PLOS ONE

Identifying Factors Associated with Health Problems of Tannery Workers, Savar,

Dhaka.
--Manuscript Draft--

Manuscript Number: PONE-D-23-19926

Article Type: Research Article

Full Title: Identifying Factors Associated with Health Problems of Tannery Workers, Savar,
Dhaka.

Short Title: Identifying Factors Associated with Health Problems of Tannery Workers

Corresponding Author: Amirul Al Rafi

University of Dhaka
dhaka, BANGLADESH

Keywords: Tannery workers, Primary data, Health problems, Tannery, Factors, Personal
Protective Equipment (PPE)

Abstract: Leather industries in Bangladesh are regarded to be among the most potentially
lucrative areas in terms of foreign cash. Still, at the same time, it creates adverse
impacts on both the health of the employees and the environment in the surrounding
area. This research investigates the incidence and patterns of health problems
experienced by tannery employees, as well as the associations between such
problems and a variety of other variables.
The BSCIC Tannery Industrial Estate served as the location for the cross-sectional
study at three randomly chosen tanneries. A total of 203 employees were questioned
using a questionnaire during in-person interviews to gather data on health problems
associated with their occupations.
The bulk (84.7%) of the participants were men. The majority of the employees (65%)
received no training about their jobs and safety precautions. Most respondents (84.2%)
admitted that they had health problems caused by their jobs. Musculoskeletal disease
(65.5%), gastrointestinal problems (38.9%), skin disease (37.9%), respiratory disease
(26.6%), and eye disease (17.7%) were the significant causes of illness. Only 24.1% of
tannery employees who use the appropriate personal protective equipment (PPE) are
less likely to have health problems at work than those who do not (p-value 0.017).
Working hours and health problems among tannery employees are significantly
associated (p-value 0.005). Also, there is an association between the mode of work
and health problems of tannery workers (p-value 0.044). The participants also stated
the scarcity of first aid and treatment services in their field.
Our research revealed that factors such as respondents' age, experience, working
hours, mode of work, types of PPE, and awareness of toxic chemical rules were
associated with health problems among tannery workers. A healthy tannery
environment, training, and improved medical facilities for the employees may ensure a
better state of health for them.

Order of Authors: Amirul Al Rafi

Nadia Mehjabeen Oyshi

Md. Jamil Hasan Karami

Opposed Reviewers: Mohammad Rifat Haider

University of Georgia College of Public Health

Because he has expertise in public health and also he can understand the
circumstances of Bangladesh.

Mohammad Hamiduzzaman
University of Newcastle

Because he has expertise in Health services research and also he can understand
disease pattern of tannery workers in Bangladesh.

Additional Information:

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Cover Letter

27 June 2023
Dear Editor,

With due respect, we would like to inform you that we have conducted a research on the health
effects of the workers in the leather industry in Savar, Dhaka, using primary data and found some
intriguing results. Based on this research, a manuscript entitled "Identifying Factors Associated with
Health Problems of Tannery Workers, Savar, Dhaka" is being submitted to your prestigious journal
PLOS ONE.

We would like to mention that, due to the use of numerous poisonous chemicals and hazardous
working conditions, the leather sector is one of the riskiest work-field in Bangladesh. In this paper,
we have investigated the incidence and patterns of health problems experienced by tannery
employees, as well as the associations between such problems and a variety of other factors. This
research will provide occupational healthcare practitioners and policymakers with greater insight
regarding efficient preventative measures in tannery industrial operations to maintain a safe, sound,
and healthy life for tannery workers.

We certify that this paper consists of original, unpublished work that is not under consideration for
publication elsewhere. We hope that the manuscript meets the high standards of your journal. We
are looking forward to receiving a favorable response from you regarding the acceptance of our
manuscript.

