to maintain one s quality of life , sound physical health and mental health are essential . it is a human right to have access to proper healthcare facilities provided by the state and society . this view is no longer considered merely as a humanitarian value that is independent of the social environment . rather , it is viewed more and more as an essential force for promoting socioeconomic progress in a society . in an undeveloped country , such as bangladesh , hospital data are available about disease patterns , but information about the morbidity patterns of a specific community is rarely available . only a community - level study can reflect the true picture of the disease patterns in a given community and determine people s preferences when they seek healthcare services . regarding this point of view , information about the morbidity patterns of garment worker and their healthcare - seeking behavior is of great importance . the salaries of female garment workers are very low , averaging about $ 40 per month , which is among the lowest in the world ( 1 ) . so , the high incidence of morbidity reduces their household budget , not only their spending money , but for the ways in which they can seek treatment and by impairing their ability to work and earn money . the most likely consequence of this situation is that their families will live in permanent poverty ( 2 ) . the ready - made garment ( rmg ) industry has played a pioneering role in the development of the industrial sector in bangladesh . the $ 16 billion this industry has earned comprise about 79% of the country s total exports and 17% of the country s gross domestic product ( gdp ) ( board of investment bangladesh report , 2013 ) . but the standard of living of female garment workers is still in a precarious condition , and they are not free from the vicious cycle of poverty . they face extreme difficulty in obtaining their basic needs for survival ( 3 ) , and this situation makes them even more vulnerable . their nutritional status is very poor because of their low pay and their extreme vulnerability . healthcare - seeking behavior refers to the sequences of remedial actions that individuals undertake to rectify perceived ill health ( 4 ) . the treatment choice depends on several factors , including socio - demographic status , the pattern and severity of illness , their existing beliefs about disease , availability of the needed services , the quality of those services , and their cost effectiveness ( 5 ) . in almost all developing and undeveloped countries , the public and private sectors are often at odds with each other , which generate a lot of controversy and conflict . as a result , in the healthcare area , little attention is paid to harmonizing this coexistence for the benefit of the users ( 7 ) . several studies have been conducted that showed the trends for the utilization of public and private healthcare , including the consideration of such factors as age , gender , women s autonomy , urban or rural habitat , economic status , severity of illness , the availability of physical infrastructure , the type of healthcare providers , and the attitudes of the providers ( 8) . in bangladesh , a wide range of therapeutic options is available , ranging from self - care to folk medicine and western medicine . but , unfortunately , poverty and gender are the two main determinants of the prevalence of disease and the lack of available , quality healthcare8 . the severity of illness may have a significant effect on peoples health care - seeking behavior . for example , when a flu - like syndrome exists , people may seek folk cures or homemade remedies ; however , with multi - system involvement and long durations of illness , people are more likely to consult a biomedical healthcare provider ( 9 ) . even though many traditional treatments are not effective , people utilize them due to lack of education , poverty , and their lack of satisfaction with healthcare providers ( 10 ) . the overall situation of the healthcare system is poor in developing countries , such as bangladesh , due to inadequate access to modern health services and poor utilization of the few services that are available . therefore , one of the public health challenges in bangladesh is to identify vulnerable groups and provide them with needed preventive and curative health services ( 11 ) . so , this study was designed to identify the specific factors that may enhance the overall health status of the garment workers considering their morbidity patterns , nutritional status , and healthcare - seeking behavior . this study was designed and implemented as a cross - sectional study from august 2012 to february 2013 . we calculated the required sample size based on our assumption of the proportion of the target population , i.e. , female workers in the garment industry that had particular characteristics , a desired 50% accuracy , and a desired degree of accuracy 0.05 ; given those assumptions , we calculated the minimum sample size to be 284 , and we enrolled 300 participants in the study . a purposive type of sampling was conducted because the study was based on some ideas that were established before it was implemented . the criteria for inclusion in the study were that participants had to be female garment workers who had worked in the industry for more than six months , were at least 18 , and were willing to participate . two garment factories were selected for the study , and 150 participants were selected from each factory following the sample selection criteria . then , data were collected using a semi - structured questionnaire ; the heights and weights of the participants were measured following the who s standard operating procedure ( sop ) . the study