For this short paper assignment, analyze the impact of the tuberculosis burden in garment factory workers in Bangladesh, including an exploration of successful intervention. In you short paper, include the following critical elements: Compare the major burden of disease that you have chosen to other types of burdens. You only need a cursory overview of other burdens here; consider that this comprises about 25% of your paper, so it should only consume about half a page or a long paragraph at most. Assess how the major burden of disease fits into the epidemiologic transition and approximately where the country is in the transition. Describe what the population looks like in terms of age and distribution, as well as poverty levels. Analyze one intervention that has successfully addressed this burden of the disease in the country. What, in your opinion, made the intervention successful? Tuberculosis in Garment Factory Workers Located in Southeast Asia, the People’s Republic of Bangladesh with a population of 164,669,751 million (2017 est.) remains one of the least developed and poorest countries in the world. The populace of Bangladesh is principally homogenous, with 98 percent being ethnic Bangla (Bengali), the remaining two percent is comprised of 27 different minority groups and the indigenous tribes (Aliprandini, 2017). Regarding matters of faith and belief, the majority of the Bangladeshi population is Muslim followed by Hindus, Buddhist, and Christians. Notably, Bangladesh and its indigenous tribes share a “rich and diverse culture which is reflected in the architecture, culture, literature, music, painting, and clothing” (National Tourism Organization, 2017, para. 3). Although rich and diverse, both religious and cultural beliefs to some degree factor into the health disparities witnessed among the Bangladeshi population. Demographic Profile According to the World Bank (2017), Bangladesh’s population density stands at 1,251.8 persons per square kilometer of land area, which is comprised of the following age and sex distribution. Also, the dependency ratio is included here as a means to showcase the imbalance between working and non-working persons. Age/Sex Structure · 34.3 percent of the population under 15 – males 28,477,712 / females 27,676,239 · 61.1 percent of the population aged 15 and 64 – males 47,501,643 / females 52,602,227 · 4.7 percent of the population 65 and older – males 3,738,570 / females 3,905,749 (Country Meters, 2017). Age Dependency Ratio/Life Expectancy With a total dependency ratio of 63.7 percent (56.1% under 15 and 7.6% for those 65 and older), it places a tremendous burden on the productive population to cover the expenditures for both children and aged individuals. Total life expectancy at birth (both sexes) for Bangladeshi’s is 69.8 percent (males 67.9 years/females 71.7 years) falls just short of the global population average of 71 years (Country Meters, 2017). Overcrowding, Poverty, and Disea ...

1. For this short paper assignment, analyze the impact of the
tuberculosis burden in garment factory workers in Bangladesh,
including an exploration of successful intervention.
In you short paper, include the following critical elements:
Compare the major burden of disease that you have chosen to
other types of burdens. You only need a cursory overview of
other burdens here; consider that this comprises about 25% of
your paper, so it should only consume about half a page or a
long paragraph at most.
Assess how the major burden of disease fits into the
epidemiologic transition and approximately where the country is
in the transition.
Describe what the population looks like in terms of age and
distribution, as well as poverty levels.
Analyze one intervention that has successfully addressed this
burden of the disease in the country. What, in your opinion,
made the intervention successful?
Tuberculosis in Garment Factory Workers
Located in Southeast Asia, the People’s Republic of
Bangladesh with a population of 164,669,751 million (2017
est.) remains one of the least developed and poorest countries in
the world. The populace of Bangladesh is principally
homogenous, with 98 percent being ethnic Bangla (Bengali), the
remaining two percent is comprised of 27 different minority
groups and the indigenous tribes (Aliprandini, 2017). Regarding
matters of faith and belief, the majority of the Bangladeshi
population is Muslim followed by Hindus, Buddhist, and
Christians. Notably, Bangladesh and its indigenous tribes share
a “rich and diverse culture which is reflected in the
architecture, culture, literature, music, painting, and clothing”
(National Tourism Organization, 2017, para. 3). Although rich
and diverse, both religious and cultural beliefs to some degree
factor into the health disparities witnessed among the

