Abstract
Background
Grain handlers are exposed to several occupational hazards, including grain dust, heat, smoke, heavy physical workload, prolonged working hours, and repetitive movements. These exposures may increase the risk of respiratory, musculoskeletal, eye, skin, and gastrointestinal problems. This study aimed to assess health problems and associated factors among grain handlers in Bangladesh.
Methods
A cross-sectional study was conducted among 292 grain handlers working in rice mills in Munshiganj Sadar Upazila, Dhaka Division, Bangladesh, in 2021. Data were collected through face-to-face interviews using a semi-structured questionnaire. Socio-demographic characteristics, work-related factors, and self-reported health problems were assessed. Descriptive statistics were used to summarize the findings. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with health problems.
Results
The mean age of the respondents was 38.04±11.01 years, with a male-to-female ratio of 5:1. Most workers worked >48 hours per week (86.3%) and reported overtime work (86.3%). Respiratory problems were the most common health problem, reported by 227 workers (77.7%), followed by musculoskeletal problems in 189 (64.7%), eye problems in 73 (25.0%), gastrointestinal problems in 49 (16.8%), and skin problems in 48 (16.4%). The most common symptoms were cough in 203 (69.5%), lower back pain in 107 (36.6%), red eye in 65 (22.3%), itching in 48 (16.4%), and abdominal pain in 29 (9.9%). In the adjusted analysis, no factor was significantly associated with respiratory problems. Eye problems were less likely among workers in the boiling section than among those in the drying section (AOR=0.40, 95% CI: 0.17-0.96; p=0.039). Primary education was associated with lower odds of skin problems compared with no formal education (AOR=0.39, 95% CI: 0.17-0.88; p=0.024). Musculoskeletal problems were significantly more common among workers aged 39-58 years than among those aged 19-38 years (AOR=2.71, 95% CI: 1.35-5.44; p=0.005) and among loading/unloading workers compared with drying workers (AOR=2.23, 95% CI: 1.10-4.53; p=0.026). Gastrointestinal problems were more likely among workers working >48 hours per week than among those working ≤48 hours per week (AOR=4.05, 95% CI: 1.16-14.15; p=0.029).
Conclusion
Grain handlers in Bangladesh experience a high burden of occupational health problems, particularly respiratory and musculoskeletal problems. Age, education, section of job, and weekly working hours were associated with selected health problems. Because of the cross-sectional design and reliance on self-reported outcomes, these findings should be interpreted as associations rather than causal effects. Improved occupational safety measures, including dust control, ventilation, ergonomic interventions, scheduled rest periods, health education, personal protective equipment, and regular health screening, are needed to protect this vulnerable workforce.
Keywords: bangladesh, grain handlers, musculoskeletal problems, occupational health, respiratory problems, rice mill workers
Introduction
Grain handling is an important occupational activity in Bangladesh, where rice is the principal staple food and rice processing provides employment for a large number of unskilled and semi-skilled workers [1]. In rice mills, grain handlers are involved in different stages of rice processing, including receiving, carrying, drying, boiling, husking, milling, sorting, packaging, loading, and unloading grains. These activities are often performed in small- or medium-scale mills where occupational safety practices may be limited [2]. Consequently, workers may be exposed to grain dust, heat, smoke, noise, heavy physical workloads, awkward postures, and repetitive movements [3].
Grain dust is a complex mixture of organic and inorganic materials, including particles from grain, husk, bran, silica, fungi, bacteria, endotoxins, insects, mites, animal waste, and chemical residues. Workers exposed to grain dust may develop respiratory symptoms such as cough, shortness of breath, chest tightness, runny nose, wheezing, and other chronic respiratory complaints. Dust exposure may also cause eye irritation, redness, watering, and a burning sensation. In addition, contact with grain dust and related materials can lead to skin problems such as itching and rashes [4-7].
Besides dust-related problems, grain handlers are also exposed to substantial ergonomic hazards. Carrying heavy sacks, lifting loads, prolonged standing, bending, repetitive hand movements, and working long hours may increase the risk of musculoskeletal problems, including neck pain, shoulder pain, back pain, knee pain, and ankle or foot discomfort. Gastrointestinal symptoms and accidental injuries may also occur due to poor working conditions, inadequate rest, lack of workplace hygiene, and limited access to occupational health services [8,9].
In Bangladesh, occupational health and safety among informal and semi-formal workers remains a neglected area. Grain handlers often belong to low socio-economic groups, have limited formal education, and may have poor awareness of occupational health risks. Inadequate or inconsistent use of personal protective equipment, long working hours, overtime work, smoking, poor ventilation, and lack of routine health screening may further increase their vulnerability [10]. Although rice milling and grain handling are common occupations in Bangladesh, evidence on the burden of health problems and associated factors among grain handlers remains limited.
Understanding the pattern of health problems among grain handlers is important for planning workplace interventions, improving occupational safety practices, and protecting the health of this vulnerable workforce. Therefore, this study aimed to assess health problems among grain handlers in Bangladesh and identify socio-demographic and work-related factors associated with these health problems.
Materials and methods
Study design and setting
This cross-sectional study was conducted among grain handlers working in rice mills in Munshiganj Sadar Upazila, Bangladesh, in 2021. The study included grain handlers from different sections of the rice mills, including drying, boiling, husking, and loading/unloading.
Study population
The study population included grain handlers aged 19 years and above who had been working in rice mills for at least six months. Workers involved in receiving, handling, storing, boiling, drying, husking, loading, unloading, or processing grains were considered eligible. Workers who were unwilling to participate or unable to provide informed consent were excluded.
Sample size and sampling
The sample size was calculated using the single population proportion formula, considering a 95% confidence level, an assumed 50% prevalence of health problems due to limited prior evidence, and a 6% margin of error. The calculated sample size was 267. After adding approximately 10% for non-response or incomplete data, the required sample size was 294. Finally, 292 grain handlers were included in the study.