protocol was approved by the ethical review committee ( erc ) of the american international university - bangladesh ( aiub ) . all participants provided both written and verbal informed after the researchers had explained the study s objectives , procedures , and likely outcomes . chi square test were used to analyze data , and the prevalence rate ratio ( prr ) was measured to determine the association of body mass index ( bmi ) and health problems . this study was designed and implemented as a cross - sectional study from august 2012 to february 2013 . we calculated the required sample size based on our assumption of the proportion of the target population , i.e. , female workers in the garment industry that had particular characteristics , a desired 50% accuracy , and a desired degree of accuracy 0.05 ; given those assumptions , we calculated the minimum sample size to be 284 , and we enrolled 300 participants in the study . a purposive type of sampling was conducted because the study was based on some ideas that were established before it was implemented . the criteria for inclusion in the study were that participants had to be female garment workers who had worked in the industry for more than six months , were at least 18 , and were willing to participate . two garment factories were selected for the study , and 150 participants were selected from each factory following the sample selection criteria . then , data were collected using a semi - structured questionnaire ; the heights and weights of the participants were measured following the who s standard operating procedure ( sop ) . the study protocol was approved by the ethical review committee ( erc ) of the american international university - bangladesh ( aiub ) . all participants provided both written and verbal informed after the researchers had explained the study s objectives , procedures , and likely outcomes . chi square test were used to analyze data , and the prevalence rate ratio ( prr ) was measured to determine the association of body mass index ( bmi ) and health problems . table 1 shows the socio - demographic characteristics of the participants . ninety percent of the participants were 30 or younger , and the ages of the remaining 10% of the participants ranged from 31 to 35 . most of them were muslims ( 94.33% ) , and the rest were hindus ( 5.67% ) . the percentages of unmarried and married participants was close , i.e. , 53.33% and 46.67% , respectively . among the 300 participants , 43.33% were illiterate , 40% had completed the primary educational level , and only 16.67% had completed the secondary educational level . concerning their living situations , 65% lived alone and 35% lived with their families . concerning their housing situations , 58.33% lived in kutcha houses and 41.67% lived in pakka houses . most of them ( 49.67% ) had at least 1.5 years of experience , whereas 36% had a year of experience , and 14.33% had only six months of experience . their monthly incomes were very low , with 19% making 4000 bdt monthly , 24.67% making 4500 bdt monthly , 22.33% making 5000 bdt monthly , and 42.33% making 5500 bdt monthly . ( note that 4000 bdt per month is approximatekly equal to $ 51.50 per month . ) generally the workers worked 10 hours per day , six days per week for these wages , with some working as much as 12 hours per day . table 2 shows the health - related complaints the participants had within the three months preceding the study . the percentages of participants who had anorexia , nausea , fever , epigastric pain , and burning micturition , and dysmenorrhea were 22.33% , 14.33% , 11.67% , 11.33% , 10.67% , and 10.33% , respectively . in addition , 8% complained about coughing , 7.67% about headaches , 7% about lower abdominal pain , 5.67% about runny noses , 4.33% about diarrhea , 4% about vomiting , 3% about menorrhagia , and 2.33% about leg pain . on examination , 31% of the participants were found to have anemia , but no other signs of deficiency disorders were observed . among those with anemia , 40.33% were within the normal weight range , 43.33% were underweight , and table 3 shows the relationship of bmi and the morbidity pattern . among the participants , 43.33% had bmis 18.5 kg / m2 , slightly more than 96% of them had different types of complaints within the last three months . among the large percentage of participants with health - related complaints , 28.67% of them had anemia , 19.67% were anorexic , 10.33% had nausea , 8% had fevers , 6.67% had epigastric pain , 6.67% had burning micturition , and 7% had dysmenorrhea . conversely , 40.33% of the participants had bmi values within the normal limits , and more than half of them ( 21.33% ) had no complaints . so , a bmi below the normal level has a significant relationship with more health - related complaints ( p - value < 0.001 ) . also , we considered those with bmi values < 18.5 kg / m2 as one group and those with bmi values  18.5 kg / m2 as another group . in each group , we further divided the participants into those with and those without complaints ; then , we measured prr and found it to be 2.59 . note that 22.33% of the participants indicated that they do not seek healthcare when they are having health - related problems . among the other 77.67% only 11.67% participants went to qualified doctors when they had a health issue , and the remaining 25.67% , 22.67% , and 17.67% went to paramedics , homeopathic doctors , and kabiraj , respectively . a very alarming finding was that only 37% of those who went to qualified doctors completed the treatment that their doctors prescribed . this was a cross - sectional study that was conducted with the aim of determining the morbidity pattern , nutritional status , and healthcare - seeking