Work Related Musculoskeletal Disorders Among Staff at Selected Laboratories in Kampala

doi:10.21203/rs.3.rs-2695804/v1

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Work Related Musculoskeletal Disorders Among Staff at Selected Laboratories in Kampala

https://doi.org/10.21203/rs.3.rs-2695804/v1

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Background

Laboratory (lab) personnel are a key component of the health care system whose daily tasks involve static and sustained awkward postures with repetitive motions that increase ergonomic risks to musculoskeletal disorders (MSDs). This may be attributed to inadequate staff numbers, staff qualifications and workload for prolonged periods however, there is a knowledge gap as regards the MSDs experienced. This study was aimed at determining the prevalence and factors associated with work related MSDs (WMSDs) among staff at selected labs in Kampala.

Methods

A cross sectional study on 203 consecutively sampled lab personnel practicing at the selected labs in Kampala was conducted. A pretested modified standardized Nordic questionnaire was used to collect data. Data was entered in EpiData v4.6 and analyzed using STATA v14. The prevalence of WMSDs was estimated as a proportion of the entire sample size. Analysis for factors associated was done by modified Poisson regression reporting robust standard errors through the survey window to control for clustering at lab level and section level. Ethical approval was sought from School of medicine research and ethics committee.

Results

The prevalence of WMSDs among the laboratory personnel was 48.3% (95%CI: 33.2–63.3). At multivariate analysis, sex (aPR: 1.37, 95% CI: 1.19–1.57), work involving repetitive motions (aPR: 0.34, 95% CI: 0.16–0.73), taking rest breaks at work (aPR: 0.67, 95% CI: 0.52–0.88) and physical exercise (aPR: 0.77 95% CI: 0.63–0.93) were significantly associated with WMSDs in this population.

Conclusions

Approximately 5 out of every 10 laboratory personnel in this study had experienced at least one or more WMSDs within the past 12 months. Sex, repetitious work, work rest breaks and physical exercise were significantly associated with WMSDs in this population. Increased awareness of injury prevention at the workplace and modification of the occupational safety and health policy to include details about the specifics of the interventions required to prevent WMSDs is encouraged.

Work related musculoskeletal disorders (WMSDs)

Musculoskeletal disorders (MSDs)

Laboratory (Lab) personnel

Uganda

Approximately 1.71 billion people worldwide were affected by musculoskeletal disorders (MSDs) in 2019 contributing more than half of the observed 2.41 billion who needed rehabilitation. Low back pain caused the highest burden with 568 million people and 64 million years of life disabilities (YLD) globally (1). MSDs are the leading contributor of disability worldwide, significantly limiting mobility and agility hence reduced ability of individuals to participate in society with lower levels of well-being and early retirement from work (2).

In low and middle income countries (LMICs), a 38.6–91.2% prevalence of reported symptoms of MSDs in at least one body site among health care workers has been observed, with low back pain being the most prevalent (44.1–72.8%) (3). In Sub-Saharan Africa, a prevalence of 44% of low back pain was reported among older adults in Kenya (4). In Uganda, 10.5% of all health care workers experienced MSDs by 2015, especially among those with more than 5 years of duration in service, worked overtime, worked in multiple health facilities, had less than 8 hours of daily sleep and those who experienced work related pressure (5).

These disorders comprise of a number of conditions that affect the locomotor system of individuals ranging from those that are sudden and short lived like fractures, sprains and strains to those that are lifelong with functioning limitations and disability (6). They are characterized by pain and usually affect joints, bones, muscles, the spine such as neck and back and multiple soft tissue such as ligaments, nerves and tendons (7).

According to literature, such disorders have been measured by a number of methods categorized into direct, semi-direct and indirect methods. The indirect methods that apply questionnaires are the most utilized, because they are more economical as compared to the other two categories (8).

Lab scientists work in confined seated or standing positions for long periods of time daily given the high workload. According to literature, workload and financial resources are the major constraints to human resource strengthening in the lab sector with all opportunities threatened by inadequate staffing, skill mix and escalating workload in Uganda. This study conducted among 100 health facilities indicated that about 87.5% of hub labs were constrained by inadequate staff numbers, 75% by inadequate staff qualifications and 81.2% by high volume of clients (9).

Their work involves continuous repetitive movements such as vortexing, pipetting - a major risk for hand/wrist injuries, use of microscopes for long hours risking the neck, shoulders and back, standing for long hours and other motions that require extremes of arm positions and neck straining (10). Lab scientists play an important role in health care, vital in disease diagnosis, prevention and outbreak investigation however, are at a high risk of exposure to these disorders because of the nature of their work as described above.

