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WORK-RELATED LOWER BACK PAIN AMONG PRIMARY SCHOOL TEACHERS IN DAR ES SALAAM, TANZANIA CR, Exams of Nursing

University of Pennsylvania (UPenn)Nursing

WORK-RELATED LOWER BACK PAIN AMONG PRIMARY SCHOOL TEACHERS IN DAR ES SALAAM, TANZANIA CRESE DAMAS NILAHI

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WORK-RELATED LOWER BACK PAIN AMONG PRIMARY SCHOOL
TEACHERS IN DAR ES SALAAM, TANZANIA
CRESE DAMAS NILAHI
Student No. 3307162
A thesis submitted in partial fulfilment of the requirements of the Degree of Masters of
Science in Physiotherapy, Faculty of Community and Health Sciences, Department of
Physiotherapy, University of the Western Cape
Supervisor: Dr Tania Steyl
November, 2014
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Download WORK-RELATED LOWER BACK PAIN AMONG PRIMARY SCHOOL TEACHERS IN DAR ES SALAAM, TANZANIA CR and more Exams Nursing in PDF only on Docsity!

WORK-RELATED LOWER BACK PAIN AMONG PRIMARY SCHOOL

TEACHERS IN DAR ES SALAAM, TANZANIA

CRESE DAMAS NILAHI

Student No. 3307162

A thesis submitted in partial fulfilment of the requirements of the Degree of Masters of

Science in Physiotherapy, Faculty of Community and Health Sciences, Department of

Physiotherapy, University of the Western Cape

Supervisor: Dr Tania Steyl

November, 2014

ii

ABSTRACT

Lower back pain (LBP) is one of the most common work-related health problems in

economically developed countries and the most prevailing musculoskeletal condition that

causes disability in the developing nations. School teachers are susceptible to LBP due to the

nature of their daily work routine which is physically demanding and include common

activities such as long hours of sitting, standing and bending that have been identified as risk

factors for LBP. The aim of the study was to determine the role of work-related activities in

the prevalence of LBP amongst primary school teachers in the Dar-es-Salaam region of

Tanzania. To achieve this goal, the study sought to meet the following three objectives: to

determine the prevalence of LBP among primary school teachers; to determine the work-

related physical activities contributing to LBP among primary school teachers, and to

determine and explore the application of kinetic handling principles in their daily work

environment. The study was conducted in eighty randomly selected primary schools from the

Temeke, Ilala and Kinondoni districts. A sequential explanatory mixed method approach was

utilised. A cross-sectional descriptive design was employed. A self-administered

questionnaire consisting of three sections (socio-demographic information; the Nordic Back

Pain Questionnaire and the Oswestry Lower back pain Questionnaire) was completed by two

hundred and eighty six primary school teachers with a mean age of 41.2 years (SD=9.9),

78.7% female and 21.3% male. Thirty primary school teachers participated in the participant

observation of the application of kinetic handling principles in their daily work environment

and focus group discussions. Results of the study found that 17.1% of the teachers had LBP

during the past week while 82.9% experienced LBP during the past year. In addition, 30.8%

of the teachers had referred pain, mostly to the thigh area (43.9%). Less than fifty percent

(43.5%) of the participants had severe pain in sitting (76 – 100mm on the VAS scale) while

iv

DECLARATION

I hereby declare that “Work-related Lower Back Pain among Primary School Teachers

in Dar es Salaam, Tanzania” is my own work, which has not been submitted, or part of it,

for any degree or examination in any other university, and that all the sources I have used or

quoted have been indicated and acknowledged by means of complete references.

Crese Damas Nilahi

Signature…………………………….. November 2014

Witness: ……………………………..

Dr Tania Steyl

v

DEDICATION

This thesis is dedicated to the Lord God Almighty. I also dedicate this work to my daughter,

Xanadu Isabella.

vii

Table of Contents

ABSTRACT............................................................................................................................................ ii DECLARATION ................................................................................................................................... iv DEDICATION ........................................................................................................................................ v

