Research by AKU highlights the effectiveness of interventions to improve the health of textile workers in Pakistan

Karachi (Muhammad Yasir)

A multi-faceted study conducted by Dr Asaad Nafees, Assistant Professor, Department of Community Health Sciences at the Aga Khan University (AKU) is the largest of its kind to determine the effectiveness of a simple intervention in reducing cotton dust-related respiratory health effects on textile workers in Pakistan. The study titled MultiTex RCT, in collaboration with the National Heart and Lung Institute (NHLI) and Imperial College London, marked a crucial step towards revolutionizing occupational health interventions for textile workers in Pakistan and other Low- and Middle-Income Countries (LMICs).

Persistent cotton dust exposure leads to the development of a disease called byssinosis, a disease prevalent among textile workers in LMICs due to limited access to occupational health and safety measures. With an initial cohort of 2031 workers from 38 textile mills in Karachi, the study tested a low-cost intervention package to ascertain if it would mitigate the adverse respiratory effects experienced by these workers. The interventions comprised training in occupational health for all workers and managers, regular refresher sessions, formation of workplace committees to enforce a health and safety plan including wet mopping and safe disposal of cotton dust, and provision of face masks. The results showed clear improvements in respiratory symptoms and lung function of the textile workers.

Funded by the Wellcome Trust for a period of three years, the findings of this important research can be applied to the larger textile landscape helping workers in Pakistan and elsewhere stay safe and minimize their disease burden. Discussing the study outcomes, Prof Paul Cullinan, formerly of Imperial College London, involved in the study said, “Studies of this caliber on occupational health interventions are extremely rare and this work has promise for large-scale uptake since the multifaceted intervention was designed to fit the local context in Pakistan.  There is no obvious reason why it could not be rolled out more widely, nationally, and internationally.  In the 200 years we have been faced with byssinosis, this work represents a landmark in its control”. He underlined the importance of these simple yet transformative interventions, advocating for their widespread adoption for the benefit the workers.

Dr Asaad Nafees, the Principal Investigator, explained that “this trial was a parallel, cluster-randomized controlled study with textile mills as the unit of randomization. It can be replicated across the region to potentially impact respiratory health of all relevant workers, and potentially result in a healthier, more productive workforce.”

Key findings were recently presented at a seminar, where Engineer Sibtain Mughal, Joint Director Labour (OSH), Government of Sindh, committed the government’s support to the implementation of the health measures recommended by the study. “Workers deserve a high level of care and attention since their health holds significant importance for the industrial productivity and economy of the country.”

Several manuscripts have been published in high-impact occupational health journals. The study was also recently accepted for publication in the European Respiratory Journal.

Malnutrition Early in Life Sets Stage for Poor Growth and Death: AKU researchers find

Better nutrition during pregnancy and childbearing years is critical in protecting children in their most vulnerable first 1,000 days, study finds.  

Malnutrition affects babies much earlier than thought, and more nutritional support is needed for mothers to-be and their newborns to prevent disease, impaired cognition and death, according to new findings by Prof Zulfiqar Bhutta, founding director of the Institute for Global Health and Development and the Centre of Excellence in Women and Child Health (COE-WCH) at the Aga Khan University. 

In a trio of papers published by the Nature’s Ki Child Growth Consortium, which comprises of researchers at UC San Francisco and UC Berkeley, Professor Bhutta examines how malnutrition affects growth in the first two years of life, underscoring a devastating reality for millions of children in the Global South, particularly Asia. Stunting, or being too short for their age, indicates chronic malnutrition, while wasting measures acute malnutrition The global health community uses both indications to monitor progress toward ending malnutrition. 

The analysis involved an international team of more than 100 researchers that examined data on nearly 84,000 children under two years old from 33 major studies that began between 1987 and 2014 The cohorts came from 15 countries in South Asia, Sub-Saharan Africa, Latin America and Eastern Europe.  

It was discovered that in 2022, more than one in five children around the world – nearly 150 million – did not get enough calories to grow normally, and more than 45 million showed signs of wasting, or weighing too little for their height. More than a million children die each year as a consequence of wasting and more than 250,000 die from stunting. “People who experienced stunting and wasting in childhood may also experience worse cognitive development, which translates into worse economic outcomes as adults”, remarked Prof Bhutta while discussing his breakthrough research. 

Appreciating the monumental findings by Prof Bhutta and his team of AKU-based researchers, President AKU, Sulaiman Shahabuddin said, “AKU is stepping up on the global stage to share its portfolio of accomplished researchers and analysts who can help formulate robust policies in child and maternal healthcare. The COE-WCH deserves its due appreciation in contributing generously to this global effort.” 

The report also finds that the effects of malnutrition are seen throughout lower resource settings, but the burden is starkest in South Asian countries like Pakistan, where 20% of children were stunted at birth and more than 52% had experienced wasting by their second birthday, according to new estimates provided by the study. This is also attributed to seasonal changes, such as rainfall, that drive seasonal food insecurity, which, in turn, leads to wasting and stunting in infants.  

“Infants who developed growth faltering when they were less than six months old had up to eight times higher mortality before the age of two and to also developed severe forms of growth failure. Poor growth this early in life strongly underscores the critical need to assess underlying prenatal factors including maternal intestinal health and a need to invest in women”, said Dr Sana Syed, a paediatric gastroenterologist whose research focuses on gut health and inflammation. 

The scenarios are far deplorable in the rural areas of Pakistan, where rising effects of climate change and poor civil infrastructures can cause food insecurity to skyrocket, but the researchers are hopeful their findings shall get the ball rolling in the right direction. “The research is a remarkable step towards designing cost-effective and accessible nutritional interventions on a global scale, especially for countries with rural populations like Pakistan”, said Prof Syed Asad Ali, Professor of Paediatrics and Community Health Sciences at the Aga Khan University. 

The report further suggests prompt healthcare monitoring and interventions in the pre-natal period, in order to stabilize infant health before they turn six months old. Moreover, nourishment plans, supplementations, and medical accessibility may also help the mother and the child in eliminating the possibility of malnourishment, which could bring down the overwhelming number of stunting and wasting cases in South Asian communities like Pakistan.