Background Occupational injury is a national priority in Bangladesh. However critical gaps remain in small-scale factories. We aimed to assess the feasibility of collaborating with workers to design and implement interventions to improve work safety in two metal factories in Dhaka.

Methods We implemented a participatory mixed methods before-and-after study articulated over four phases. Phase_1 explored dynamics of injuries, hazards and risks using hazard assessments, surveillance, and in-depth interviews. Triangulation of phase_1 findings informed design and implementation of intervention packages in phase_2. In phase _3 and 4 we repeated hazard assessments and qualitative methods to document changes in hazards and perspectives.

Results An average of 65 workers were enrolled with a turnover of 41.5% during the study. Phase_1 data revealed frequent injuries amongst workers (129 over an average of 17 weeks), particularly young workers. Hazard risk scores (HRS) were 54% in factory A and 36% in factory B. Phase_2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Phase_3 showed a two-fold reduction in the HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase_4 revealed that improvement was sustained in one factory; the final HRS was 27% in factory A and 36% in factory B. Workers observed improvements in workplace safety but noted challenges in sustainability and worker turnover.

Conclusions It was feasible to implement interventions improving safety in collaboration with workers, however sustainability was mixed. Findings indicate urgent action is needed to improve safety, particularly for young workers, in small-scale factories.