Similar studies have been conducted in Asia and in only a few African countries. A study conducted among Nigerian medical lab scientists reported a 12 months and point prevalence of 67.4% and 29.8% respectively, with low back pain as the most prevalent at 35.8% (11). In the above study, repetitive job performance was the most perceived associated factor, age and years of experience being significantly associated with work related musculoskeletal disorders (WMSDs). A study conducted in Saudi Arabia among lab workers indicated a prevalence of 82% of WMSDs associated with age < 30 years and working in hematology/ flowcytometry sections (10).

However, no related studies among lab personnel in Uganda were found. This study was therefore aimed at determining the prevalence and factors associated with work related MSDs among staff at selected labs in Kampala, Uganda.

A cross sectional study was conducted to determine the prevalence and factors associated with work related musculoskeletal disorders (WMSDs) among staff at selected laboratories (labs) in Kampala. This was conducted at Mulago National Referral hospital laboratories (MNRH), Central Public Health Laboratory (CPHL), College of Health sciences research laboratories (CHS) and St. Francis Hospital Nsambya laboratory. The study included 203 laboratory personnel who were practicing within the selected laboratories in Kampala and provided written informed consent to participate in the study between July and September 2022. Laboratory personnel with known history of co-morbid conditions like systemic diseases such as fibromyalgia, a history of chronic inflammatory conditions that relate to the musculoskeletal system and those who were in their third trimester of pregnancy were excluded from the study. The questionnaires distributed were 212 in total however, only 203 completed questionnaires were returned. The participants were sampled consecutively. WMSDs measured as a binary outcome (presence and absence) was the dependent variable. The independent variables included; social demographic characteristics (age, sex and dominant hand), physical work related factors (work experience/ number of years spent doing the same kind of work, total duration of working hours per week and laboratory section), ergonomics factors (repetitive activities, working in awkward or cramped body postures, prolonged standing or sitting work positions, use of vibrating equipment and training on ergonomics/ injury prevention), psychosocial work related factors (work breaks, working in shifts and stress), individual lifestyle factors (alcohol consumption, smoking and physical activity like exercise, digging or sports activities after work).

Participants were contacted during their less busy hours of day according to guidance from the management of each study site. Sites were visited for data collection one by one on a day to day basis. Eligible participants were taken through the informed consent process and then given each, the self-administered questionnaire. The validated standardized Nordic questionnaire (7) was modified, pretested and used in this study. This tool was developed from a project funded by the Nordic council of ministers for nine symptom sites (neck, shoulders, upper back, elbows, low back, wrist/hands, hips/thighs, knees and ankles/feet) for use in epidemiological studies. Data on physical activity was collected by incorporating questions from the Global physical activity questionnaire (GPAQ) for physical activity surveillance developed by the World Health Organization (12) into the modified questionnaire that was used for this study. All raw data was backed up on a password protected laptop and an external drive. Completed questionnaires and consent forms were filed and stored under lock and key in a secure location.

Double data entry and cleaning was done using Epidata v4.6 and exported to STATA v14 for analysis. At univariate analysis, all were categorical variables and summarized using frequencies, proportions and percentages. The prevalence of WMSDs was determined as a percentage of all the study participants. For factors associated, a generalized linear model (modified Poisson) reporting clustered robust standard errors through the survey window to adjust for clustering at laboratory level and section level was used. Bivariate analysis was performed and variables with a p value < 0.2 were considered for the multivariate model. At multivariate analysis, interaction and confounding were assessed using the chunk test and a difference of ≥ 10% between the crude and adjusted measure of effect (prevalence ratio) respectively, at a level of significance set at 0.05.

Questionnaires were checked for completeness during data collection by the principal investigator. The research assistant was trained for two consecutive days about the questionnaire and tools to be used in the study prior to data collection. The reliability of this tool among laboratory personnel in Uganda was also analyzed for and Cronbach’s alpha reported (13).

In this study, there was a high response rate of 95.7% with 203 of 212 distributed questionnaires returned, (Fig. 1).

Description of study participants:

Majority of the participants were male (n = 108, 53.2%), aged less or equal to 29 years (n = 107, 52.7%) and right handed (n = 180, 88.7%). More than half of the study participants were physically active (n = 127, 62.6%) and did not use alcohol (n = 170, 83.7%). The details of the participants’ social demographic characteristics and lifestyle factors are in Table 1.