Data collection procedure
Data were collected through face-to-face interviews using a semi-structured questionnaire. The questionnaire was developed after reviewing relevant occupational health literature and included information on socio-demographic characteristics, work-related conditions, and self-reported health problems. Socio-demographic variables included age, gender, religion, educational qualification, marital status, number of family members, type of house, monthly income, and smoking status. Work-related variables included duration of work experience, section of job, weekly working hours, and overtime work.
Outcome variables
The main outcome variables were self-reported health problems among grain handlers within the previous 14 days. Health problems were grouped into broad anatomical or system-based symptom categories commonly used in occupational health assessments: respiratory, eye, skin, musculoskeletal, and gastrointestinal problems, as well as accidental injuries. Respiratory problems included cough, shortness of breath, chest tightness, and a runny nose. Eye problems included eye redness, watery eyes, and a burning sensation in the eyes. Skin problems included itching and rash. Musculoskeletal problems included pain, numbness, or discomfort in different body regions, including the neck, shoulder, elbow, wrist/hand, upper back, lower back, hip/thigh, knee, ankle, or foot. Gastrointestinal problems included abdominal pain, anorexia, and constipation. For each category, participants were classified as having a health problem if they reported at least one symptom within that category during the previous 14 days. These outcome categories, therefore, represented self-reported symptom prevalence rather than clinically confirmed disease prevalence. Symptom severity, duration, chronicity, and clinical diagnosis were not assessed.
Independent variables
The independent variables included socio-demographic and work-related characteristics. Age was categorized into 19-38 years, 39-58 years, and ≥59 years. Educational qualification was categorized as no formal education/signature only, primary education, and secondary education. Monthly income was categorized as ≤10000 BDT and >10000 BDT. Work experience was categorized as ≤10 years and >10 years. Weekly working hours were categorized as ≤48 hours/week and >48 hours/week. Section of job was categorized as drying, boiling, husking, and loading/unloading.
Statistical analysis
Data were checked for completeness, cleaned, and analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics were used to summarize socio-demographic characteristics, work-related conditions, and reported health problems. Categorical variables were presented as frequencies and percentages. Continuous variables, such as age, monthly income, and weekly working hours, were summarized using means and standard deviations. Bivariable analysis was first performed to examine the association between socio-demographic and work-related variables and each health problem. Crude odds ratios (COR), 95% confidence intervals (CI), and p-values were estimated using logistic regression. Chi-square or Fisher’s exact test was also used where appropriate to compare proportions. Multivariable logistic regression analysis was then performed separately for each major health outcome: respiratory problems, eye problems, skin problems, musculoskeletal problems, and gastrointestinal problems. Adjusted odds ratios (AOR), 95% CI, and p-values were reported. Variables were selected for multivariable models based on conceptual relevance to occupational health outcomes, previous evidence, bivariable findings, biological plausibility, and model stability. Sparse cells and potential collinearity were also considered. Overtime was not included in the adjusted models because it was collinear with weekly working hours. The number of outcome events was 227 for respiratory problems, 73 for eye problems, 48 for skin problems, 189 for musculoskeletal problems, and 49 for gastrointestinal problems. Therefore, models for skin and gastrointestinal problems had relatively fewer events, and the adjusted estimates from these models should be interpreted cautiously. A p-value of <0.05 was considered statistically significant.
Ethical considerations
Ethical approval was obtained from the Institutional Review Board of the National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh (Memo No: NIPSOM/IRB/2021/18, dated 13/12/2021). Informed consent was obtained from all participants before data collection. Participation was voluntary, and respondents were informed about the purpose of the study. Confidentiality of all information was maintained, and data were used only for research purposes.
Results
Socio-demographic characteristics
Table 1 presents the socio-demographic characteristics of the respondents. The mean age was 38.04±11.01 years, with a range of 19-65 years. Most respondents were male (243 (83.2%)), Muslim (282 (96.6%)), and married (255 (87.3%)). Nearly half had no formal education or could only provide a signature (144 (49.3%)), while 133 (45.5%) had primary education and 15 (5.1%) had secondary education. Most respondents lived in tin-shed houses (262 (89.7%)). The mean monthly income was BDT 10113.01±2891.97, and 189 (64.7%) had a monthly income of ≤BDT 10000. More than half of the respondents were smokers (153 (52.4%)).
Table 1. Socio-demographic characteristics of the grain handlers.
Data are presented as N (%) for categorical variables and mean±SD (range) for continuous variables. Percentages were calculated using the total sample size of 292.
BDT, Bangladeshi Taka; SD, standard deviation
| Characteristic | Category | N (%) or mean±SD; range |
| Age, years | 19-38 | 144 (49.3) |
| 39-58 | 136 (46.6) | |
| ≥59 | 12 (4.1) | |
| 38.04±11.01; 19-65 | ||
| Gender | Male | 243 (83.2) |
| Female | 49 (16.8) | |
| Religion | Muslim | 282 (96.6) |
| Hindu | 10 (3.4) | |
| Educational qualification | No formal education/signature only | 144 (49.3) |
| Primary education | 133 (45.5) | |
| Secondary education | 15 (5.1) | |
| Marital status | Unmarried | 37 (12.7) |
| Married | 255 (87.3) | |
| Family members | ≤4 | 119 (40.8) |
| >4 | 173 (59.2) | |
| Number of family members | 4.84±1.41; 2-9 | |
| Housing type | Semi-pucca | 30 (10.3) |
| Tin-shed | 262 (89.7) | |
| Monthly income, BDT | ≤10000 | 189 (64.7) |
| >10000 | 103 (35.3) | |
| 10113.01±2891.97; 6000-18000 | ||
| Smoking habit | Non-smoker | 139 (47.6) |
| Smoker | 153 (52.4) |
Work-related characteristics
Table 2 presents the work-related characteristics of the respondents. Nearly half of the respondents had more than 10 years of work experience (142 (48.6%)). Regarding the section of job, 103 (35.3%) worked in the drying section, 74 (25.3%) in loading/unloading, 58 (19.9%) in husking, and 57 (19.5%) in boiling. Most respondents worked more than 48 hours per week (252 (86.3%)), and the same number reported overtime work (252 (86.3%)).
Table 2. Work-related characteristics of the grain handlers.
