Abstract
Eight in ten female readymade garment (RMG) workers in Bangladesh suffer from anemia, a condition which damages both health and productivity. This study evaluated the effectiveness of a workplace nutrition program on anemia reduction in female RMG workers of Bangladesh. A quasi-experimental mixed method study was conducted on 1310 non-pregnant female RMG workers from four factories. Two types of intervention packages (A and C) were tested against their respective controls (B and D) over a 10-month period. Among factories that already provided lunch to workers with regular behavior change counseling (BCC), one intervention (A) and one control (B) factory were selected, and among factories that did not provide lunches to their workers but provided regular BCC, one intervention (C) and one control (D) factory were selected: (A) Lunch meal intervention package: daily nutritionally-enhanced (with fortified rice) hot lunch, once weekly iron-folic acid (IFA) supplement and monthly enhanced (with nutrition module) behavior change counseling (BCC) versus (B) Lunch meal control package: regular lunch and BCC; and (C) Non-meal intervention package: twice-weekly IFA and enhanced BCC versus (D) Non-meal control package: BCC alone. Body weight and capillary hemoglobin were measured. Changes in anemia prevalence were estimated by difference-in-difference (DID) method. Thematic analysis of qualitative in-depth interviews with RMG workers was performed and findings were triangulated. Anemia was reduced significantly in both lunch meal and non-meal intervention (A and C) group (DID: 32 and 12 percentage points, p: <0.001 and <0.05 respectively). The mean hemoglobin concentration also significantly increased by 1 gm/dL and 0.4 gm/dL in both A and C group (p: <0.001 respectively). Weight did not change in the intervention groups (A and C) but significantly increased by more than 1.5 kg in the comparison groups (B and D). The knowledge of different vitamin and mineral containing foods and their benefits was increased significantly among all participants. Workplace nutrition programs can reduce anemia in female RMG workers, with the greatest benefits observed when both nutritionally enhanced lunches and IFA supplements are provided.
Highlights
The readymade garment (RMG) industry is one of Bangladesh’s most important industries and contributes 81% of total export earnings and more than 14% of the GDP (2016–2017) [1]
To the best of our knowledge, this is the first nutrition intervention study in Bangladesh conducted among female RMG workers, which showed the effectiveness of a combination of interventions to reduce anemia
Anemia prevalence in female RMG workers was reduced by 32 percentage points through the provision of a workplace nutrition program that included a nutritionally enhanced lunch through dietary diversification which involved micronutrient-fortified rice along with weekly iron-folic acid supplements and an enhanced health and nutrition behavior change approach
Summary
The readymade garment (RMG) industry is one of Bangladesh’s most important industries and contributes 81% of total export earnings and more than 14% of the GDP (2016–2017) [1]. The sector directly employs approximately 3 million women [1]. This industry has contributed to the growth of the economy and foreign earnings, it faces many limitations with respect to the low wage rate, insecure employment conditions, as well as the lack of safety and respect for female workers’ rights. In Southeast Asia, it has been estimated that iron deficiency anemia is the cause of 26% of all anemia in women of reproductive age [8]. There is a scarcity of evidence on the etiology of anemia and their relative proportion to the causes of anemia
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