Table 1

Social demographic and lifestyle characteristics of the study participants.
Variable	Categorization	N (%)
Sex	Female	95(46.8)
	Male	108(53.2)
Age	≤ 29	107(52.7)
	> 29	96(47.3)
Dominant Hand	Right	180(88.7)
	Left	23(11.3)
Alcohol use	Yes	33(16.3)
Alcohol use	No	170(83.7)
Physical exercise	≥ 600	127(62.6)
(minutes/week)	< 600	76(37.4)
^{N – Number of participants, % − percentage}

Majority of the participants had a work experience of less or equal to 5 years (n = 102, 50.3%), worked for a minimum of less or equal to 40 hours per week (n = 119, 58.6%), did not work in shifts (n = 126, 62.1%), had rest breaks at work (n = 131, 64.5%) and did not use equipment that produced hand/ arm vibrations (n = 115, 56.6%). Thirty two percent (n = 64) of the participants performed tasks within general laboratory sections at the time of the study. More than half of the lab personnel had never received any training on ergonomics and injury prevention at work (n = 156, 76.8%) yet majority performed work that involved extreme/ awkward postures (n = 130, 64.0%), repetitive motions (n = 178, 87.7%) and prolonged sitting/ standing postures (n = 107, 52.7%), (Table 2).

Table 2

Work related psychosocial, physical and ergonomics factors of the study participants.
Variable	Categorization	N (%)
Hours of work per week	≤ 40	119(58.6)
	> 40	84(41.4)
Work experience (years)	≤ 5	102(50.3)
Work experience (years)	> 5	101(49.7)
Work in shifts	Yes	84(41.4)
Work in shifts	No	119(58.6)
Work rest breaks	Yes	131(64.5)
Work rest breaks	No	72(35.5)
Stress	Yes	77(37.9)
	No	126(62.1)
Work in awkward postures	Yes	130(64.0)
Work in awkward postures	No	73(36.0)
Repetitive motions	Yes	178(87.7)
Repetitive motions	No	25(12.3)
Use vibrating equipment	Yes	88(43.4)
Use vibrating equipment	No	115(56.6)
Work in similar prolonged positions	Yes	96(47.3)
Work in similar prolonged positions	No	107(52.7)
Ergonomics training	Yes	47(23.2)
Ergonomics training	No	156(76.8)
Laboratory department	Bio-repository	3(1.5)
	Clinical chemistry	18(8.9)
	General	64(31.5)
	Hematology	31(15.3)
	Histopathology	4(1.9)
	Immunology	10(4.9)
	Microbiology	48(23.6)
	Molecular biology	12(5.9)
	Mycobacteriology	4(2.0)
	Parasitology	2(1.0)
	Sample reception	7(3.5)
^{N – Number of participants, % − percentage}

Prevalence of work related musculoskeletal disorders among the 203 study participants at Mulago Hospital, St. Francis Nsambya hospital, College of health sciences and Central Public Health Laboratory.

The overall prevalence of WMSDs was 48.3% (CI: 33.2–63.3). This was higher among females (n = 55, 57.9%) than males (n = 43, 39.8%) and higher among those above 29 years of age (n = 47, 49.0) as compared to those less or equal to 29 years of age (n = 51, 47.7), (Table 3).

Table 3

Prevalence of Work related Musculoskeletal Disorders among the study participants.
Variable	Frequency	WMSDS, N (%)	CI
Overall	203	98(48.3)	33.2–63.3
Sex
Female	95	55(57.9)	41.8–72.5
Male	108	43(39.8)	27.4–53.8
Age(years)
≤ 29	107	51(47.7)	34.4–61.2
> 29	96	47(49.0)	30.5–67.8
^{WMSD− work related musculoskeletal disorders, N− Number of participants, %−percentage}

Factors associated with Work related musculoskeletal disorders (WMSDs)

At multivariate analysis, sex (aPR: 1.37, 95% CI: 1.19–1.57), work involving repetitive motions (aPR: 0.34, 95% CI: 0.16–0.73), taking rest breaks at work (aPR: 0.67, 95% CI: 0.52–0.88) and physical exercise (aPR: 0.77 95% CI: 0.63–0.93) were significantly associated with WMSDs in this population. Working in awkward postures (aPR: 2.50 95% CI: 0.96–6.50) was retained in the model because it confounded the relationship between work involving repetitive motions and WMSDs, (Table 4).