Sincerely yours,

Md. Jamil Hasan Karami

Address: Department of Statistics, University of Dhaka, Bangladesh.
Email: karami.stat@du.ac.bd
Phone: +8801817522559
Manuscript Click here to access/download;Manuscript;Manuscript.docx

1 Identifying Factors Associated with Health Problems of

2 Tannery Workers, Savar, Dhaka

3 Amirul Al Rafi1¶*, Nadia Mehjabeen Oyshi1¶, Md. Jamil Hasan Karami1

4
1
5 Department of Statistics, University of Dhaka, Dhaka, Bangladesh
6 *Corresponding author
7 *amirulalrafi1998@gmail.com
8 ¶ These authors contributed equally to this work.

9 ABSTRACT

10 Leather industries in Bangladesh are regarded to be among the most potentially lucrative areas in

11 terms of foreign cash. Still, at the same time, it creates adverse impacts on both the health of the

12 employees and the environment in the surrounding area. This research investigates the incidence

13 and patterns of health problems experienced by tannery employees, as well as the associations

14 between such problems and a variety of other variables.

15 The BSCIC Tannery Industrial Estate served as the location for the cross-sectional study at three

16 randomly chosen tanneries. A total of 203 employees were questioned using a questionnaire during

17 in-person interviews to gather data on health problems associated with their occupations.

18 The bulk (84.7%) of the participants were men. The majority of the employees (65%) received no

19 training about their jobs and safety precautions. Most respondents (84.2%) admitted that they had

20 health problems caused by their jobs. Musculoskeletal disease (65.5%), gastrointestinal problems

21 (38.9%), skin disease (37.9%), respiratory disease (26.6%), and eye disease (17.7%) were the

22 significant causes of illness. Only 24.1% of tannery employees who use the appropriate personal

1
23 protective equipment (PPE) are less likely to have health problems at work than those who do not

24 (p-value 0.017). Working hours and health problems among tannery employees are significantly

25 associated (p-value 0.005). Also, there is an association between the mode of work and health

26 problems of tannery workers (p-value 0.044). The participants also stated the scarcity of first aid

27 and treatment services in their field.

28 Our research revealed that factors such as respondents' age, experience, working hours, mode of

29 work, types of PPE, and awareness of toxic chemical rules were associated with health problems

30 among tannery workers. A healthy tannery environment, training, and improved medical facilities

31 for the employees may ensure a better state of health for them.

32 INTRODUCTION

33 The Bangladeshi government has designated the leather and leather goods industry as a priority

34 sector [1]. The entire export income for this sector in FY 2021 was $941.67 million. The

35 government and sectoral entrepreneurs claim that leather and leather products account for 4% and

36 0.5%, respectively, of Bangladesh's overall exports. According to EPB data, leather exports

37 climbed by 33.29%, leather items by 33.34%, and leather footwear by 13.72% in the first quarter

38 of FY 2022 [2]. In 2003, the government took the initiative to build the BSCIC Tannery Industrial

39 Estate on 200 acres (81 hectares) of land at Hemayetpur on accounts of moving all tanneries from

40 the capital's Hazaribagh to prevent environmental pollution of the Buriganga. Finally, in 2017, all

41 Hazaribagh tanneries were relocated to Savar in order to save Buriganga [3].

42 Leather manufacture is one of the world's oldest trades, using a chemical process that converts

43 animal hides into the far less perishable substance, leather. After the top layer of skin and any

2
44 excess subcutaneous tissue have been removed, a chemical procedure commonly referred to as

45 tanning is used to stabilize the dermal collagen fibers [4]. According to the European Commission,

46 the tanning scheme comprises four phases: Beam house mechanism, wet finishing, dry finishing,

47 and packaging [5, 6].

48 Despite enormous strides in Bangladesh's health and nutrition, the condition of tannery employees'

49 health is still dismal [7]. Due to the use of numerous poisonous chemicals and hazardous working

50 conditions, the leather sector is one of the riskiest in Bangladesh [8, 9]. Workers in these

51 occupations must work in hazardous situations, such as a poor work environment, a soiled working

52 floor, chemicals, and interacting with machines and equipment. As a result of the risks in the

53 tannery sector, workers are at risk of developing various health problems.

54 According to studies, tannery workers face a double burden of health problems: as tannery

55 workers, they are exposed to various chemicals and suffer from toxic effects of chemicals and

56 wastes generated during the manufacturing process [7, 10, 11, 12, 13]. Chemicals used in tanning

57 have been shown to be potentially irritating and sensitizing to those who come into contact with

58 them [14, 15]. Not just tanning chemicals but also inexperienced work and a lack of PPE practice

59 endanger human health in the leather sector [16]. For those who work in leather tanneries,

60 accidents are the main source of disability. Slips and falls are common on wet and oily floors, as

61 are knife cuts while trimming skins. Furthermore, the equipment used to process the skins can

62 crush and inflict bruising, abrasions, and amputations. Many risks are associated with machine

63 operating parts, such as accidents caused by spinning drums, in-running rollers, and blades [17,

64 18, 19].

65 In the majority of developing nations, occupational health and safety (OHAS) practices do not

66 meet the norms of more industrialized nations, which often have stricter regulations. Developing

3
67 nations frequently have fewer occupational health and safety programs and fewer or less designed

68 and enforced rules and regulations than industrialized ones [20]. OHAS must be practiced in

69 tanneries, or there will be a health risk to the employees who are directly involved in production

70 [21].

71 The effluents of tanneries comprise chromate and bichromate salts, butyl acetate, ethanol, aniline,

72 benzene, toluene, chlorine, calcium salts surfactant salts, sulphuric acid, sodium sulfide, organic

73 debris, hazardous material, and colors [22, 23]. During the procedure of tanning hides and skins,

74 employees at tanneries are exposed to the risk by a number of potentially harmful substances.

75 According to research, some of the chemicals that are utilized in the tanning process have the

76 potential to irritate and sensitize employees [14, 15, 20, 24]. Additionally, raw materials that are

77 highly contaminated with disease-causing organisms poses a constant risk of infection for the

78 workforce [25, 26].

79 A cross-sectional study in India reported that leather tannery workers frequently complained of

80 low-back pain (61.0%), dermatitis (31.0%), asthma (38.0%), and chronic bronchitis (14.0%) in the

81 one year prior to the survey [26]. The prevalence of asthma among tannery workers was estimated

82 at 5.3% in Pakistan [28], 3.0% in Istanbul [25], whereas it varied from 2.2% to 38.0% among the

83 leather tannery workers in India in older studies [29,30,31]. To present, the vast majority of

84 research has shown that tannery workers who are exposed to chromium in the workplace are at a

85 higher risk of developing dermatitis, respiratory illnesses, and ulcers [7, 14, 20, 22, 23, 24, 25, 26,

86 32].

87 According to a study of 179 tannery employees from six tanneries performed by the Society for

88 Environment and Human Development (SEHD) of Bangladesh, 58% of tannery workers suffered

4
 89 from gastrointestinal disorders, 31% from dermatological illnesses, 12% from hypertension, and

90 19% from jaundice [33].

91 Dalju, Innawu, et al. (2019) conducted a comparative cross-sectional study utilizing the stratified

92 sampling approach, which found that the incidence of respiratory disorders was greater among

93 exposed employees (tannery workers) than among unexposed workers (civil servants). The factors

94 associated with occupational respiratory symptoms included gender, job status, ventilation of

95 working areas, lack of occupational health and safety training, and failure to use personal

96 protective equipment. To determine the variables related to respiratory symptoms, binary logistic

97 regression analysis was employed [34].

98 Despite the findings of numerous surveys, only a small number of research have examined the

99 relationship between inevitable occupational exposure and health issues among leather tannery

100 employees. No comprehensive occupational illness registry, long-term health assessment, health

101 surveillance, other hazard assessment initiatives have been implemented for the tannery industry

102 in Bangladesh. This research will provide occupational healthcare practitioners and policymakers

103 with greater insight into their challenges while working in settings with weaker legal requirements

104 and substantial economic and healthcare system differences compared to industrialized nations.

105 The aim of our study is to determine patterns of health problems of the tannery workers, and to

106 find out the factors associated with those health problems, to understand the extent of awareness

107 about occupational health risks involved in tannery occupation and adopted preventive measures

108 by the tannery workers.

5
109 MATERIALS AND METHODS

110 STUDY AREA AND POPULATION

111 In our study we conducted a cross-sectional study using primary data at three randomly selected

112 tanneries in the BSCIC Tannery Industrial Estate in Savar from June to July 2022. Workers in the

113 beam house, wet and dry sections of tanneries (both men and women) voluntarily participated in

114 our survey.

115 DETERMINATION OF SAMPLE SIZE

116 By applying the Simple Random sampling approach, these tanneries were chosen. The stratified

117 random sampling process was adopted along with the proportional allocation procedure.

118 There were several formulas available for determining the sample size. Here we chose the formula,

𝑍2 𝑃𝑄
𝑑2
119 n= 1 𝑍2 𝑃𝑄
[35], where the population sizes of the three tanneries were 350, 132 and 107
1+ ( 2 −1)
𝑁 𝑑

120 which were obtained from the administrative offices of these tanneries .The 95% confidence level

121 and degree of precision, d =0.05, were taken into account. We considered the disease prevalence

122 rate, P = 0.72 [7]. Then the sample size becomes 203. Again, applying the formula for stratum-
𝑛
123 specific sample size, 𝑛ℎ = 𝑁 𝑁ℎ (for hth strata), the sample sizes determined for each of the three

124 tanneries were 121, 45, and 37.

125 DATA COLLECTION

126 Data were collected through in-person interviews using a questionnaire with both open-ended and

127 closed-ended questions. Note that all the ethical issues were satisfied during this process.

128 DATA AND VARIABLES

6
129 Dependent variable: Health problems

130 Independent variables:

131 Socio-Demographic Variables: Gender, Age, Religion. Education, Marital status, Family

132 income, Smoking status

133 Occupational Variables: Experience, Working hours, Mode of work, Training status, Use of PPE,

134 Types of PPE, Source of PPE, Awareness of the use of chemicals, Awareness of toxic rules of

135 chemicals, Awareness that the chemicals are harmful to health, Having Diabetes, Having health

136 problems, Taking any medicine, Accidents in workplace, Availability of health care facility in

137 tannery

138 STATISTICAL METHODS

139 Data were analyzed using SPSS (Statistical Package for Social Science, version 22) software and

140 Microsoft Excel (version 2013) including univariate, bivariate and binary logistic regression.

141 Conducting univariate analysis, we tried to extract the statistical summary of each of the variables.

142 We converted our quantitative data (e.g. Age, Family income, Experience, Working hours) into

143 categories. We also explored the association between health problems (dependent variable) and

144 independent variables (age, gender, education, smoking status, experience of job in year, working

145 hours, Mode of work, protective equipment use, and awareness of toxic rules) through Chi-square

146 test and Fisher's exact test. Then Binary logistic regression is also performed considering the

147 presence and absence of health problems. The linear predictor of the logistic model is

148 𝒙𝒊 𝒃 = 𝜷𝟎 + 𝜷𝟏 𝒙𝒊𝟏 + 𝜷𝟐 𝒙𝒊+⋯ + 𝜷𝒑 𝒙𝒊𝒑

149 The fitted or predicted value of the logistic model is based on the link function,

150 log(μ/(1 − μ)) Each βx is a term indicating the value of a predictor, x, and its coefficient,β.