Data are presented as N (%) for categorical variables and mean±SD; range for continuous variables. Percentages were calculated using the total sample size of 292.
SD, standard deviation
| Characteristic | Category | N (%) or mean±SD; range |
| Working experience, years | ≤10 years | 150 (51.4) |
| >10 years | 142 (48.6) | |
| 12.69±8.96; 1-40 | ||
| Working section | Drying | 103 (35.3) |
| Boiling | 57 (19.5) | |
| Husking | 58 (19.9) | |
| Loading/unloading | 74 (25.3) | |
| Weekly working hours | ≤48 hours/week | 40 (13.7) |
| >48 hours/week | 252 (86.3) | |
| Weekly working hours | 65.94±12.72; 40-84 | |
| Overtime work | Yes | 252 (86.3) |
| No | 40 (13.7) |
Prevalence of health problems
Health problems were common among the grain handlers. Respiratory problems were the most frequently reported, affecting 227 workers (77.7%). Musculoskeletal problems were reported by 189 workers (64.7%), followed by eye problems in 73 (25.0%), gastrointestinal problems in 49 (16.8%), and skin problems in 48 (16.4%). Accidental injuries were reported by nine workers (3.1%) (Figure 1).
Figure 1. Health problems among the grain handlers.
Among specific symptoms (Table 3), cough was the most common respiratory symptom, reported by 203 workers (69.5%), followed by chest tightness or discomfort in 95 (32.5%), shortness of breath in 52 (17.8%), and runny nose in 33 (11.3%). Among musculoskeletal symptoms, lower back pain was the most common, reported by 107 workers (36.6%), followed by ankle/foot pain in 68 (23.3%), knee pain in 66 (22.6%), and neck pain in 51 (17.5%). Eye redness was reported by 65 workers (22.3%), watery eyes by 44 (15.1%), and a burning sensation of the eyes by 17 (5.8%). Itching was reported by 48 workers (16.4%), while skin rash was reported by four (1.4%). Among gastrointestinal symptoms, abdominal pain was reported by 29 workers (9.9%), anorexia by 24 (8.2%), and constipation by five (1.7%).
Table 3. Symptoms reported by the grain handlers.
Data are presented as N (%). Percentages were calculated using the total sample size of 292.
| Health problem category | Symptom | Yes, N (%) |
| Respiratory symptoms | Cough | 203 (69.5) |
| Shortness of breath | 52 (17.8) | |
| Chest tightness/discomfort | 95 (32.5) | |
| Running nose | 33 (11.3) | |
| Eye symptoms | Red eye | 65 (22.3) |
| Watering from eye | 44 (15.1) | |
| Eye burning | 17 (5.8) | |
| Skin symptoms | Itching in any body part | 48 (16.4) |
| Skin rash | 4 (1.4) | |
| Musculoskeletal symptoms | Neck pain/discomfort | 51 (17.5) |
| Shoulder pain/discomfort | 50 (17.1) | |
| Elbow pain/discomfort | 11 (3.8) | |
| Hand/wrist joint pain/discomfort | 38 (13.0) | |
| Upper back pain/discomfort | 11 (3.8) | |
| Lower back pain/discomfort | 107 (36.6) | |
| Hip/thigh pain/discomfort | 16 (5.5) | |
| Knee joint pain/discomfort | 66 (22.6) | |
| Ankle/foot pain/discomfort | 68 (23.3) | |
| Gastrointestinal symptoms | Abdominal pain | 29 (9.9) |
| Anorexia/distaste | 24 (8.2) | |
| Constipation | 5 (1.7) |
Factors associated with respiratory problems
In bivariable analysis, no socio-demographic or work-related factor was significantly associated with respiratory problems. Although respiratory symptoms were highly prevalent among grain handlers, the odds of respiratory problems did not vary significantly by age, gender, education, marital status, income, smoking status, work experience, section of job, or weekly working hours (Table 4).
Table 4. Factors associated with respiratory problems among grain handlers.
Data are presented as N (%). COR and AOR are presented with 95% CIs. P-values <0.05 were considered statistically significant; p<0.001 indicates strong statistical significance.
AOR, adjusted odds ratio; BDT, Bangladeshi Taka; CI, confidence interval; COR, crude odds ratio
| Variable | Category | Total, N | Problem present, N (%) | COR (95% CI) | P-value | AOR (95% CI) | P-value |
| Age group (years) | Overall p=0.107 | ||||||
| 19-38 | 144 | 105 (72.9) | 1.00 | - | 1.00 | - | |
| 39-58 | 136 | 111 (81.6) | 1.65 (0.93-2.91) | 0.085 | 1.50 (0.81-2.77) | 0.200 | |
| ≥59 | 12 | 11 (91.7) | 4.09 (0.51-32.70) | 0.185 | 3.80 (0.47-30.86) | 0.212 | |
| Gender | Overall p=0.473 | ||||||
| Male | 243 | 187 (77.0) | 1.00 | - | 1.00 | - | |
| Female | 49 | 40 (81.6) | 1.33 (0.61-2.91) | 0.474 | 1.25 (0.56-2.77) | 0.582 | |
| Religion | Overall p=0.467 | ||||||
| Muslim | 282 | 218 (77.3) | 1.00 | - | - | - | |
| Hindu | 10 | 9 (90.0) | 2.64 (0.33-21.25) | 0.361 | - | - | |
| Educational qualification | Overall p=0.271 | ||||||
| No formal/signature only | 144 | 116 (80.6) | 1.00 | - | - | - | |
| Primary | 133 | 98 (73.7) | 0.68 (0.38-1.19) | 0.174 | - | - | |
| Secondary | 15 | 13 (86.7) | 1.57 (0.33-7.35) | 0.568 | - | - | |
| Marital status | Overall p=0.111 | ||||||
| Unmarried | 37 | 25 (67.6) | 1.00 | - | 1.00 | - | |
| Married | 255 | 202 (79.2) | 1.83 (0.86-3.88) | 0.115 | 1.37 (0.60-3.13) | 0.449 | |
