sector employs most of the children however, data on health including injuries and place of work for children are limited. As the deadline for the Sustainable Development Goals to end child labour is upon us, it is paramount to document the impact of child labour on health. This study aims to contribute to this knowledge gap by presenting medical data from occupational health clinics (OHCs) set up by Médecins Sans Frontières (MSF) in a peri-urban area of Dhaka, Bangladesh.
METHODS
We did a retrospective analysis of health care records of children attending MSF OHCs between February 2014 and December 2023. We stratified the analysis by sex and age (< 14 years and ≥ 14- < 18 years). We looked at morbidities according to type of factory, whether children reported working with machinery, and examined nutritional and mental health (2018–2023) status.
RESULTS
Over the study period, there were 10,200 occupational health consultations among children < 18 years, of which 4945 were new/first time consultations. The average age of children attending their first consultation was 14.7 years, of which 61% were male. Fifteen percent reported living inside the factory. Children worked in all prohibited categories of the informal sector. Almost all children reported operating machinery. Musculoskeletal (26%) and dermatological (20%) were the most identified conditions, and 7.5% of consultations were for work-related injuries. A higher proportion of male children had injuries (11% vs 2.5% in girls). Children working in metal factories accounted for most injuries (65%). Mood-related disorders accounted for 86% of the 51 mental health consultations. Half of all children were malnourished with higher levels in boys and those < 14 years.
CONCLUSIONS
Findings suggest that children face hazardous realities; engaged in the worst form of labour, bearing important morbidity and injury burden, with vulnerabilities varying by sex and age. Despite their economic contributions to the informal sector, they remain largely invisible and exploited. This study highlights the urgent need for child rights-based research and cross-sectoral approaches that actively involve children to develop sustainable, targeted solutions to eliminate child labour.
Critical failings in humanitarian response: a cholera outbreak in Kumer Refugee Camp, Ethiopia, 2023
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared