Heat stress and illness among injera baking workers in Addis Ababa

Injera baking in Ethiopia involves labor-intensive work in high-temperature environments, raising concerns about occupational heat stress. Despite this, data on heat exposure and related health impacts in this setting are limited. This study aimed to assess heat exposure levels, the prevalence of heat-related illnesses (HRI), and associated factors among workers in the Injera Baking and Local Market sectors in Addis Ababa. A comparative cross-sectional study was conducted among 309 workers (159 bakers and 150 local market workers) who were selected through random sampling. Heat stress is measured by a combination of external heat and internal metabolic heat generation. Health and environmental data were collected via a modified HOTHAPS questionnaire (administered through Kobo Toolbox), supported by an observational checklist. Multivariable logistic regression was used to identify key factors associated with HRI. The median and range of WBGT during working hours at the Baking Center were 25 and 20.8–32.4 °C, respectively, higher than the comparative site, 19.5 and 13–22 °C. It exceeded ACGIH limits for moderate work from 10 AM to 4 PM at the baking center. Heat-related illness was more prevalent among bakers (46.1%) than among comparative workers (9.7%), with common symptoms including excessive sweating and fatigue. Statistically significant factors associated with HRI included workplace type (Adjusted odds ratio (AOR) = 13.2, 95% CI: 3.4–50.7), lack of cold drinking water (AOR = 4.3, 95% CI: 1.69–10.9), inadequate rest breaks (AOR = 3.5, 95% CI: 1.5–8.13), and daily water intake < 3 L (AOR = 3.9, 95% CI: 1.55–9.73). The findings underscore the urgent need for workplace interventions to reduce heat exposure and improve hydration and rest practices among Injera baking workers.