  • CHAPTER ONE ACKNOWLEDGEMENTS vi
  • INTRODUCTION
    • 1.1 Introduction
    • 1.2 Background of the study
    • 1.3 Problem statement
    • 1.4 Research question
    • 1.5 Aim of the study......................................................................................................................
    • 1.6 Objectives of the study............................................................................................................
    • 1.7 Significance of the study
    • 1.8 Definition of key words and terms
    • 1.9 Abbreviations
    • 1.10 Summary of chapters
  • CHAPTER TWO
  • LITERATURE REVIEW
    • 2.1 Introduction
    • 2.2 Global prevalence of lower back pain.........................................................................................
    • 2.3. Prevalence of lower back pain among school teachers
    • 2.4 Risk factors for the development of lower back pain
    • 2.4.1 Work-related (physical activities) factors and lower back pain
    • 2.4.2 Psychosocial factors and lower back pain................................................................................
    • 2.4.3 Socio-economic factors and lower back pain...........................................................................
    • 2.5 The effect of lower back pain on individuals
    • 2.6 The role of physiotherapy in the management of lower back pain
    • 2.7 Prevention of work-related low back pain
    • 2.7.1 Application of kinetic handling principles in the prevention of LBP
    • 2.7.2 Health Education
    • 2.7.3 Physical Fitness and Exercise
    • 2.8 Summary of the Chapter
  • CHAPTER THREE viii - METHODOLOGY - 3.1 Introduction - 3.2 Research setting - 3.3 Research approach - 3.4 Research design - 3.5 Study population and sampling - 3.5.1 Quantitative component - 3.5.2 Qualitative component - 3.6 Instrument for data collection - 3.6.1 Quantitative component - 3.6.2 Qualitative component
    • 3.7 Reliability and validity of the developed questionnaire (quantitative data)
    • 3.8 Validity of the qualitative data
      • 3.9 Data collection procedure
        • 3.9.1 Quantitative component
        • 3.9.2 Qualitative component
      • 3.10 Data analysis
        • 3.10.1 Quantitative component
        • 3.10.2 Qualitative component
      • 3.11 Ethics considerations
      • 3.12 Summary of the Chapter
  • CHAPTER FOUR.................................................................................................................................
  • RESULTS - 4.1 Introduction - (LBP)..................................................................................................................................... 4.2 Socio-demographic characteristic of the primary school teachers with lower back pain - 4.2.1 Physical measurements of primary school teachers with lower back pain (LBP) - 4.3 Characteristics of work environment of primary school teachers with lower back - pain (LBP) (n=286) - 4.4 Prevalence of work-related lower back pain among primary school teachers (n=286) - 4.5 Severity of lower back pain during daily school activities in Visual analogy scale (n=286) - 4.6 Prevalence of lower back pain during different teaching activities (n=286) - 4.7 Functional disability of primary school teachers (n = 286) - 4.8 Application of kinetic handling principles at school................................................................. ix - 4.8.1 Sitting - 4.8.2 Standing - 4.8.3 Lifting - 4.9 Preventative measures for lower back pain - 4.10 Barriers to effective back care - 4.10.1 Work environment - 4.10.2 Uncertainty about the desired practice - 4.11 Summary of the Chapter
  • CHAPTER FIVE
  • DISCUSSION - 5.1 Introduction - 5.2 Prevalence of lower back pain among primary school teachers - 5.2.1 Lower back pain and gender - 5.2.2 Lower back pain and Body Mass Index (BMI) - 5.2.3 Lower back pain and age - 5.2.4 Lower back pain and marital status............................................................................... - 5.3 Work-related factors contributing to Lower Back Pain - 5.3.1 Work experience - 5.3.2 Workload....................................................................................................................... - 5.3.3 Work-related physical activities....................................................................................
    • 5.4 Application of kinetic handling principles at work
      • 5.5 Summary of the chapter
  • CHAPTER SIX
  • SUMMARY, CONCLUSION AND RECOMMEDATIONS - 6.1 Introduction - 6.2 Summary
    • 6.3 Conclusions…………………………………………………………………………………
      • 6.4 Strengths and Limitations of the Study……………………………………………………..…
        • 6.4.1 Strength of the Study.....................................................................................................
        • 6.4.2 Limitations of the study
      • 6.5 Recommendations
    • 6.6 Summary of the chapter…………………………………………………………………….
  • REFERENCES x
  • APPENDICES
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix
  • Appendix

xi

LIST OF FIGURES

Figure 4.1 Prevalence and areas of referred pain (n=88) ........................................................ 49

Figure 4.2 Severity of lower back pain during school activities using the VAS scale ........... 50

Figure 4.3 Posture in sitting .................................................................................................... 55

Figure 4.4 Posture in standing ................................................................................................ 56

Figure 4.5 Posture when bending and lifting .......................................................................... 58

CHAPTER ONE

INTRODUCTION

1.1 Introduction

This chapter provides background information on the thesis. It explains the problem

statement, research question, aim of the study as well as the specific objectives. Furthermore,

the chapter outlines the significance of this study as well as providing working definitions on

key concepts used in this thesis. The chapter ends with abbreviations used in the study as well

as a summary of the forthcoming chapters.

1.2 Background of the study

Lower back pain (LBP) is the most prevailing musculoskeletal condition that causes

disability in low and middle income countries (Louw, Morris, & Grimmer-Somers, 2007).