behavior of female garment workers in bangladesh , who are now the key personnel of the country s growing economy and development . in bangladesh , most female garment workers are adults , and almost half of them are married . another country in the same region , sri lanka , has very similar circumstances to those in bangladesh ( 1314 ) . the mean age of our participants was 25.73  5.31 years , and more than half of them were unmarried ( 53.33% ) and living alone ( 65% ) . considering the educational level 59.67% were literate , whereas the literacy rate among young females in bangladesh is 76.86% ( world bank , 2010 ) . the garment workers average monthly income was $ 63.20  $ 14.01 , but the average monthly income of the bangladeshi people in general is $ 68.16 ( bangladesh bureau of statistics , 201011 ) . so , the garment workers have low education levels and low income levels , both of which increase their vulnerability . most of the participants ( 53.67% ) had different kinds of symptoms . among the participants , the percentages who had anorexia , nausea , fever , epigastric pain , burning micturition , dysmenorrhea were 22.33% , 14.33% , 11.67% , 11.33% , 10.67% , and 10.33% , respectively . on examination , 31% of the participants had anemia , and no other signs of deficiency disorders were observed . but a recent study shows that 79% of the female garment workers had some illness , and the major problems were diarrhea and respiratory tract infections ( 11 ) . however , another study showed that the illnesses were headaches , excessive menstrual bleeding , and eye problems ( 13 ) , which clearly do not match the results of the previous study . however , studies conducted in countries that have similar socio - demographic characteristics as bangladesh , such as sri lanka and fiji , showed that headaches , accidents , fatigue , stress , and depression were the most commonly - experienced health - related issues among garment workers ( 14 , 15 ) . 43.33% had bmi values less than 18.5 kg / m2 , but the average bmi among such workers in sri lanka was 20.9  3.6 ( 14 ) . again , these malnourished people had significant rates of high morbidity ( p - value < 0.001 ) and , overall , an prr of 2.59 signifies bmis below the normal level , which is a risk factor of high morbidity . a recent study showed that about one - third ( 30.8% ) of bangladeshi women of reproductive age are malnourished ( bmi < 18.5 kg / m2 ) ( 12 ) , which means that that the ratio of malnutrition is higher among the female garment workers than in the general population of women . moreover , their healthcare - seeking behavior is poor , i.e. , 22.33% of the participants indicated that usually they do not seek healthcare for health - related problems . among the others , only 11.67% participants go to qualified doctors , and 25.67% , 22.67% , and 17.67% of the participants go to paramedics , homeopathic doctors , and kabiraj , respectively . the most alarming situation is that those who did seek medical care , only 37% of them completed the treatment that their healthcare provider prescribed . another study conducted in bangladesh showed that 11% did not seek healthcare services and that 87% of them did not go to qualified doctors ( 11 ) , so the two studies were in close agreement . the low educational levels and poor economic status of female garment workers make them much more vulnerable to illnesses , and this study showed that they have high morbidity , poor nutrition , and poor healthcare - seeking behavior , so policy makers and owners should take notice and proactively provide sufficient incentives and awareness programs to help correct the healthcare and economic conditions their workers face .
background : the ready - made garment ( rmg ) sector is the main pillar of bangladesh s economy , and female garment workers are the key workers in this sector . 
 unfortunately , they are paid very little ; in fact , their pay is among the lowest anywhere in the world . 
 this situation makes the workers very vulnerable to different kinds of health - related problems , including malnutrition , and it also results in their having poor healthcare - seeking behavior . 
 so , the aim of this study was to determine their nutritional status , their various kinds of health - related problems , and their healthcare - seeking behavior.methods:this was a cross - sectional study in which purposive sampling was done . 
 data were collected through a structured questionnaire , and the participants heights and weights were measured according the guidelines provided by the world health organization ( who ) . 
 all data were computed and analyzed using spss version 16.01 software . 
 chi squared values were calculated to analyze the data and the prevalence rate ratio ( prr ) was measured to determine the association of body mass index ( bmi ) with health problems.results:more than half of the participants ( 53.67% ) had various health problems , and almost half of them ( 43.33% ) were underweight ( bmi  18.5 kg / m2 ) . among those who were underweight , 
 about 96% of them had one or more health - related problems in the last three months ( p - value < 0.001 ) . 
 their prr was 2.59 , which comprises low bmi as a risk factor for high morbidity . among the workers who had one or more health - related problems , more than 22% of them 
 did not go to see a doctor during their illnesses . 
 only about 12% of them went to qualified practitioners , and , surprisingly , 37% of those completed the prescribed treatment.conclusion:the study showed that there is high morbidity among female garment workers who have low bmi values and poor healthcare - seeking behavior , factors that should be addressed by their employers and policy makers .