7
 𝒖
151 ln(𝟏−𝒖𝒊 )=𝒙𝒊 𝒃 = 𝜷𝟎 + 𝜷𝟏 𝒙𝒊𝟏 + 𝜷𝟐 𝒙𝒊+⋯ + 𝜷𝒑 𝒙𝒊𝒑
𝒊

152 Logit(u) =𝜷𝟎 + 𝜷𝟏 𝒙𝒊𝟏 + 𝜷𝟐 𝒙𝒊+⋯ + 𝜷𝒑 𝒙𝒊𝒑

153 The logistic regression equation

𝐞𝐱𝐩(𝒙𝒃 ) 𝟏
154 𝒖 = 𝟏+𝐞𝐱𝐩(𝒙𝒃) = 𝟏+𝐞𝐱𝐩(−𝒙𝒃) [36]

155

156 RESULTS

157 Socio-demographic characteristics of the study participants

158 According to the survey findings, of the 203 respondents, 172 (84.7%) are male and 31 (15.3%)

159 are female. 39.4% of the 203 respondents were between the ages of 25 to 34. The age group 35-

160 44 has the second greatest share (25.1%). The third and fourth biggest age groups are 45-54 and

161 15-24, with 19.2 and 12.8 percent, respectively. The age group 55-64 has the lowest proportion,

162 3.4. The majority of the 203 respondents identify as Muslims; the percentage for this group is 98%.

163 Our study found, 25.1% of respondents have not completed any form of formal education, 49.8%

164 of respondents have completed their elementary school, and 25.1% of respondents had education

165 up to secondary level. The majority of responders were married, accounting for 90.1% of the total.

166 Additionally, the household income ranges from 1,500 to 30,000 tk. is significantly greater than

167 most other percentages, coming in at 68.0 percent. The group with a total of 0-15000 tk. had a

168 percentage of 18.2, making it the second-highest percentage. However, the rate for families with

169 earnings greater than 30,000 tk is 13.8%, making this the lowest rate group. The vast majority of

170 workers at the tannery are smokers (66.5% of them), and every single one of them is a man.

171

8
172 Occupational variables of the study participants

173 According to the survey findings, 37.9% of workers have experience that is greater than 10 years,

174 which is the highest rate. 30% of workers have been working in the tannery for 1-5 years, and

175 that's the lowest of all. 104 out of 203 workers work in the tannery for 9–11 hours, with the highest

176 percentage of 51.2. 30.5% of workers work 12–14 hours, which is the second highest figure. Only

177 18.2% of them work for 6–8 hours per day. A total of 42.4% of the respondents were employed in

178 the beam house, 34.5% worked in the dry-finishing section, and the remaining respondents were

179 employed in the wet-finishing section (23.1%).

180 In addition to this, it was discovered that 65% of the respondents had no training in any aspect of

181 the tanning industry. Only 34.0% of workers do not use PPE, while the majority of workers (66%)

182 do use PPE. There are about 24% of workers in the tanning industry who use full PPE in their

183 workplace, and there are about 42% who use partial PPE. Despite receiving PPE from the

184 tanneries, 95.1% of tannery employees do not utilize it because they are unaware of its benefits.

185 107 workers are aware of the harmful chemical laws; thus, 52.7% of workers are aware of these

186 standards. As a result, 47.3% are unaware of the rules. The majority of respondents (88.7%) are

187 aware that chemicals can have a negative impact on one's health. The vast majority of respondents

188 (77.3% of them) do not have diabetes. According to our survey, 171 out of 203 workers are dealing

189 with some kind of health problem, while the remaining 32 workers are completely free of any

190 health concerns. Only 76 employees, or 37.4%, out of 203 workers receive any form of medical

191 treatment. Moreover, the statistics show that 44.8% of employees get treatment supplements from

192 the administration of the tanneries, despite becoming sick regularly owing to hazardous working

193 conditions.

194 Insert Figure 1 here.

9
195 According to Figure 1, 65.5% of workers suffer from musculoskeletal disease, whereas 38.9%

196 have gastrointestinal disorders. Other common health difficulties among tannery workers include

197 skin disease (37.9%), respiratory disease (26.6%), and eye disease (17.7%).