Table 4

Multivariate analysis of factors associated with WMSDs
Variable	aPR(95%CI)	P-value
Sex
Female	1.37(1.19–1.57)	< 0.001*
Male	Reference
Work rest breaks
Yes	0.67(0.52–0.88)	0.004*
No	Reference
Repetitive motions
Yes	Reference
No	0.34(0.16–0.73)	0.006*
Physical exercise (minutes/week)
≥ 600	0.77(0.63–0.93)	0.009*
< 600	Reference
Awkward postures
Yes	2.50(0.96–6.50)	0.058
No	Reference
^{95% CI –Confidence intervals aPR− adjusted Prevalence ratio}

Prevalence:

In this cross sectional study, the 12 months prevalence of WMSDs was 48.3% (95% CI: 33.2–63.3). Much as there are no studies on the prevalence of WMSDs among laboratory personnel in Uganda, the prevalence established in this study was below that reported from similar studies conducted elsewhere which was between 67.4–82.0% (11), (14), (10). This could be due to the fact that these studies all had a higher sample size than the current study and used diverse populations from both private and public hospital laboratories. The prevalence (39.6%) established in a cross sectional descriptive study conducted among 245 health care workers at Arua general hospital (15) was within the confidence interval of the current study.

It is possible that musculoskeletal disorders’ incidence in this population could be higher than 48.3%. This is because many of the laboratory personnel may have feared to report the pain due to job insecurities in some situations. The commonest societal phenomenon that may contribute directly to an employee’s decision to report a problem is peer influence (16). Given the fact that questionnaires were used to report pain that had occurred within a period of 12 months, it is possible that some of the lab personnel had forgotten about previous occurrences. The prevalence established from this study is indicative of a considerable burden of WMSDs among laboratory personnel which needs to be given due attention.

Risk factors:

WMSDs were significantly associated with sex, work rest breaks, repetitive motions and physical exercise. Awkward postures confounded the relationship between work involving repetitive motions and MSDs.

The prevalence of WMSDs among females was 1.37 times that among males in this population. This could be because women have less muscular strength than men so the same working conditions can have a greater effect. Their family responsibilities could combine with working conditions to produce muscle fatigue. Physiologically, they react more to work organizational factors that together with physical stressors produce MSDs (17), (18). Findings from this study are consistent with those from a cross sectional study conducted among 741 nursing professionals in Uganda (19).

Age and dominant hand were not significantly associated with WMSDs in this study. This was contrary to a study that reported a significant association between age (30 to 41 years) and WMSDs among lab personnel (11). This study had a higher sample size of 282 participants and included participants practicing from both private medical laboratories and public hospitals. Furthermore, the current study had a younger population with most of the participants less or equal to 29 years of age compared to the above stated study. However this study is similar to a study that reported no significant association between dominant hand and WMSDs (10).

The prevalence of WMSDs among individuals who were involved in physical exercise outside work for at least 600 minutes per week was 0.77 times that among individuals who were not. In other words, being physically active outside work is protective from WMSDs. Physical exercise can improve the body’s sensitivity and muscle coordination and is also known to reduce low back pain (20). Findings from this study are consistent to a cross sectional survey conducted among 692 nurses in China (21) and a cross sectional study conducted among 220 dentists in Poland which revealed a significant association between not using physical and relaxation exercises and neck/spine pain (22).

Alcohol use was not significantly associated with WMSDs in this study. This could be attributed to the very low frequencies of alcohol consumers in the current study population. These findings are contrary to a cross sectional study among 880 nurses at Mulago hospital which revealed a protective association between alcohol use and WMSDs (19).

The proportion of people with WMSDs was 0.67 times less among those who take rest breaks at work, in this population. This means that laboratory personnel who take rest breaks at work were less likely to report MSDs compared to those who did not. This could be because resting is known to release fatigue and other bodily stresses. These findings are similar to those revealed in a case control study conducted among 3,947 factory employees in China which reported a significant association between sufficient rest time and WMSDs (23).

In this study, the prevalence of WMSDs among individuals whose daily work did not involve repetitive motions was 0.34 times that of individuals whose daily work involved repetitive tasks. Work that involves repetitive motions has a detrimental association with WMSDs. Repetitive motions like pipetting do not allow for full recovery within the short periods of time between cycles of a particular task. However, these tasks act in combination with other risk factors like awkward postures in similar prolonged positions for example having to maintain the neck and shoulder in a similar position to exert some force. This results into increased muscle stress hence increased MSD risk (24). This finding is similar to that revealed by a cross sectional study that was conducted among 282 Nigerian laboratory personnel in Nigeria (11).

