Musculoskeletal Symptoms among Female Garmenmts Worker : Working Environment

Working environments were causing musculoskeletal symptoms of female garments worker and continuing substantial health problem. These disorders affect millions of garments worker in developing and developed nations. The purpose of the study was to determine the musculoskeletal symptoms of female garments worker, to assess the socio-demographic status among the respondents at garments factory. A descriptive cross-sectional study was conducted with a semi-structured questionnaire to collect information. Total respondents among the female garments worker were selected as purposive sampling technique. Data were numerically coded and put in SPSS 16.0 version software program. A total of 150 respondents 89 sewing worker, 61 non-sewing workers; they were significant (P= .009) and mean age 26.91 ± 8.774. The result showed 58.7% respondents had musculoskeletal symptoms. The most common symptom was pain 28.7% and maximum affected part of the body were lower back 24.7%, neck14% and these were highly significant P= .000. Visual Analogue Scale (VAS) used for pain measurement, where noted 36.7% moderate and 1.3% severe pain. Working tools and unadjusted ergonomic setup with body 79.3% and 80.7% respectively. Working with long duration of faulty posture 81.3% (P= .000) were statistically significant. It was identified the first experience of musculoskeletal symptom 7 days to 12 months were highest 43.4% and next 2 to 3 years 13.3. Musculoskeletal pain in the back due to the Ergonomical condition was a concern for the health in garments worker. Musculoskeletal symptom symbolized significant burden for garments worker.


Introduction
Musculoskeletal condition (MSKC) has been raiding over the time throughout the globe, simultaneously developing and industrialized country.In developing country, it much more commonly observed among female Readymade Garments (RMG) workers.In Bangladesh, RMG sector played an inevitable role in the overall development of economy [1].There were 5,100 garment factories, where around two million workers amongst them 80% female.It was exclusively highest remittance about 76% earning sector, which was worth mentioning [1,2].
United Nations (UN), World Health Organization (WHO), World Bank and many governments and international organizations across the world declared MSK conditions were major burden on individual's health and social system, having a substantial influence on health and quality of life and social care systems, with direct and indirect costs being predominant [3,4,5].
The prevalence of MSKC was increased in the world with the amount of MSK disorders in developing countries [6].Musculoskeletal (MSK) problems (69.64%) were the commonest health problem [7].Globally, work-related MSK disorders liable for around 40% of the total compensated cost of occupational disease and injury [6].Aetiology of the arising symptoms among the garments worker by performing the same movements like lifting, reaching, packaging, sewing and repetitive motion1, activities or the working environment like rapid motion, forceful exertion, awkward posture or non-neutral posture, prolonged stationary postures, and vibration [6].In terms of ergonomic adjustment in workplace assessment of Asian garment factories spectacled that most of the reported incidences in the back, neck, and shoulders are relatively high and most likely the result of working with constrained postures, poorly designed workstations, and non-ergonomic tools [8,9].
Study in different country like Denmark, Botswana and Slovenia illustrated higher prevalence among sewing machine operators [8].High prevalence rates of difficulties in the upper body (the neck, shoulders, arms, hands, and back) were also detected by others [9].In support of this a conducted research in Srilanka, musculoskeletal problems were stated by 15.5% of these workers; among those with musculoskeletal problems, 57.3% (n = 94) complained of back pain [10].In addition other common symptoms were found pain (69.23%), weakness (38.46%), and stiffness (23.08%) of the affected parts [7].

Methods
A descriptive Cross-sectional study was conducted to determine the musculoskeletal symptoms among female garments workers, at Ashulia, Dhaka, Bangladesh.Study was conducted over the four months from September to December 2016.The study populations consisted of female whose age range were 16 -45 years.The total sample size was 150 and to select the sample purposive sampling technique were adopted.Visual analog scale as a pain measurement tool used for categories (mild, moderate and severe) the pain severity.Data were collected by Face to face interview with a pretested semistructured questionnaire.English questionnaire also translated into Bengali for the better understanding of the respondents.Prior to the data collection, verbal consent was taken from the Garments Industry.Participants who were willing to give consent and they were asked for the interview.Those who refused to provide information written consents & interview simply they were excluded from the study.Participants had the right to withdraw themselves from any stage of the study.
All interviewed questionnaires were checked for its completeness, accuracy and consistency to exclude missing or inconsistent data.The analyzed data were presented in tables, graphs, charts and bars, descriptive statistics performed at the aim of interpretation of the findings.To determine the association among the variables chi square test were observed in cross tabulation.The data were analyzed by using the software SPSS 16th.

Discussions
Current study depicts that 57.3% female participants were younger, whose age range in between 16-25 and mean age ± SD 26.91 ± 8.774.Interestingly, lions portion among the participants were married around 64.7%.Considering literacy, only 10% completed HSC but the 40% passed class eight.Most of their job experience was within 2 to 5 years (Table -1).The previous study describe the demographic details were (mean} SD): age, 34.5 ± 11.5 [11].The mean age of the study participants was 30.53 years [12].In a study, total of 150 participants were observed where females were more in number as compared to males Female swing 98.57% (n=69).Total female 78.67 (n=118).Age of sewing Mean ±SD 30.59±7.89 [13].The average age of the 39 workers assessed was 29 years with a range from 19-44; 62% were female.It was observed from that musculoskeletal problems were more common among workers among workers aged 35 years and above (95%) compared to workers with age less than 35 years (71.4%)[14].