198 Factors Associated with health problems of tannery workers

199 According to Table 1, the percentages of health problems among workers for the age range 15-24,

200 25-34, 35-44, and 45-54 were respectively 57.7%, 83.8%, 92.9%, and 92.3%. There is an

201 association (p=.001) between the age of workers and their health problems. We can also see that

202 as workers get older, they are more likely to fall ill.

203 Table 1 shows that the health problem rate for employees is 65.6% among those who have worked

204 for 1-5 years. It goes up to 93.8% among those who have worked for 6-10 years. Then this rate

205 becomes 90.9% among those who have worked for 11 years or more. There is a significant

206 association (p <.001) between experience and health problems. We can see that as their experience

207 grows, their health problems increase. Then after some years, their body becomes immune, and

208 their disease rate decreases little. There is a significant relationship (p=.005) between workers'

209 working hours (per day) and their health problems. Workers who work 6-8 hours a day have a

210 disease rate of 67.6%, while those who work 9-11 hours have a disease rate of 85.6%, and those

211 who work 12-14 hours a day have a disease rate of 91.9%. It has been observed that workers who

212 work long hours every day are more likely to become ill. According to Table 1, there is a significant

213 association (p=.044) between their mode of work and health problems. A higher proportion of

214 workers in wet finishing (91.5%), dry finishing (75.7%), and beam house (87.3%) have diseases.

215 The percentage is highest in the wet finishing sector because the workers are exposed to dangerous

216 chemicals. The workers who wear PPE (p=.0017) correctly have a lower incidence of illness. But

10
217 it is not possible for this to be true for those who only use some of the recommended precautions.

218 As we can see, the health problem rate among workers who do not use PPE is 87%, whereas among

219 those who do use it is 71.4%. Ultimately, it may be concluded that PPE effectively protects people

220 against chemical and other hazards. There is a significant association (p=.033) between awareness

221 of the rules of using toxic chemicals and health problems. While analyzing the association, it led

222 us to a result that was not expected. Of the individuals who were aware of the rules, 89.7% of

223 people among them were suffering from health issues. In contrast, 78.1% of workers had health

224 problems and were unaware of those rules. We know that people who work in the wet-finishing

225 area have to deal with more chemicals than those who work in the dry finishing area or the beam

226 house. People who dealt with chemicals were aware of the rules. This may lead us to this situation.

227 Table 1. Association of health problems of tannery workers with different risk
228 factors (Cross table)
Characteristics Health Problem Total Test of Significance
Yes(n=172) No(n=31) (n=203) p-value
Gender
Male 148(86%) 24(14%) 172(84.7%)
Female 23(74.2%) 8(25.8%) 31(15.3%) p=.110 (Fisher’s exact
test)
Age (in years)
15-24 15(57.7%) 11(42.3%) 26(12.8%)
25-34 67(83.8%) 13(16.3%) 80(39.4%) χ2=18.145
35-44 47(92.2%) 4(7.8%) 51(25.1%) p=.001
45-54 36(92.3%) 3(7.7%) 39(19.2%)
55-64 6(85.7%) 1(14.3%) 7(3.4%)
Education
Illiterate 38(74.5%) 23(25.5%) 51(25.1%) χ2=5.440
Primary 90(89.1%) 11(10.9%) 101(49.8%) p=.066

11
 Secondary 43(84.3%) 8(15.7%) 51(25.1%)
Experience (in years)
1-5 40(65.6%) 21(34.4%) 61(30%) χ2=23.102
6-10 61(93.8%) 4(6.2%) 65(32%) p<.000
>11 70(90.9%) 7(9.1%) 77(37.9%)
Working hours (per day)
6-8 25(67.6%) 12(32.4%) 37(18.2%) χ2=10.651
9-11 89(85.6%) 15(14.4%) 104(51.2%) p=.005
12-14 57(91.9%) 5(8.1%) 62(30.5%)
Mode of work
Beam house 75(87.2%) 11(12.8%) 86(42.4%) χ2=6.263
Wet finishing 43(91.5%) 4(8.5%) 47(23.2%) p=.044
Dry finishing 53(75.7%) 17(24.3%) 70(34.5%)
Using PPE
Yes 111(82.8%) 23(17.2%) 134(66%) χ2=.582
No 60(87%) 9(13%) 69(34%) p=.544
Types of PPE
Full PPE 35(71.4%) 14(28.6%) 49(24.1%) χ2=8.152
Partial PPE 76(89.4%) 9(10.6%) 85(41.9%) p=.017
No PPE 60(87%) 9(13%) 69(34%)
Aware of rules
Yes 96(89.7%) 11(10.3%) 107(52.7%) χ2=5.123
No 75(78.1%) 21(21.9%) 96(47.3%) p=.033

