Parenchymal asbestosis due to primary asbestos exposure among ship-breaking workers: report of the first cases from Bangladesh

Our plain-English summary of Parenchymal asbestosis due to primary asbestos exposure among ship-breaking workers: report of the first cases from Bangladesh, by V. Muralidhar, M.F. Ahasan, A.M. Khan (BMJ Case Reports, 2017).

The study

• Authors: V. Muralidhar, M.F. Ahasan, A.M. Khan
• Journal: BMJ Case Reports
• Published: 2017;2017
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report for the first time asbestosis among ship-breaking workers of Sitakunda in Bangladesh who were exposed to asbestos during ship-based and beach-based operations for at least 10 years. Asbestosis was present among 35% of workers. Years of work (>20) and forced vital capacity (<80% of predicted) were significantly associated with the disease. Currently, global ship-breaking operations are mainly concentrated in the Indian subcontinent, and Bangladesh has the majority share. Ninety per cent of domestic steel is produced in the ship-breaking operations in Bangladesh and is an important contributor to the economy. It also gives employment to more than 100 000 people. It is imperative to medically check up all the workers for benign and malignant diseases causally related to asbestos among these vulnerable population of workers.

© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

In plain English

This article, published as a case report, described asbestosis among ship-breaking workers in Sitakunda, Bangladesh. It opened with one worker, aged 45, who had worked in the shipyards for 22 years in ship-based cutting and beach-based operations. This worker was a non-smoker with breathlessness and was diagnosed with asbestosis. The authors then reported on two medical check-up camps held between July 2016 and January 2017. Workers with 10 or more years of asbestos exposure, mainly cutters and fitters, were checked. Of 99 workers who came, 94 were analysed, all men. Asbestosis was diagnosed in 33 of the 94 (35%). Having worked more than 20 years, and having lung capacity (FVC) below 80% of predicted, were both statistically significantly linked to asbestosis. The authors concluded that this was the first report of asbestosis among current workers in Bangladesh. They said their sample was small, biased and selected by the union. They also said exposure could not be measured and that workers moved between jobs, so different tasks could not be compared.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one worker, plus a case series of workers seen at two medical check-up camps. Diagnosis used a questionnaire, examination, spirometry, chest X-ray read by ILO guidelines, and chi-square tests.
• Who was studied: Ship-breaking workers at Sitakunda, Chittagong, Bangladesh. 99 workers attended; 5 with less than 10 years of exposure were excluded, leaving 94 for analysis. There were no women, and the average age was 38 years. The index case was a 45-year-old worker with 22 years in the shipyards.
• Exposure: Asbestos exposure during ship-based operations (mainly cutting in confined spaces) and beach-based dismantling, for 10 years or more. Sources included boilers, turbines, pipe insulation, cables and other ship materials. Fiber type was not specified, and exposure was based on workers' own history, not measured.
• Main results:
  • Asbestosis was diagnosed in 33 of the 94 workers analysed (35%).
  • 42 of the 94 workers (44%) had been exposed to asbestos for more than 20 years.
  • Among the 94 workers, 25 (26%) had FVC below 80% of predicted, and 23 (24%) had FEV1 below 80% of predicted.
  • More than 20 years of exposure (chi-square test, P less than 0.0001) and FVC below 80% of predicted (chi-square test, P less than 0.005) were each statistically significantly associated with asbestosis.
  • The index case, a non-smoking worker with 22 years in the shipyards, had FVC of 76% and FEV1 of 75% of expected. The chest X-ray showed reticular opacities with ILO profusion 1/1, and asbestosis was diagnosed.
• The authors' conclusion: The authors concluded that this was the first report of asbestosis among current workers in Bangladesh. They also stated that both ship-based and beach-based dismantling lead to significant asbestos exposure and to asbestosis among the workers.
• Limitations the authors state:
  • The sample was biased and may not represent typical shipyard workers.
  • The sample was small and limited to union-selected workers willing to risk their jobs to attend.
  • Asbestos exposure was based on workers' own history and could not be quantified.
  • Workers were rotated between tasks, so disease could not be compared across different work processes.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening, Shipyards and maritime work.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure.

Related studies

• Asbestos-related disease in Bangladeshi ship breakers: a pilot study — M.N. Courtice, P.A. Demers, et al. (2011)
• Radiological evidence of asbestos disease among ship repair workers — I.J. Selikoff, W.J. Nicholson, et al. (1980)
• Prevalence of chronic respiratory disease. Asbestosis in ship repair workers — B.G. Ferris, M.V. Panadive, et al. (1971)
• Incidence of bronchial carcinoma in shipyard workers with pleural plaques — J.R. Edge (1979)
• Assessment of the future mesothelioma disease burden from past exposure to asbestos in ship recycling yards in India — R. Singh, J.W. Cherrie, et al. (2020)
• Asbestos and ship-building: fatal consequences — J. Hedley-Whyte, D.R. Milamed (2008)

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