2. Bangladeshi population.
Demographic Profile
According to the World Bank (2017), Bangladesh’s
population density stands at 1,251.8 persons per square
kilometer of land area, which is comprised of the following age
and sex distribution. Also, the dependency ratio is included here
as a means to showcase the imbalance between working and
non-working persons.
Age/Sex Structure
· 34.3 percent of the population under 15 – males 28,477,712 /
females 27,676,239
· 61.1 percent of the population aged 15 and 64 – males
47,501,643 / females 52,602,227
· 4.7 percent of the population 65 and older – males 3,738,570 /
females 3,905,749 (Country Meters, 2017).
Age Dependency Ratio/Life Expectancy
With a total dependency ratio of 63.7 percent (56.1% under
15 and 7.6% for those 65 and older), it places a tremendous
burden on the productive population to cover the expenditures
for both children and aged individuals. Total life expectancy at
birth (both sexes) for Bangladeshi’s is 69.8 percent (males 67.9
years/females 71.7 years) falls just short of the global
population average of 71 years (Country Meters, 2017).
Overcrowding, Poverty, and Disease
As previously stated, the population of Bangladesh stands
at 164,669,751 million; thus, ranking the eighth most populous
country in the world. Interestingly, only 34 percent of the
Bangladeshi populous live in urban areas; thus, an astonishing
66 percent of this country’s population reside in urban locals
(World Meters, 2017). Notwithstanding the significant
difference between urban and rural population rates, there
remains little escape from overcrowding, as well as the ease in
which disease(s) can spread within congested populations.

3. Additionally, poverty is a pressing concern when
considering 24.3 percent of the population (37.9 million people)
lives below the national poverty line of which 12.9 percent (4.9
million people) live in extreme poverty (World Bank, 2017).
Collectively, population density and poverty have further
strained Bangladesh’s already inadequate and struggling health
care system. The latter stems from a significant shortage of
hospitals and health care workers in urban locals and near
extinct palliative care services available to rural i nhabitants
(Aliprandini, 2017). Consequently, theses untied forces leave
Bangladesh ill-equipped to combat the major burdens of
diseases threatening its people.
Communicable and Non-Communicable Diseases
Although Bangladesh has witnessed substantial progress in
disease prevention, new and old communicable diseases, like
malaria, acquired immunodeficiency syndrome (AIDS), and
tuberculosis (TB) will persist as a significant health burden for
the foreseeable future. The latter results from migration,
urbanization, trade, and travel. Of notable concern is microbial
evolution, which often strengths said diseases. Equally
concerning, is the emergence of drug-resistant TB and Malaria,
which increases this population’s risk (World Health
Organization, 2017). Noteworthy non-communicable diseases as
a source of substantial death and disability among adults
include cancer, heart disease, diabetes, and mental disorders,
whereas malnutrition is the leading cause of death and disability
among children. Estimates suggest 75 percent of a child’s life is
consumed by illness because of malnutrition-related infections
and disability (WHO, 2017). Notwithstanding the personal and
economic impact resulting from the aforementioned burdens of
disease, TB is particularly concerning.
Tuberculosis Burden
Compared to Malaria and HIV/AIDS, TB is by far the most
predominant communicable disease in Bangladesh. According to

4. the World Health Organization (2017), “in 2014, there were
187,005 new cases of TB in Bangladesh and it was the leading
cause of death, accounting for 81,000 fatalities” (para. 1).
Estimates for 2016, indicate improvements in TB prevention
with a rate of 221 new infections per 100,000 people or 361,000
new cases (males 232,000 / females 129,000). Markedly, years
of healthy life lost due to TB (both sexes) is 481.0 per 100,000
people and the mortality rate rests at 40 per 100,00 people the
equivalent of 65,868 lives lost per year (WHO, 2017). Given the
population of Bangladeshi’s is witnessing new, resurgent, and
drug-resistant TB incidences, it indicates the country has
entered the third epidemiological transition (Mahmood, Ali, &
Islam, 2013). Although improved, these statistics remain
alarming, yet for those working in the garment industry, the
picture is much bleaker.
Factory Garment Workers and Tuberculosis
The more than 5,600 garment factories in Bangladesh employ an
estimated 4.2 million people, of which women and young girls
account for 85 percent of the workforce (Ghosh, 2014).
Important to note, TB outbreaks are closely linked to
overcrowding, poor ventilation, poor working conditions,
malnutrition, and an imbalanced healthy workforce, all of which
are prevalent issues in Bangladesh garment factories. Thus,
when taking into account that “TB is spread through the air
when people who have an active TB infection, cough, sneeze, or
otherwise transmit respiratory fluids through the air, garment
factories provide an environment ripe for the spread of
(Bangladesh Garment Manufacturers and Exporters Association,
2015, para. 3).
With that said, “a study among 2281 workers from 30 garment
factories in Dhaka city, the prevalence of TB was found to be
higher (960 per 100,000) than in the general population” (Islam,
Akramul Islam, Islam, Ahmed, & Islam, 2015, p. 2). Thus, when
compared to the general population, garment factory workers
are 2.4 times more likely to develop active TB. As such, “TB
patients lose 3-4 months of work time, resulting in an average