229

230 BINARY LOGISTIC REGRESSION ANALYSIS

231 To discover which variables best explain and predict workers' health issues, all significant

232 variables in the bivariate analysis were incorporated into the model. A p-value less than .001

12
233 indicates that the model is statistically significant. Table 2 contains the estimates, odds ratios (OR),

234 and 95% confidence intervals for odds ratio.

235 It is revealed that the factor mode of work has an association with health issues (p-value 0.017).

236 Here we consider the dry finishing section as a reference category. The likelihood of experiencing

237 health issues was higher for beam-house and wet-finishing section employees. Workers in the wet

238 finishing section have a 7.885 times higher chance of suffering from diseases (CI: 1.702-36.525),

239 whereas workers in the beam-house area are 3.474 times more likely to suffer from various health

240 problems (CI: 1.129-10.690). Workers in the wet finishing department have a greater risk of

241 contracting infections because of their exposure to hazardous chemicals.

242 Additionally, there is a strong relationship (p-value 0.027) between working hours and health

243 issues. As a reference range, we took 12–14 hours into account. Workers who worked less than 12

244 hours had a lower risk of having diseases. The odds ratios for employees working 6 to 8 hours and

245 9 to 11 hours are 0.149 and 0.514, respectively. This means that if a worker works 6–8 hours

246 instead of more than 11 hours, their chance of experiencing health issues lowers by 85.1%.

247 Furthermore, if a worker works 9–11 hours rather than 12–14 hours, their likelihood of having

248 disease drops to 48.6%.

249 The reference category for examining the relationship between types of PPE usage and health

250 problems is considered to be not using any protective equipment. There is a 0.295 odds ratio in

251 favor of wearing complete PPE. This indicates that utilizing a full PPE set (mask, boot, gloves,

252 and goggles) instead of not using any protective equipment reduces the chance of developing a

253 disease by 70.5%. Workers who only use a few components of their PPE set while working have

254 an odds ratio of 0.956. This states that using a minimal amount of personal protective equipment

255 (PPE) will only lower a worker's chance of contracting a disease by 4.4%. Hence, wearing PPE

13
256 greatly reduces the risk of exposure to numerous toxic substances and also aids in preventing many

257 diseases.

258 While analyzing the association between workers' awareness of toxic rules and their risk of

259 developing diseases, an unexpected outcome was discovered. Those who were aware of the

260 guidelines for using chemicals are 2.181 times more likely to suffer from various health issues

261 than workers who were not. This situation arises because employees who handle chemicals,

262 particularly those in the wet-finishing area, are aware of the restrictions regarding poisonous

263 substances, in contrast to those who work in the beam-house and the dry-finishing section.

264 Workers in the wet finishing section have a considerable risk of disease development since they

265 are constantly exposed to harmful chemicals. Despite knowing the rules of using toxic chemicals,

266 they may not properly follow or are ignorant of the rules. Table 4 also illustrates that those aged

267 15 to 24 and 25 to 34 had a decreased chance of developing health problems. Here, we choose the

268 55 to 64 age range as our reference group. However, compared to the oldest age group, those aged

269 35 to 44 and 45 to 54 are more likely to develop diseases. Moreover, while analyzing the

270 association between the experience of workers in tannery and health issues, it is found that

271 employees who worked for 1 to 5 years had a lower risk of developing diseases compared to those

272 who worked for more than ten years. However, workers working 6-10 years had a higher risk of

273 having various diseases compared to those working more than ten years. Workers' progressive

274 adaptation to their environment and immunity-building led to this unexpected outcome.