| Family members | Overall p=0.315 | ||||||
| ≤4 | 119 | 89 (74.8) | 1.00 | - | - | - | |
| >4 | 173 | 138 (79.8) | 1.33 (0.76-2.32) | 0.316 | - | - | |
| Type of house | Overall p=0.282 | ||||||
| Semi-pucca | 30 | 21 (70.0) | 1.00 | - | - | - | |
| Tin-shed | 262 | 206 (78.6) | 1.58 (0.68-3.63) | 0.285 | - | - | |
| Monthly income (BDT) | Overall p=0.389 | ||||||
| ≤10000 | 189 | 144 (76.2) | 1.00 | - | - | - | |
| >10000 | 103 | 83 (80.6) | 1.30 (0.72-2.34) | 0.389 | - | - | |
| Smoking habit | Overall p=0.562 | ||||||
| Non-smoker | 139 | 106 (76.3) | 1.00 | - | - | - | |
| Smoker | 153 | 121 (79.1) | 1.18 (0.68-2.04) | 0.562 | - | - | |
| Working experience | Overall p=0.310 | ||||||
| ≤10 years | 150 | 113 (75.3) | 1.00 | - | - | - | |
| >10 years | 142 | 114 (80.3) | 1.33 (0.76-2.32) | 0.310 | - | - | |
| Section of job | Overall p=0.417 | ||||||
| Drying | 103 | 83 (80.6) | 1.00 | - | - | - | |
| Boiling | 57 | 42 (73.7) | 0.67 (0.31-1.45) | 0.314 | - | - | |
| Husking | 58 | 48 (82.8) | 1.16 (0.50-2.67) | 0.734 | - | - | |
| Loading/unloading | 74 | 54 (73.0) | 0.65 (0.32-1.32) | 0.234 | - | - | |
| Weekly working hours | Overall p=0.969 | ||||||
| ≤48 hours/week | 40 | 31 (77.5) | 1.00 | - | - | - | |
| >48 hours/week | 252 | 196 (77.8) | 1.02 (0.46-2.26) | 0.969 | - | - | |
| Overtime | Overall p=0.969 | ||||||
| No | 40 | 31 (77.5) | 1.00 | - | - | - | |
| Yes | 252 | 196 (77.8) | 1.02 (0.46-2.26) | 0.969 | - | - |
Factors associated with eye problems
In bivariable analysis, eye problems were significantly associated with weekly working hours and overtime work. In the multivariable model, section of job and weekly working hours remained significantly associated with eye problems. Compared with workers in the drying section, workers in the boiling section had lower odds of eye problems (AOR=0.40, 95% CI: 0.17-0.96; p=0.039). Workers who worked >48 hours per week also had lower odds of eye problems than those who worked ≤48 hours per week (AOR=0.33, 95% CI: 0.16-0.68; p=0.003) (Table 5). Because this latter finding is counterintuitive, it should be interpreted cautiously and not as evidence that longer working hours protect against eye problems.
Table 5. Factors associated with eye problems among grain handlers.
Data are presented as N (%). COR and AOR are presented with 95% CI. P-values <0.05 were considered statistically significant; p<0.001 indicates strong statistical significance.
AOR, adjusted odds ratio; BDT, Bangladeshi Taka; CI, confidence interval; COR, crude odds ratio
| Variable | Category | Total, N | Problem present, N (%) | COR (95% CI) | P-value | AOR (95% CI) | P-value |
| Age group (years) | Overall p=0.102 | ||||||
| 19-38 | 144 | 29 (20.1) | 1.00 | - | 1.00 | - | |
| 39-58 | 136 | 39 (28.7) | 1.59 (0.92-2.77) | 0.097 | 1.40 (0.69-2.84) | 0.356 | |
| ≥59 | 12 | 5 (41.7) | 2.83 (0.84-9.57) | 0.094 | 2.39 (0.61-9.38) | 0.212 | |
| Gender | Overall p=0.086 | ||||||
| Male | 243 | 56 (23.0) | 1.00 | - | 1.00 | - | |
| Female | 49 | 17 (34.7) | 1.77 (0.92-3.43) | 0.089 | 1.01 (0.24-4.27) | 0.989 | |
| Religion | Overall p=0.071 | ||||||
| Muslim | 282 | 73 (25.9) | 1.00 | - | - | - | |
| Hindu | 10 | 0 (0.0) | 0.14 (0.01-2.35) | 0.170 | - | - | |
| Educational qualification | Overall p=0.295 | ||||||
| No formal/signature only | 144 | 41 (28.5) | 1.00 | - | - | - | |
| Primary | 133 | 30 (22.6) | 0.73 (0.42-1.26) | 0.261 | - | - | |
| Secondary | 15 | 2 (13.3) | 0.39 (0.08-1.79) | 0.224 | - | - | |
| Marital status | Overall p=0.919 | ||||||
| Unmarried | 37 | 9 (24.3) | 1.00 | - | - | - | |
| Married | 255 | 64 (25.1) | 1.04 (0.47-2.33) | 0.919 | - | - | |
| Family members | Overall p=0.731 | ||||||
| ≤4 | 119 | 31 (26.1) | 1.00 | - | - | - | |
| >4 | 173 | 42 (24.3) | 0.91 (0.53-1.56) | 0.731 | - | - | |
| Type of house | Overall p=0.180 | ||||||
| Semi-pucca | 30 | 4 (13.3) | 1.00 | - | 1.00 | - | |
| Tin-shed | 262 | 69 (26.3) | 2.32 (0.78-6.90) | 0.129 | 1.83 (0.59-5.71) | 0.297 | |
| Monthly income (BDT) | Overall p=0.437 | ||||||
| ≤10000 | 189 | 50 (26.5) | 1.00 | - | - | - | |
| >10000 | 103 | 23 (22.3) | 0.80 (0.45-1.41) | 0.437 | - | - | |
| Smoking habit | Overall p=0.155 | ||||||
| Non-smoker | 139 | 40 (28.8) | 1.00 | - | 1.00 | - | |
| Smoker | 153 | 33 (21.6) | 0.68 (0.40-1.16) | 0.157 | 0.89 (0.46-1.74) | 0.733 | |
| Working experience | Overall p=0.137 | ||||||
| ≤10 years | 150 | 32 (21.3) | 1.00 | - | 1.00 | - | |
| >10 years | 142 | 41 (28.9) | 1.50 (0.88-2.55) | 0.138 | 1.07 (0.53-2.15) | 0.846 | |
| Section of job | Overall p=0.091 | ||||||
| Drying | 103 | 29 (28.2) | 1.00 | - | 1.00 | - | |
| Boiling | 57 | 10 (17.5) | 0.54 (0.24-1.22) | 0.138 | 0.40 (0.17-0.96) | 0.039 | |
| Husking | 58 | 20 (34.5) | 1.34 (0.67-2.68) | 0.403 | 0.94 (0.22-3.93) | 0.929 | |
| Loading/unloading | 74 | 14 (18.9) | 0.60 (0.29-1.23) | 0.160 | 0.58 (0.28-1.23) | 0.158 | |
| Weekly working hours | Overall p<0.001 | ||||||
