A systematic review of occupational health risks in the textile and garment industry and a conceptual framework for multi hazard risk integration

The textile and garment industry employs over 40 million workers worldwide and remains a major source of occupational hazards, particularly in low- and middle-income countries where regulatory enforcement is often limited. Following PRISMA 2020 guidelines and a preregistered protocol, we conducted a systematic review of peer-reviewed studies published between 2000 and 2025. Ten studies met the inclusion criteria, comprising seven cross-sectional studies, two systematic reviews, and one meta-analysis. Review-level evidence was included for contextual triangulation, while duplication of findings across evidence sources was avoided. Risk of bias was assessed using the Newcastle–Ottawa Scale, and findings were synthesized narratively because of substantial heterogeneity in study design, exposure assessment, and outcome definitions. Included studies reported that workers in spinning, dyeing, and finishing processes were frequently exposed to ergonomic, physical, chemical, and biological hazards, which were associated with musculoskeletal, respiratory, and dermatological health outcomes. Ergonomic and physical hazards were the most commonly reported exposures, while inadequate ventilation, repetitive tasks, prolonged working hours, and inconsistent use of personal protective equipment were recurrent contributing factors. Evidence indicated that workers were often exposed to multiple co-occurring hazards rather than isolated risks. To address this complexity, we introduce the Textile Occupational Health Risk Integration Model (TOHRIM), a systems-based conceptual framework that integrates multi-hazard exposures with organizational and contextual determinants. TOHRIM may help identify intervention priorities, strengthen workplace risk management, and inform occupational health policy development for workers, employers, and policymakers.