275
276 Table 2. Parameter estimates (binary logistic regression) on risk variables and
277 health problems among tannery workers
95% Confidence Interval (
Variables Estimate OR for OR) P-value

14
 Age
15-24 -1.191 0.304 .019-4.757 .396
25-34 -0.542 0.581 .046-7.343 .675
35-44 0.769 2.158 .165-28.177 .557
45-54 0.772 2.165 .155-30.244 .566
55-64 (Ref) 1
Working hours (daily)
6-8 hours -1.903 0.149 .036-.620 .009
9-11 hours -0.665 0.514 .155-1.703 .277
12-14 hours
(Ref) 1
Experience (years)
1-5 years -0.423 0.655 .151-2.849 .573
6-10 years 0.59 1.805 .378-8.607 .459
> 10 years
(Ref) 1
Mode of Work
Beam-house 1.245 3.474 1.129-10.690 .030
Wet finishing 2.065 7.885 1.702-36.525 .008
Dry
finishing(Ref) 1
Awareness of Toxic Rules
Yes 0.78 2.181 .766-6.212 0.144
No (Ref) 1
Types of PPE usage
Full PPE -1.22 0.295 .080-1.091 .067
Partial PPE -0.045 0.956 .299-3.056 .939
No PPE (Ref) 1

278

279 CONCLUSION

280 This study explores the incidence and patterns of health problems reported by employees of

281 tanneries, as well as the associations between these problems and a wide range of other factors.

282 The findings of this study showed tannery workers had a significantly higher incidence of

15
283 musculoskeletal diseases, whereas only a tiny minority of workers experienced eye problems. The

284 driving elements behind health problems were direct exposure to harmful chemicals, dust, and gas

285 produced by various chemicals, a lack of safety precautions, and ignorance of the proper use of

286 PPE.

287 To test and evaluate the relationship between health problems and a variety of other variables, a

288 chi-square test was conducted, and the result showed that the workers' age, years of experience in

289 the tannery, daily working hours, mode of work, types of PPE used, and knowledge of the rules

290 for using toxic chemicals were all significant.

291 Implementing proper training, providing protective equipment, upgrading healthcare access, and

292 ensuring adequate PPE for workers can improve the situation at BSCIC Tannery Industrial Estate.

293 The government and tannery owners should carefully implement Bangladesh's Labor Act (2006)

294 and encourage occupational health and safety. The government must also take effective

295 preventative steps to ensure a safe and healthy life for tannery workers.

296 Author Contributions

297 Conceptualization: Amirul Al Rafi, Nadia Mehjabeen Oyshi, Md. Jamil Hasan Karami

298 Data curation: Amirul Al Rafi, Nadia Mehjabeen Oyshi

299 Formal analysis: Amirul Al Rafi, Nadia Mehjabeen Oyshi

300 Investigation: Amirul Al Rafi, Nadia Mehjabeen Oyshi

301 Methodology: Amirul Al Rafi, Nadia Mehjabeen Oyshi, Md. Jamil Hasan Karami

302 Supervision: Md. Jamil Hasan Karami

16
303 Writing – original draft: Amirul Al Rafi, Nadia Mehjabeen Oyshi

304 Writing – review & editing: Amirul Al Rafi, Nadia Mehjabeen Oyshi, Md. Jamil Hasan

305 Karami

306

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22
Figure Click here to access/download;Figure;Fig.tif.docx

Disease Pattern of tannery workers

70.00%
60.00% 65.50%
50.00%
40.00%
30.00% 37.90% 38.90%
20.00% 26.60%
10.00% 17.70%
0.00%
Skin Disease Gastrointestinal Respiratory Musculoskeletal Eye Disease
Disease Disease Disease

Fig 1. Disease pattern of tannery workers

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