5. lost potential earning of 20% to 30% of annual household
income” (21st Century Academic Forum, 2017, 12:46).
However, there’s a significant gender disparity in “TB detection
and diagnosis, with a female: male ratio of 0.38 compared with
0.51 in South-East Asia and 0.71 worldwide” (21st Century
Academic Forum, 2017, 12:46). Markedly, young women as the
driving force of the garment industry belong to low -income
families; thus, suffer from malnutrition, which increases their
risk for TB. Subsequently, these statistics suggest the
importance of continuing TB control programs in garment
factories, as well as TB education directed toward the
workforce.
Tuberculosis Prevention
As is often the case with most communicable diseases’
awareness, education, and access to health services are pivotal
to reducing incidences of the disease, which in this case is TB.
Bangladesh’s National Strategic Plan for TB Control (2015-
2020) is one program that’s proving successful. Under the
program, as of 2016, they have achieved a treatment success
rate of 93 percent among all new and relapsed cases, as w ell as
a multi-drug resistant TB treatment with a success rate of 73
percent. Contributing to this success is the increased number of
automated diagnostic machines that from a small sample can
detect TB infection (WHO, 2017). While the efforts of the
National Strategic Plan for TB Control have proven fruitful
much work remains. The latter is especially true if Bangladesh
hopes to achieve the Sustainable Development Goals set forth
by the World Health Organization, which is a “95% reduction in
deaths and a 90% reduction in TB incidence by 2035 (WHO,
2017, para.1). Although successful, it’s fundamentally
important to bring TB awareness and education to the extremely
vulnerable population of garment factory works. In doing so, it
will not only improve the health of the workforce, it also
increases production rates and profits, which could help to
increase garment factory workers wages.

6. References
Aliprandini, M. (2017). Our world Bangladesh. Retrieved from
doi:10.3331/our_world_481_250188
Bangladesh Garment Manufacturers and Exporters Association.
(2015, March 15). Garment workers being infected with
tuberculosis. News Bangladesh. Retrieved from
http://www.newsbangladesh.com/english/details/598
Ghosh, P. (2014). Despite low Pay, poor work conditions,
garment factories empowering millions of Bangladeshi women.
Retrieved from http://www.ibtimes.com/despite-low-pay-poor-
work-conditions-garment-factories-empowering-millions-
bangladeshi-women-1563419
Health Grove. (2016). Tuberculosis: Impact in Asia. Retrieved
from http://global-diseases.healthgrove.com/l/4/Tuberculosis
Islam, Q. S., Akramul Islam, M., Islam, S., Ahmed, S. M., &
Islam, M. A. (2015). Prevention and control of tuberculosis in
workplaces: how knowledgeable are the workers in
Bangladesh. BMC Public Health, 15(1), 1-10.
doi:10.1186/s12889-015-2622-4
Mahmood, S.A., Ali, S., & Islam, R. (2013). Shifting from
infectious diseases to non-communicable diseases: A double
burden of disease in Bangladesh. Journal of public health and
epidemiology, 5(11), 424-434. Retrieved from
doi:10.1186/s40249-017-0310-6
National Tourism Organization. Visit Bangladesh. Retrieved
from http://visitbangladesh.gov.bd/about-bangladesh/culture-
religion-language/
World Bank. (2017). Bangladesh: Country profile. Retrieved
from
http://databank.worldbank.org/data/Views/Reports/ReportWidge

7. tCustom.aspx?Report_Name=CountryProfile&Id=b450fd57&tba
r=y&dd=y&inf=n&zm=n&country=B
World Health Organization. (2017). Health profile of
Bangladesh. Retrieved from
http://www.whoban.org/country_health_profile.html
World Health Organization. (2017). WORLD TB DAY 2016:
Bangladesh continues its battle against the disease. Retrieved
from http://www.searo.who.int/bangladesh/world-tb-day-
2016/en/
World Meters. (2017). Countries in the world by population
(2017). Retrieved from http://www.worldometers.info/world-
population/population-by-country/
21st Century Academic Forum. (2017, March 12). Gender
Disparity in Management of Tuberculosis Patients among
Garments Workers[Video File]. Retrieved from
https://www.youtube.com/watch?v=qHXwz3jvKK8