A puzzling phenomenon has plagued factories in Cambodia for years. Scores of workers at a time — most of them women in garment factories — are fainting, one after another. Every year, more than a thousand workers faint for unexplained reasons in garment factories in Cambodia. In 2018, a single incident involved more than 200 workers at a shoe factory fainting at the same time. School of Public Health Assistant Professor Hyun Kim recently led a commentary on research into the mass faintings and suggests that investigators should consider the possibility that the illnesses are caused by multiple factors. The commentary was published in the journal Global Epidemiology. 

“Mass fainting in workplaces are often due to poor work environments, such as exposing workers to chemicals without providing adequate ventilation or personal protective equipment,” said Kim. “However, the mass faintings among Cambodian garment workers are very mysterious.”

According to the authors, investigators have researched the causes, often arriving at singular conclusions that make the most sense within their particular areas of expertise. For instance, one study looked at the nutritional status of female garment factory workers and found that they are malnourished, anemic, and underweight. Other studies have suggested the causes include dehydration, “mass hysteria” and anxiety about fainting, and even social protest against employers. Yet, the faintings continue.

“Mass faintings have not been reduced in Cambodia even after many attempts to fix the identified causal factors,” said Kim. “Rather than look for a hidden cause, we probably need to consider the effects of multiple factors, maybe as they accumulate one-by-one or happen simultaneously.”

The authors recommend using a classical epidemiology concept, known as the “sufficient component cause model,” to guide researchers to think about the entire problem using a systems approach. The model implies that there may be multiple contributing factors within several sufficient causes that act together to result in an illness. Removing one of the contributing factors from one of the sufficient causes can prevent some, but perhaps not all, cases of the disease.

“By considering the problem more holistically, it may be possible to identify several contributing causes, and therefore, employ multiple interventions to stop the mass faintings,” said Kim.