Musculoskeletal Symptoms among Female Garmenmts Worker: Working Environment
Copyright: maladjusted with the body.In considering egronomical status, not only 79.3% tools were unadjusted with the body but also 80.7% furniture was not adjusted with the body properly.56.7% performed with both upper limbs in gripping clothes in different direction and 43.3% used both hand and right foot (Table 2).Compared with a Cambodian study sewing machine worker prolong sitting and non-sewing operator worked 10 to 12 hours per days and repeated or forceful motion [6].Another study showed that Malaysian sewing operators had repetitive tasks awkward static posture, awkward grips and hand movement pulling, lifting, pushing, in India 65.8% of the workers were working in those sections which involved prolonged hours of standing [8,12].
In our current study, contributors stated common site of the experiencing pain which was also statistically significant (p= 0.000) where among the different body regions the highest in lower back 24.7%, next to the neck 14%, followed by shoulder 5.3% upper back 2.0%, elbow 2.0%, wrist 4.7%, hip 0.7%, knee 2.0%, ankle 3.3% (Table 3).Norwegian study showed that lower back 30%, neck 15% and shoulder 11% [15].In Taiwan lower back 19.7%, neck 10%, Shoulder 17.4% and wrist 10%.In China participations complain lower back 22.0%, neck 16.7%, Shoulder 27.3% [16].Interestingly, all three studies found the same pattern in site of pain were highest in three regions like lower back, neck and shoulder.Somewhat different result found in an Indian study where lower back 41.03% and neck 64.10%, but another study of India, where they found the most common sites affected in neck 32.1%, knee 28.7% and low back (26.6%)[7,12].Almost similar results found other research in Bangladesh were respondents who had musculoskeletal disorders and pain in different sites whereas neck-36.7%,lower back-22.2%,shoulder joint-18.9%and rest of them was pain in elbow, upper back and in hip joint [4].Comparison with automobile mechanic professionals, estimated that 77% troubled with musculoskeletal symptoms and he most affected body parts were lower back 67% and then the hip 53% [17].
Study reported regarding the first experience of MSK symptoms from 7 days to 12 months around 43.4 % and only 2% reported in 4-5 years.In terms of receiving treatment, most of them about 36% were intake medication from the advice of doctor and fewer 10% received physiotherapy treatment from physiotherapist.As the consequences, only small number 23.3% were improved and little bit lower 20.7% noticed remain unchanged but 14.7% noted condition become worsen from the past (Table 4).In other study with the large sample size 1058 in garment factory workers employed in the free trade zone of Kogalla, Sri Lanka where 164 (15.5%) female workers reported musculoskeletal symptoms occurring more than 3 times or lasting a week or more during the previous 12-month period in subjects having 5 or more years of work experience (92.4%) compared to those with less than 5 years of experience (70.9%) [18,14].In Nigeria participant's health seeking behavior most of them prefer self-medication 31.4% and herbal 17.8% [19].
The current study showed that 58.7% respondent was musculoskeletal symptom whereas only 41.3% did not have any symptoms.The majority of musculoskeletal symptoms were perceived as work-related (Figure -1).In MSKC where proper maintaining of the posture accordingly was an important factor to arise the symptoms but in our study 81.3% did not maintain erect posture (p=0.000)(Figure 2).Significantly (P=.000) adapted percentage of faulty posture among the workers, 51.3% possessed forward bending position in work (Figure 3).Considering symptoms (p=0.000),both tingling sensation and aching symptoms were reported from equal percentage 10.7% respondent, even though the maximum 28.7% perceived and noticed pain (Figure 4).Regarding severity of pain (P=0.000),36.2% ached from moderate pain, 20.4% suffered from mild pain, and 1.3% grieved from severe pain (Figure 5).Almost similar 60.7 and 57.5% percentages found in other study in Bangladesh [20,21].It was higher 69.64% and 77.6% in our neighboring country India, but surprisingly lower 39.5% in Taiwan likewise European nation 49% in Norway [7,12,22].In Africa higher trained about 69% observed in Nigeria [19].In respond form the other research, severity of the pain 38.5% was mild pain, 35.2% was moderate pain and 2.4% was severe pain (P=.000) [20].Among them low back pains (78.2%) were found more common, followed by ankle / feet pain (76.3%) and neck pain (73.7%) during the last 7 days [12].

Conclusion
Study suggested that the garments workers in different inadequate setting was affected considerably and need more suitable modern technology in terms of adopting operator's appropriate posture and adjustable ergonomics, so that the recent and upcoming devastating effect of musculoskeletal disorder among the productive group can be avoided.Further study can be done in a larger scale with number of population.

Figure 1 :Figure 2 :
Figure 1: Distribution of respondents by musculoskeletal symptom

Figure 3 :
Figure 3: Distribution of respondents by presence of faulty posture of the garments workers

Figure 5 :
Figure 5: Distribution of the respondents according to severity of pain

Table 1 :
Distribution of the respondents according to the Sociodemographic characteristics

Table 2 :
Distribution of the respondents according to the pattern of working condition and characteristics of work place

Table 3 :
Distribution of the respondents according to site of pain

Table 4 :
Distribution of the respondents according to the musculoskeletal symptoms

Table 5 :
Distribution of the respondents Association between variable factors and musculoskeletal problems