TCF POST Report
DHAKA — Research has exposed a worrying health burden among textile and garment workers, with surveys pointing to high levels of musculoskeletal pain, heat-related illness, fatigue, respiratory problems and workplace injuries. The evidence also suggests that workers are increasingly facing several risks at the same time, raising questions over whether conventional factory safety checks are capturing the full picture.
A 2026 systematic review published in Discover Public Health examined peer-reviewed studies from 2000 to 2025 and found that ergonomic and physical hazards remain the most frequently reported risks in textile and garment production. Chemical and biological hazards were also repeatedly identified, particularly where ventilation, sanitation and PPE practices were inadequate.
The research was led by Mohammad Ariful Hoque, an independent researcher in Newton, Iowa. Co-author Sajjadul Alam is affiliated with the Bangladesh Garment Manufacturers and Exporters Association (BGMEA) and VitaAware, while Hossain Mahmud Sammi is with the Department of Biology at Georgia Southern University in the US.
The authors argue that the biggest concern is the co-existence of multiple hazards, rather than any single workplace risk. Their proposed Textile Occupational Health Risk Integration Model (TOHRIM) is intended to help factories and regulators assess these risks together.
New survey finds widespread musculoskeletal risks
One of the most recent pieces of evidence comes from a 2026 survey of 656 RMG workers in Savar and Gazipur. Using the Nordic Musculoskeletal Questionnaire and Rapid Entire Body Assessment, the study found that during the previous 12 months:
- 39.5% of workers reported lower-back pain;
- 33.5% reported neck pain;
- 33.5% reported ankle pain; and
- more than 53% of workers assessed through the REBA subsample were classified as facing high or very high ergonomic risk.
The study also found higher risks among female workers, needlework employees, overtime workers and those maintaining prolonged seated postures. The findings reinforce the 2026 systematic review, which identifies repetitive tasks, prolonged sitting or standing, awkward postures and poorly designed workstations as major contributors to musculoskeletal disorders.
Heat is emerging as a new workplace threat
A 2025 study of two RMG factories in Bangladesh adds another concern: heat exposure. Based on focus-group discussions and interviews with workers, factory officials, health professionals, government officials and other stakeholders, the study found reports of headaches, dizziness, fatigue and nausea associated with heat exposure. Health professionals also reported changes in cardiovascular strain during summer, while stakeholders linked hot conditions with increased absenteeism. The findings add climate-related heat to an occupational-health agenda that has traditionally focused more heavily on dust, chemicals, noise and ergonomic hazards.
Injury risks remain sharply higher in hazardous workplaces
A 2025 study using Bangladesh’s nationally representative Labour Force Survey 2016–17, covering 13,738 textile and garment workers, found an overall occupational-injury prevalence of 1.8%. The rate was considerably higher in textiles, at 3.8%, compared with 1.2% in garments. Within textiles, jute manufacturing recorded a 12.3% injury prevalence, the highest among the subsectors examined. In garments, embroidery and wearing industries recorded 1.8%.
The study found that workers in hazardous environments had 13.06 times higher odds of occupational injury in textiles and 3.13 times higher odds in garments. Garment workers without adequate protective equipment or clothing had 1.90 times higher odds of injury. Because the underlying Labour Force Survey dates from 2016–17, these figures should be treated as a national benchmark rather than current injury prevalence.
PPE remains a major weak point
The 2026 systematic review also exposes a significant gap between PPE availability and actual use. One study cited by the review found that while 67% of workers had PPE available, only 42% used it consistently. Another study reported 54% worker satisfaction with available PPE.
The finding suggests that simply supplying protective equipment does not guarantee protection. The researchers recommend fit testing, worker training, comfort and usability assessments, compliance monitoring and supervisor accountability. They also emphasize that PPE should not replace engineering and administrative controls.
Dust and ventilation continue to threaten respiratory health
Respiratory risks remain particularly important in spinning and other dust-intensive operations. The systematic review cites one study reporting cough among 60.0%–73.7% of workers and chronic bronchitis among 13.5%. Cotton-dust exposure, department-specific exposure, long employment duration and PPE underuse were among the reported risk factors.
The authors say cotton-dust exposure deserves continued attention because conditions such as byssinosis are preventable through effective exposure controls and workplace monitoring. They recommend stronger ventilation standards, airborne-exposure monitoring, local exhaust ventilation, dust-control systems and routine respiratory-health surveillance in spinning, dyeing and finishing areas.
The bigger concern: workers face several risks simultaneously
Taken together, the recent evidence points to a more complex occupational-health challenge. A worker may face repetitive movements, prolonged sitting, overtime and heat at the same time. In another production area, workers may simultaneously encounter cotton dust, chemicals, noise, poor ventilation and inadequate PPE.
The 2026 review argues that these overlapping exposures are often missed when hazards are assessed separately. TOHRIM attempts to address this by linking ergonomic, physical, chemical and biological hazards with workplace factors such as ventilation, workload, production quotas and access to PPE.
Worker health is becoming a supply-chain issue
The consequences extend beyond individual workers. The review links occupational illness with absenteeism, lower productivity, increased healthcare expenditure, income loss and workforce turnover. For global apparel brands and sourcing companies, the implications are increasingly commercial as well as social. Poor occupational-health conditions can affect worker retention, productivity, compliance and supply-chain resilience. The researchers recommend that factories and regulators track measurable indicators including ventilation performance, airborne particulate levels, noise, workstation risks, PPE compliance, sanitation, access to clean water and worker-health screening.
From safety compliance to total health exposure
The latest evidence suggests that the industry’s occupational-health challenge is moving beyond the traditional question of whether a factory has basic safety measures in place. The more important question is how the entire production system affects workers’ health.
Recent surveys are highlighting persistent musculoskeletal problems, while newer research is bringing heat exposure and climate-related workplace risks into sharper focus. At the same time, PPE compliance, ventilation and ergonomic controls remain inconsistent.
The 2026 review’s TOHRIM framework offers a way of connecting these risks, but the researchers stress that it remains a conceptual framework rather than a validated predictive model. More longitudinal studies, standardized exposure assessments and intervention research are needed.
For the global textile and apparel industry, the message is increasingly clear: worker health can no longer be treated as a separate factory welfare issue. It is becoming a measurable part of productivity, responsible sourcing and supply-chain resilience.