The prevalence of LBP is increasing globally at the estimate of 60% - 70 % of people in

developed countries (Duthey, 2013). Furthermore, the annual incidence of LBP is

approximated to be 5% with a prevalence of 15% – 45% annually in developed countries.

There has been significant increase of people with LBP in North Carolina, USA, affecting

both races with 9.8% white and 10% black respectively, with whites presenting with more

chronic LBP than other groups. More than 34 million people (17%) living in USA are

reported to have LBP (Strine & Hootman, 2007); the prevalence is lower than Iran 29.3%

(Biglarian et al., 2012) and UK 59% respectively (Waxman, Tennant, & Helliwell, 2000).

The global annual prevalence is ranging between 25% to 60% (Andersson, 1999; McBeth &

Jones, 2007; Louw et al., 2007). Furthermore, the prevalence was lower in the Latino

population (6.3%) (Carey et al., 2009; Carey et al., 2010). People working in rural areas are

not spared from lower back pain as findings from China indicated a prevalence of 64%

(Ehrlich and Khaltaev, 1999 quoted in Duthey, 2013). In Australia, LBP is the second major

disease with a prevalence of 7% of which 45% of them have chronic LBP (Department of

Health, 2013).

The prevalence of LBP is also increasing in Africa with a rate of 46.8% reported in Nigeria

(Ogunbode, Adebusoye, & Alonge, 2013). A comparative systematic review conducted in

South Africa compared lifetime prevalence in African and Western societies. The study

reported a higher prevalence of LBP, ranging between of 30% and 80% in Western societies

as compared to African (28% to 74%) (Van Vuuren, Zinzen, Van Heerden, Becker, &

Meeusen, 2007). This is similar to another systematic review by Louw et al., (2007) which

reported that the prevalence of LBP is notably lower in Africa than in developed countries,

although the difference is minimal. In Ethiopia, the prevalence of LBP was highest among

nurses working in the Obstetrics and Gynaecology Units (26.67%) and least among tutors

(4.17%) (Lamina Sikiru & Shmaila, 2009). In Rwanda the prevalence of LBP in nurses in

Kanombe Military Hospital is as high as 78% of nurses (Mukaruzima, 2010). Tanzania

recorded the prevalence of LBP at the rate of 48.5% among nurses who work in the

Paediatric ward in Muhimbili Referral Hospital (Mwilila, 2008).

LBP is reported to be one of the five major causes of disability in Australia, ranking first

among of the four leading causes of disability followed by other musculoskeletal conditions

since 1990 to 2010 (Department of Health, 2013). In the 1990s LBP was the second most

common reason for visits to medical doctors and the fifth-ranking cause of admission to

hospital and the third most common cause of surgery in USA (Andersson, 1999). The

condition is considered as part of disability, of which 5% of the people suffering LBP spend

more time and financial resources on the health care services globally (Chou et al., 2007).

According to (Luo, Pietrobon, Sun, Liu, & Hey, 2004), the health care costs for persons with

LBP is approximately 60% higher than people without LBP.

considered that as long as the population is ageing, the global population of people with

lower back pain is likely to increase substantially over the coming years (Hoy et al., 2012).

Hoy et al., (2012) report that people with lower back pain have a higher chance of missing

work, among different working age groups, including school teachers. Globally, 37% of LBP

are attributed to occupation. Different professionals whose work demands prolonged standing

or sitting, for example, health-care workers and occupational drivers, as well as those

exposed to vibrations (construction and mining workers) are also more likely to suffer from

LBP. This is due to the fact that LBP is highly associated with biomechanical risk factors

including bending, and twisting. This finding was consistent with other studies (Punnett et al.,

2005; Bener et al., 2006; Karacan et al., 2004; Coeuret-Pellicer, Descatha, Leclerc, & Zins,

2010). The abovementioned risk factors can increase the chances of LBP due to unrecovered

fatigue. It is therefore noted that the risk of getting LBP could be higher in workers who do

heavy physical work, or whose posture is awkward during work (Duthey, 2013).

