Evidence map›Paper›PMID 41130225›Full record

Trial reportThe Lancet. Planetary health2025

Sustainable cooling strategies for workers in the ready-made garment factory industry in Bangladesh under simulated extreme heat: a randomised crossover trial.

James W Smallcombe, Ruindu N Ranhotty, Aaron J E Bach, Jean P Palutikof, Fahim N Tonmoy, Ashikur R Joarder, Monir Hossain, Nathan B Morris, Anthony Capon, Yorgi Mavros and 1 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Lancet. Planetary health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

James W SmallcombeHeat and Health Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Ruindu N RanhottyHeat and Health Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Aaron J E BachNational Climate Change Adaption Research Facility (NCCARF), Griffith University, Gold Coast, QLD, Australia; School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia.
Jean P PalutikofNational Climate Change Adaption Research Facility (NCCARF), Griffith University, Gold Coast, QLD, Australia.
Fahim N TonmoyNational Climate Change Adaption Research Facility (NCCARF), Griffith University, Gold Coast, QLD, Australia; Deloitte, Brisbane, QLD, Australia.
Ashikur R JoarderDepartment of Architecture, Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh.
Monir HossainDepartment of Architecture, Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh.
Nathan B MorrisCollege of Nursing and Health Sciences, University of Colorado, Colorado Springs, CO, USA.
Anthony CaponMonash Sustainable Development Institute, Monash University, Melbourne, VIC, Australia.
Yorgi MavrosHeat and Health Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Ollie JayHeat and Health Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Electronic address: ollie.jay@sydney.edu.au.

Funding

Wellcome Trust 216059
6 · The paper itself

Abstract

backgroundBangladesh frequently experiences extreme heat and humidity, which threatens the health, wellbeing, and productivity of ready-made garment workers. Scalable, sustainable, and low-cost cooling strategies are urgently needed to protect this workforce in low-income and middle-income countries. Therefore, we examined the effects of building-level and personal-level cooling alternatives to air conditioning on worker heat strain in a simulated Bangladesh ready-made garment factory.

methodsIn a randomised cross over trial (ACTRN12622000457741), healthy participants (aged 18-40 years) recruited from a convenience sample of volunteers from diverse ethnic backgrounds completed six 3-h gender-specific ready-made garment work simulations (males ironed and females sewed) in a climate chamber at the University of Sydney: (1) current factory (control [CON]=40°C, 38% relative humidity); (2) CON with fan (FAN); (3) FAN with drinking water (FAN+HYD); (4) modified rooftop (ROOF=37·5°C, 38% relative humidity); (5) ROOF with fan (ROOF+FAN); and (6) air conditioning (AC=24°C, 40% relative humidity). Primary outcomes were end-trial core temperature, heart rate, and sweat loss fluid deficit. Linear mixed models with fixed effects of intervention and sex and random effects of participant were used for analysis. Pre-planned contrasts compared each intervention to CON, with Dunnett's correction for multiple testing.

findingsBetween March 16, 2022, and Nov 25, 2023, 42 participants (20 identifying as females, 22 as males) completed 247 trials. Compared to CON, male core temperature decreased with FAN+HYD (-0·27°C [99% CI -0·44 to -0·09]), ROOF (-0·35°C [-0·53 to -0·17]), ROOF+FAN (-0·28°C [-0·45 to -0·10]), and AC (-0·71°C [-0·89 to -0·53]), but in females, core temperature decreased only with AC (-0·42°C [-0·60 to -0·24]). Male heart rate was lower with FAN (-6 beats per minute [-12 to 0]), FAN+HYD (-13 beats per minute [-19 to -7]), ROOF (-8 beats per minute [-14 to -2]), ROOF+FAN (-11 beats per minute [-17 to -5]), and AC (-34 beats per minute [-41 to -28]), and female heart rate was lower with FAN+HYD (-7 beats per minute [-13 to 0]), ROOF (-8 beats per minute [-15 to -2]), ROOF+FAN (-10 beats per minute [-16 to -4]), and AC (-25 beats per minute [-31 to -18]). Male sweat loss fluid deficit was reduced with FAN+HYD (-704 g [-817 to -591]), ROOF (-205 g [-317 to -93]), and AC (-853 g [-966 to -741]), and in females with FAN+HYD (-439 g [-554 to -324]), ROOF (-131g [-246 to -16]), and AC (-513g [-628 to -398]).

interpretationSustainable cooling interventions can reduce physiological heat strain under peak heat stress conditions in a typical non-airconditioned Bangladeshi ready-made garment factory. Cooling benefits were greater in males, highlighting potential gender-based workplace heat stress inequalities.

fundingWellcome Trust.

Indexed as

Air ConditioningExtreme HeatHeat Stress DisordersOccupational ExposureAdolescentAdultBangladeshCross-Over StudiesFemaleHumansHumidityMaleYoung Adult

Identifiers

PMID41130225
PMCPMC7618560

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.