| ≤48 hours/week | 40 | 19 (47.5) | 1.00 | - | 1.00 | - | |
| >48 hours/week | 252 | 54 (21.4) | 0.30 (0.15-0.60) | <0.001 | 0.33 (0.16-0.68) | 0.003 | |
| Overtime | Overall p<0.001 | ||||||
| No | 40 | 19 (47.5) | 1.00 | - | - | - | |
| Yes | 252 | 54 (21.4) | 0.30 (0.15-0.60) | <0.001 | - | - |
Factors associated with skin problems
In bivariable analysis, skin problems were significantly associated with gender (p<0.001), educational qualification (p=0.004), monthly income (p=0.050), smoking habit (p=0.004), and section of job (p=0.001). After adjustment in the multivariable logistic regression model, educational qualification remained significantly associated with skin problems. Workers with primary education had lower odds of skin problems compared with those with no formal education/signature only (AOR=0.39, 95% CI: 0.17-0.88; p=0.024). Other variables that were significant in the bivariable analysis did not remain statistically significant after adjustment (Table 6).
Table 6. Factors associated with skin problems among grain handlers.
Data are presented as N (%). COR and AOR are presented with 95% CI. P-values <0.05 were considered statistically significant; p<0.001 indicates strong statistical significance.
AOR, adjusted odds ratio; BDT, Bangladeshi Taka; CI, confidence interval; COR, crude odds ratio
| Variable | Category | Total, N | Problem present, N (%) | COR (95% CI) | P-value | AOR (95% CI) | P-value |
| Age group (years) | Overall p=0.715 | ||||||
| 19-38 | 144 | 23 (16.0) | 1.00 | - | 1.00 | - | |
| 39-58 | 136 | 22 (16.2) | 1.02 (0.54-1.92) | 0.963 | 0.63 (0.30-1.32) | 0.222 | |
| ≥59 | 12 | 3 (25.0) | 1.75 (0.44-6.97) | 0.425 | 1.04 (0.22-4.88) | 0.962 | |
| Gender | Overall p=0.001 | ||||||
| Male | 243 | 32 (13.2) | 1.00 | - | 1.00 | - | |
| Female | 49 | 16 (32.7) | 3.20 (1.58-6.46) | 0.001 | 0.90 (0.21-3.83) | 0.891 | |
| Religion | Overall p=0.216 | ||||||
| Muslim | 282 | 45 (16.0) | 1.00 | - | - | - | |
| Hindu | 10 | 3 (30.0) | 2.26 (0.56-9.06) | 0.251 | - | - | |
| Educational qualification | Overall p=0.004 | ||||||
| No formal/signature only | 144 | 34 (23.6) | 1.00 | - | 1.00 | - | |
| Primary | 133 | 12 (9.0) | 0.32 (0.16-0.65) | 0.002 | 0.39 (0.17-0.88) | 0.024 | |
| Secondary | 15 | 2 (13.3) | 0.50 (0.11-2.32) | 0.374 | 0.59 (0.11-3.00) | 0.521 | |
| Marital status | Overall p=0.363 | ||||||
| Unmarried | 37 | 8 (21.6) | 1.00 | - | - | - | |
| Married | 255 | 40 (15.7) | 0.67 (0.29-1.58) | 0.365 | - | - | |
| Family members | Overall p=0.410 | ||||||
| ≤4 | 119 | 17 (14.3) | 1.00 | - | - | - | |
| >4 | 173 | 31 (17.9) | 1.31 (0.69-2.49) | 0.411 | - | - | |
| Type of house | Overall p=0.191 | ||||||
| Semi-pucca | 30 | 2 (6.7) | 1.00 | - | 1.00 | - | |
| Tin-shed | 262 | 46 (17.6) | 2.98 (0.69-12.96) | 0.145 | 2.50 (0.54-11.63) | 0.244 | |
| Monthly income (BDT) | Overall p=0.050 | ||||||
| ≤10000 | 189 | 37 (19.6) | 1.00 | - | 1.00 | - | |
| >10000 | 103 | 11 (10.7) | 0.49 (0.24-1.01) | 0.053 | 0.93 (0.40-2.19) | 0.877 | |
| Smoking habit | Overall p=0.004 | ||||||
| Non-smoker | 139 | 32 (23.0) | 1.00 | - | 1.00 | - | |
| Smoker | 153 | 16 (10.5) | 0.39 (0.20-0.75) | 0.005 | 0.70 (0.31-1.60) | 0.396 | |
| Working experience | Overall p=0.671 | ||||||
| ≤10 years | 150 | 26 (17.3) | 1.00 | - | - | - | |
| >10 years | 142 | 22 (15.5) | 0.87 (0.47-1.63) | 0.672 | - | - | |
| Section of job | Overall p=0.001 | ||||||
| Drying | 103 | 17 (16.5) | 1.00 | - | 1.00 | - | |
| Boiling | 57 | 4 (7.0) | 0.38 (0.12-1.20) | 0.098 | 0.34 (0.11-1.11) | 0.073 | |
| Husking | 58 | 19 (32.8) | 2.46 (1.16-5.25) | 0.019 | 1.44 (0.33-6.25) | 0.624 | |
| Loading/unloading | 74 | 8 (10.8) | 0.61 (0.25-1.51) | 0.287 | 0.62 (0.24-1.58) | 0.314 | |
| Weekly working hours | Overall p=0.266 | ||||||
| ≤48 hours/week | 40 | 9 (22.5) | 1.00 | - | - | - | |
| >48 hours/week | 252 | 39 (15.5) | 0.63 (0.28-1.43) | 0.269 | - | - | |
| Overtime | Overall p=0.266 | ||||||
| No | 40 | 9 (22.5) | 1.00 | - | - | - | |
| Yes | 252 | 39 (15.5) | 0.63 (0.28-1.43) | 0.269 | - | - |
Factors associated with musculoskeletal problems
In bivariable analysis, musculoskeletal problems were significantly associated with age group (p<0.001), educational qualification (p=0.001), marital status (p=0.011), type of house (p=0.003), work experience (p=0.013), and section of job (p=0.005). In multivariable analysis, age group and section of job remained significantly associated with musculoskeletal problems. Workers aged 39-58 years had higher odds of musculoskeletal problems compared with those aged 19-38 years (AOR=2.71, 95% CI: 1.35-5.44; p=0.005). Workers engaged in loading/unloading also had higher odds of musculoskeletal problems compared with workers in the drying section (AOR=2.23, 95% CI: 1.10-4.53; p=0.026). These associations may be influenced by cumulative work duration and unmeasured ergonomic exposures. Other factors were not statistically significant after adjustment (Table 7).
Table 7. Factors associated with musculoskeletal problems among grain handlers.
Data are presented as N (%). COR and AOR are presented with 95% CI. P-values <0.05 were considered statistically significant; p<0.001 indicates strong statistical significance.
AOR, adjusted odds ratio; BDT, Bangladeshi Taka; CI, confidence interval; COR, crude odds ratio
| Variable | Category | Total, N | Problem present, N (%) | COR (95% CI) | P-value | AOR (95% CI) | P-value |
| Age group (years) | Overall p<0.001 | ||||||
| 19-38 | 144 | 75 (52.1) | 1.00 | - | 1.00 | - | |
| 39-58 | 136 | 106 (77.9) | 3.25 (1.93-5.47) | <0.001 | 2.71 (1.35-5.44) | 0.005 | |
| ≥59 | 12 | 8 (66.7) | 1.84 (0.53-6.38) | 0.337 | 1.55 (0.39-6.26) | 0.536 | |
| Gender | Overall p=0.083 | ||||||
| Male | 243 | 152 (62.6) | 1.00 | - | 1.00 | - | |
| Female | 49 | 37 (75.5) | 1.85 (0.92-3.72) | 0.087 | 1.34 (0.28-6.54) | 0.716 | |
| Religion | Overall p=0.746 | ||||||
| Muslim | 282 | 183 (64.9) | 1.00 | - | - | - | |
| Hindu | 10 | 6 (60.0) | 0.81 (0.22-2.94) | 0.751 | - | - | |
| Educational qualification | Overall p=0.001 | ||||||
| No formal/signature only | 144 | 107 (74.3) | 1.00 | - | 1.00 | - | |
| Primary | 133 | 71 (53.4) | 0.40 (0.24-0.66) | <0.001 | 0.58 (0.32-1.06) | 0.075 | |
| Secondary | 15 | 11 (73.3) | 0.95 (0.29-3.17) | 0.935 | 2.21 (0.59-8.26) | 0.237 | |
| Marital status | Overall p=0.011 | ||||||
| Unmarried | 37 | 17 (45.9) | 1.00 | - | 1.00 | - | |
| Married | 255 | 172 (67.5) | 2.44 (1.21-4.90) | 0.012 | 1.31 (0.56-3.04) | 0.534 | |
| Family members | Overall p=0.995 | ||||||
| ≤4 | 119 | 77 (64.7) | 1.00 | - | - | - | |
| >4 | 173 | 112 (64.7) | 1.00 (0.61-1.63) | 0.995 | - | - | |
| Type of house | Overall p=0.003 | ||||||
| Semi-pucca | 30 | 12 (40.0) | 1.00 | - | 1.00 | - | |
| Tin-shed | 262 | 177 (67.6) | 3.12 (1.44-6.78) | 0.004 | 2.27 (0.96-5.35) | 0.061 | |
| Monthly income (BDT) | Overall p=0.494 | ||||||
| ≤10000 | 189 | 125 (66.1) | 1.00 | - | - | - | |
| >10000 | 103 | 64 (62.1) | 0.84 (0.51-1.38) | 0.494 | - | - | |
| Smoking habit | Overall p=0.139 | ||||||
| Non-smoker | 139 | 96 (69.1) | 1.00 | - | 1.00 | - | |
| Smoker | 153 | 93 (60.8) | 0.69 (0.43-1.13) | 0.140 | 0.92 (0.49-1.70) | 0.779 | |
| Working experience | Overall p=0.013 | ||||||
| ≤10 years | 150 | 87 (58.0) | 1.00 | - | 1.00 | - | |
| >10 years | 142 | 102 (71.8) | 1.85 (1.13-3.01) | 0.014 | 1.01 (0.52-1.97) | 0.970 | |
| Section of job | Overall p=0.005 | ||||||
| Drying | 103 | 57 (55.3) | 1.00 | - | 1.00 | - | |
| Boiling | 57 | 32 (56.1) | 1.03 (0.54-1.98) | 0.922 | 0.76 (0.37-1.53) | 0.439 | |
| Husking | 58 | 44 (75.9) | 2.54 (1.24-5.19) | 0.011 | 1.08 (0.23-5.11) | 0.924 | |
| Loading/unloading | 74 | 56 (75.7) | 2.51 (1.30-4.85) | 0.006 | 2.23 (1.10-4.53) | 0.026 | |
| Weekly working hours | Overall p=0.268 | ||||||
| ≤48 hours/week | 40 | 29 (72.5) | 1.00 | - | - | - | |
| >48 hours/week | 252 | 160 (63.5) | 0.66 (0.31-1.38) | 0.270 | - | - | |
| Overtime | Overall p=0.268 | ||||||
| No | 40 | 29 (72.5) | 1.00 | - | - | - | |
| Yes | 252 | 160 (63.5) | 0.66 (0.31-1.38) | 0.270 | - | - |
Factors associated with gastrointestinal problems
In bivariable analysis, most socio-demographic and work-related factors were not significantly associated with gastrointestinal problems. In multivariable analysis, weekly working hours remained significantly associated with gastrointestinal problems. Workers who worked >48 hours per week had higher odds of gastrointestinal problems compared with those who worked ≤48 hours per week (AOR=4.05, 95% CI: 1.16-14.15; p=0.029). The wide CI indicates statistical imprecision; therefore, this association should be interpreted cautiously (Table 8).
Table 8. Factors associated with gastrointestinal problems among grain handlers.
Data are presented as N (%). COR and AOR are presented with 95% CI. P-values <0.05 were considered statistically significant; p<0.001 indicates strong statistical significance.
AOR, adjusted odds ratio; BDT, Bangladeshi Taka; CI, confidence interval; COR, crude odds ratio
| Variable | Category | Total, N | Problem present, N (%) | COR (95% CI) | P-value | AOR (95% CI) | P-value |
| Age group (years) | Overall p=0.502 | ||||||
| 19-38 | 144 | 22 (15.3) | 1.00 | - | 1.00 | - | |
| 39-58 | 136 | 26 (19.1) | 1.31 (0.70-2.45) | 0.395 | 1.14 (0.57-2.26) | 0.712 | |
| ≥59 | 12 | 1 (8.3) | 0.50 (0.06-4.10) | 0.522 | 0.47 (0.05-4.04) | 0.488 | |
| Gender | Overall p=0.456 | ||||||
| Male | 243 | 39 (16.0) | 1.00 | - | 1.00 | - | |
| Female | 49 | 10 (20.4) | 1.34 (0.62-2.91) | 0.458 | 1.95 (0.32-11.81) | 0.467 | |
| Religion | Overall p=1.000 | ||||||
| Muslim | 282 | 48 (17.0) | 1.00 | - | - | - | |
| Hindu | 10 | 1 (10.0) | 0.54 (0.07-4.38) | 0.565 | - | - | |
| Educational qualification | Overall p=0.529 | ||||||
| No formal/signature only | 144 | 26 (18.1) | 1.00 | - | - | - | |
| Primary | 133 | 22 (16.5) | 0.90 (0.48-1.68) | 0.739 | - | - | |
| Secondary | 15 | 1 (6.7) | 0.32 (0.04-2.58) | 0.287 | - | - | |
| Marital status | Overall p=0.161 | ||||||
| Unmarried | 37 | 3 (8.1) | 1.00 | - | 1.00 | - | |
| Married | 255 | 46 (18.0) | 2.49 (0.73-8.47) | 0.143 | 2.65 (0.71-9.86) | 0.146 | |
| Family members | Overall p=0.199 | ||||||
| ≤4 | 119 | 24 (20.2) | 1.00 | - | - | - | |
| >4 | 173 | 25 (14.5) | 0.67 (0.36-1.24) | 0.201 | - | - | |
| Type of house | Overall p=0.193 | ||||||
| Semi-pucca | 30 | 2 (6.7) | 1.00 | - | 1.00 | - | |
| Tin-shed | 262 | 47 (17.9) | 3.06 (0.70-13.30) | 0.136 | 3.23 (0.71-14.61) | 0.128 | |
| Monthly income (BDT) | Overall p=0.223 | ||||||
| ≤10000 | 189 | 28 (14.8) | 1.00 | - | - | - | |
| >10000 | 103 | 21 (20.4) | 1.47 (0.79-2.75) | 0.225 | - | - | |
| Smoking habit | Overall p=0.466 | ||||||
| Non-smoker | 139 | 21 (15.1) | 1.00 | - | - | - | |
| Smoker | 153 | 28 (18.3) | 1.26 (0.68-2.34) | 0.466 | - | - | |
| Working experience | Overall p=0.496 | ||||||
| ≤10 years | 150 | 23 (15.3) | 1.00 | - | - | - | |
| >10 years | 142 | 26 (18.3) | 1.24 (0.67-2.29) | 0.497 | - | - | |
| Section of job | Overall p=0.076 | ||||||
| Drying | 103 | 16 (15.5) | 1.00 | - | 1.00 | - | |
| Boiling | 57 | 15 (26.3) | 1.94 (0.88-4.30) | 0.102 | 1.89 (0.83-4.32) | 0.130 | |
| Husking | 58 | 11 (19.0) | 1.27 (0.55-2.96) | 0.576 | 0.59 (0.10-3.45) | 0.557 | |
| Loading/unloading | 74 | 7 (9.5) | 0.57 (0.22-1.46) | 0.240 | 0.44 (0.17-1.17) | 0.100 | |
| Weekly working hours | Overall p=0.112 | ||||||
| ≤48 hours/week | 40 | 3 (7.5) | 1.00 | - | 1.00 | - | |
| >48 hours/week | 252 | 46 (18.3) | 2.75 (0.81-9.32) | 0.103 | 4.05 (1.16-14.15) | 0.029 | |
| Overtime | Overall p=0.112 | ||||||
| No | 40 | 3 (7.5) | 1.00 | - | - | - | |
| Yes | 252 | 46 (18.3) | 2.75 (0.81-9.32) | 0.103 | - | - |
Discussion
This cross-sectional study found a high burden of self-reported health problems among grain handlers working in rice mills in Bangladesh. Respiratory problems were the most frequently reported health problems, followed by musculoskeletal problems. Eye, gastrointestinal, and skin problems were also reported. These findings suggest that grain handlers experience multiple health complaints in a work environment characterized by dust, smoke, heat, prolonged working hours, repetitive movements, awkward postures, and heavy manual workload. However, because of the cross-sectional design and reliance on self-reported symptoms, the findings should be interpreted as associations and not as evidence of causality.