Although biomechanical risk factors such as poor ergonomics, prolonged standing, bending,

lifting, or improper office furniture are the widely considered predisposing factors for LBP

and have been traditionally investigated, there is a growing trend for research on psychosocial

factors as possible risk factors for LBP (Yilmaz & Dedeli, 2012). It was argued that LBP is

not only related to low quality of life but also a major cause towards a decrease in labour

productivity due to absenteeism from work and early retirement ((Tsuboi, Takeuchi,

Watanabe, Hori, & Kobayashi, 2002). More so, LBP is a renowned musculoskeletal disease,

which is categorised as an occupational disease basing on its effect on work (Padula,

Carregaro, Melo, da Silva, & Oliveira, 2012; Yilmaz & Dedeli, 2012). It is further

highlighted by (Padula et al., 2012) that factors such as extensive working hours,

inappropriate posture, psychological and physical stresses contribute to the emergence of

work-related LBP. Lambeek, van Mechelen, Knol, Loisel, and Anema (2010) reported that

lower back pain is liable for 10-25% of patients’ absenteeism from work, the rising social and

financial deprivation and is responsible for 75% of the cost due to sick leave and disability in

Western societies. These figures are substantially lower than the results from Guo (2002),

who reported that LBP is responsible for about 40% of sick leave from work, making it the

second major cause of organisational absenteeism after the common cold. However, Yilmaz

and Dedeli (2012), found that industries incur more costs due to sick leave and compensation

to their employees who suffered LBP at work. Although literature identified a number of risk

factors for LBP related to work among teachers such as occupational posture, depressive

moods due to working environment, obesity, body height and age, the causes of the onset of

lower back pain remain ambiguous (Duthey, 2013).

Lower back pain is a burden and it is considered to be among one of the commonest health

problems globally, affecting individuals, communities and the financial status of societies

(Dionne, Dunn, & Croft, 2006; Rapoport, Jacobs, Bell, & Klarenbach, 2004). LBP is a

substantial health problem with reported lifetime prevalence between 49% and 70% (Manuel

et al., 2012; Manuel et al., 2012). It is one of the most common work-related health problems

in developed and developing countries, causing an enormous economic burden on

individuals, families, societies, industries and governments (Hoy et al., 2012). Despite the

economic status of developed countries, lower back pain is remains a remarkable health

concern and a major cause of decline in activity among people aged 45 years and above

(Andersson, 1999). It is the cause of activity limitation that leads to absence from work

world-wide (Hoy et al., 2012).

School teachers nevertheless form part of an occupational group among which the prevalence

of LBP and other musculoskeletal disorders are considered high (Yue, Liu, & Li, 2012).

develop prevention strategies and health promotion interventions to curb the emergence of

LBP in this population.

1.4 Research question

What is the role of work-related activities in the prevalence of LBP among primary school

teachers in the Dar-es-Salaam region of Tanzania?

1.5 Aim of the study

The study aims to determine the role of work-related activities in the prevalence of LBP

amongst primary school teachers in the Dar-es-Salaam region of Tanzania.

1.6 Objectives of the study

The specific objectives of the study are:

1.6.1 To determine the prevalence of LBP among primary school teachers with a history of

previous LBP in the Dar-es-Salaam region of Tanzania.

1.6.2 To determine work-related physical activities that could contribute to LBP among

primary school teachers the in Dar-es-Salaam region of Tanzania.

1.6.3 To examine the knowledge and application of kinetic handling principles in the

prevention of work-related LBP in the Dar-es-Salaam region of Tanzania.

1.7 Significance of the study

Lower back pain (LBP) is amongst the disabling musculoskeletal disorder with a negative

impact on an individual as well as on a nation, both in developed and developing countries

(Galukande, Muwazi, & Mugisa, 2006). The information obtained from this study could be

useful in recommending change in the work-environment and the life-style of the primary

school teachers. It could also assist in developing specific interventions for prevent of lower

back pain among these professionals. Interventions would positively contribute in reducing

absenteeism rates at work, early retirement and in cutting off associated medical costs all of

which in return could lessen the economic impact of LBP on individual teachers and the

government in general. Furthermore, the newly uncovered information would assist schools

management in Tanzania in coming up with appropriate health policies address the emerging

problem of LBP and enhance the quality of life and productivity of teachers.

1.8 Definition of key words and terms

Lower Back Pain : It is defined as pain that is limited to the region between the lower

margins of the last rib and the gluteal folds, regardless of the presence or absence of the leg

pain (Manek & MacGregor, 2005; Louw et al., 2007).

Acute lower back pain: Acute back pain is the most common presentation and is usually

self-limiting, lasting less than three months regardless of treatment (“Low Back Pain,” n.d.).

Chronic lower back pain : It is considered to be chronic if it has been present for longer than

three month ( Andersson, 1999).

Work-related low back pain: Work-related low back pain, is any back pain originating in

the context of work and considered clinically to have been probably caused, at least in part, or

exacerbated by the claimant’s job (European Agency for Safety and Health at Work, 2000).

Ergonomics: It is the scientific discipline concerned with the understanding of interactions

among humans and other elements of a system, and the profession that applies theory,

principles, data and methods to design in order to optimise human well-being and overall

system performance (Schutte, 2005).