Respiratory problems were highly prevalent, with cough being the most common symptom. This may be related to frequent exposure to rice dust, husk particles, bran, silica, fungi, bacteria, endotoxins, and other contaminants during drying, husking, loading, unloading, and milling [6,11]. The prevalence in this study was higher than that reported by Ansari et al. among rice mill workers in Bangladesh, where 34.0% had chronic respiratory symptoms [12]. This difference may be due to differences in symptom definition, recall period, exposure level, work setting, and whether symptoms were self-reported or clinically assessed. The broad symptom definition used in the present study may have increased the reported prevalence because even isolated or mild symptoms were included.
In adjusted analysis, no socio-demographic or work-related factor was significantly associated with respiratory problems. This may be because respiratory hazards were common across most sections of job, resulting in limited variation in exposure between worker groups. Smoking is also an important potential contributor to respiratory symptoms; although smoking status was included in the analysis, detailed smoking exposure, such as pack-years, and its interaction with dust exposure could not be assessed. The use of self-reported symptoms without spirometry, clinical examination, or dust exposure measurements may also have limited the ability to identify specific risk factors.
Musculoskeletal problems were reported by nearly two-thirds of workers. Lower back pain was the most common symptom, followed by ankle/foot pain, knee pain, and neck pain. This pattern is consistent with the physical demands of grain handling, including lifting and carrying heavy sacks, prolonged standing, bending, and repetitive movements. Similar findings have been reported in previous studies among rice mill workers [13,14]. In the present study, workers aged 39-58 years had significantly higher odds of musculoskeletal problems than those aged 19-38 years, and loading/unloading workers had higher odds than drying workers. These findings are plausible given the physical workload involved; however, residual confounding from work duration, task history, and unmeasured ergonomic exposures may still exist.
Eye problems were reported by one-fourth of the respondents. Redness, watering, and a burning sensation of the eyes may be related to exposure to dust, smoke, heat, and poor ventilation. Workers in the boiling section had lower odds of eye problems compared with those in the drying section, which may reflect greater airborne dust exposure during drying activities. However, this explanation remains speculative because environmental dust levels were not measured. Workers who worked more than 48 hours per week also had lower odds of eye problems compared with those working ≤48 hours per week. This counterintuitive finding should be interpreted cautiously and should not be considered evidence that longer working hours are protective. It may reflect residual confounding, selection effects, reporting bias, the healthy worker effect, or differences in task assignment. Eye problems such as redness, watering, and a burning sensation may be related to continuous exposure to dust, smoke, heat, and poor ventilation in the rice mill environment. Similar ocular complaints among rice mill workers were reported in previous studies [14,15].
Skin problems were reported by 16.4% of workers, mainly itching and rash. These symptoms may result from direct contact with grain dust, husk, bran, sweat, heat, and contaminated surfaces. In adjusted analysis, workers with primary education had lower odds of skin problems compared with those with no formal education/signature only. This may reflect better awareness of hygiene and protective practices among workers with some formal education, although residual confounding cannot be excluded. Comparable dermatological complaints among agricultural and rice mill workers were also documented in earlier studies [16,17].
Gastrointestinal problems were reported by 16.8% of workers. These symptoms may be related to irregular meals, dehydration, poor workplace sanitation, and long working hours. In multivariable analysis, working more than 48 hours per week was associated with higher odds of gastrointestinal problems. However, the CI was wide, indicating statistical imprecision. This finding suggests that prolonged working time may affect eating habits, rest, hydration, and overall health. Similar gastrointestinal morbidities among rice mill workers were also observed in previous studies [14,15]. Longer working hours may adversely affect eating patterns, hydration, and adequate rest.
This study has several limitations. The cross-sectional design prevents causal inference and does not allow determination of whether symptoms began before or after employment. Health problems were self-reported within a 14-day recall period and may be affected by recall or reporting bias. The outcomes represented symptom prevalence rather than clinically confirmed disease prevalence. The broad symptom definitions may have overestimated the burden of health problems because mild, isolated, or transient symptoms were classified in the same way as more clinically significant conditions. Objective assessments such as spirometry, clinical examination, personal dust monitoring, heat measurement, ventilation assessment, air quality monitoring, and structured ergonomic evaluation were not performed. Therefore, associations between specific workplace exposures and reported symptoms could not be directly quantified. The study may also be affected by the healthy worker survivor effect because workers who had left rice mill work due to illness, dust exposure, or heavy physical workload were not included. Smoking intensity and the interaction between smoking and dust exposure could not be assessed. Unequal representation across participant groups may have introduced selection bias and should be considered when interpreting the study findings. Finally, the study was conducted in rice mills in only one upazila, which may limit generalizability to grain handlers in other regions of Bangladesh where mill technology, work organization, socioeconomic conditions, exposure levels, and occupational safety practices may differ.
Conclusions
Grain handlers in Bangladesh reported a high burden of occupational health-related symptoms, particularly respiratory and musculoskeletal symptoms. Selected socio-demographic and work-related factors, including age, education, section of job, and weekly working hours, were associated with some self-reported health symptom categories. These findings should be interpreted cautiously because of the cross-sectional design, reliance on self-reported symptoms, absence of objective clinical or exposure assessments, and limited generalizability from one study area. These findings highlight the need for improved occupational safety measures, including dust control, better ventilation, ergonomic interventions, scheduled rest periods, health education, appropriate PPE, and regular health screening.
Disclosures
Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of the National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh issued approval NIPSOM/IRB/2021/18.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Acquisition, analysis, or interpretation of data: Md Faizul Ahasan, Naima Ferdous, Mohammad Ataour Rahman, Aparna Mandal Anee, Nishat Jahan Nishi, Ahad Mahmud Khan, Shahria Sattar
Critical review of the manuscript for important intellectual content: Md Faizul Ahasan, Naima Ferdous, Mohammad Ataour Rahman, Aparna Mandal Anee, Nishat Jahan Nishi, Ahad Mahmud Khan, Shahria Sattar
Concept and design: Naima Ferdous, Shahria Sattar
Drafting of the manuscript: Naima Ferdous
Supervision: Shahria Sattar
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