Stress, prolonged sitting/standing positions, awkward postures and more than 40 hours of work per week were significant at bivariate analysis but eventually became non-significant at multivariate analysis. This is because in this study, not taking rest breaks at work controlled for the effect of stress on WMSDs among the laboratory personnel. However, some studies have revealed a significant association between WMSDs and job stress (25), (26). Furthermore, working in awkward positions controlled for the effect of working in prolonged sitting or standing positions on WMSDs in this study population.

The observed relationship between performing work involving repetitive motions and WMSDs is due to differences in the presence or absence of work involving awkward postures as performed in this population. Ergonomically unsafe working areas can make individuals to assume unnatural sometimes awkward positions. Working in the same position for long can cause muscular fatigue and low back pain due to stretching and compressing of the tendons and nerves (24). Data from various studies among different occupational groups indicated a significant association between awkward postures, repetitious tasks, over standing with MSDs both separately and in combination (27) and (15).

Not taking rest breaks at work controls for the effect of working more than 40 hours per week on MSDs in this study population. The amount of time that a worker spends continuously exposed to a risk factor without taking breaks increases the probability of, in this case, general and local fatigue. A cross sectional study among 300 nurses revealed a significant association between work hours and MSDs (28).

In this study, work experience was not significantly associated with WMSDs. This is contrary to a study conducted among 282 laboratory personnel in Nigeria (11). This could be due to a difference in the kind of participants involved. These were from teaching hospitals, private, public and research laboratories as compared to the current study which had participants from mostly public hospitals.

The Cronbach’s alpha as an index of reliability was calculated for the data collection tool used (modified standardized Nordic questionnaire) in this population. The alpha coefficient for the MSD test scale based on all 9 items had an internal consistency of 0.73 which is acceptable based on the recommended 0.70 to 0.95 (29).

Study Limitations:

There could have been recall bias rising from the fact that the 12 months prevalence of work related musculoskeletal disorders was measured using a questionnaire. The study was prone to selection bias due to non-probability sampling and non-response however, non-response was at only 4.2% hence no big effect on the results. This had been catered for in calculation of sample size for both objectives. Stress was measured subjectively as a dichotomous variable which didn’t capture the true estimation of the levels of this psychosocial predictor. Body mass index is known according to literature to be a potential confounder for work related musculoskeletal disorders but unfortunately, it was not studied in this population. Most of the participants were uncomfortable with taking their anthropometric measurements of height and weight.

Approximately 5 out of every 10 laboratory personnel in this study had experienced at least one or more work related musculoskeletal disorders (WMSDs) in the last 12 months with the burden higher among women than men.

Females, performing work that involves repetitive motions, taking work rest breaks and being physically active outside work were significantly associated with WMSDs among the laboratory personnel at Mulago hospital, St. Francis Nsambya hospital, CHS and CPHL laboratories.

Laboratory personnel are encouraged to get involved in physical exercises outside of the work environment of at least 600 minutes weekly. Laboratory departmental heads are encouraged to increase awareness of injury prevention at the workplace through trainings and modify work schedules to include intermittent rest breaks at work. Wellness programs for staff, inclusive of physical exercises may also be incorporated into the work place interventions against WMSDs.

The Ministry of health may modify the occupational safety and health policy to include details about the interventions required at workplaces as regards prevention of WMSDs and adequately describe the associated factors to look out for and enforce implementation of these policies. Further research should be done with a larger sample size especially cohort studies country wide to compare private and public laboratories and establish causation.

AFRO African regional office

BMI Body Mass Index

CEU Clinical Epidemiology Unit

CHS College of Health Sciences

CI Confidence interval

CPHL Central Public Health Laboratories

GBD Global Burden of Disease

IDs Identification numbers

IRB Institutional Review Board

JSI Job stain index method

Lab Laboratory

LMICs Low and Middle Income Countries

MSDs Musculoskeletal Disorders

SOMREC School of Medicine Research Ethics Committee

STATA Statistical software for data science

WHO World Health Organization

WMSDs Work-Related Musculoskeletal Disorders

YLD Years lived with Disability

Ethics Approval and consent to participate:

The current research was carried out with guidance of the relevant guidelines and regulations according to the declaration of Helsinki. Permission to conduct the study was sought from Makerere University Clinical Epidemiology Unit (CEU) followed by ethical approval from the School of Medicine Research and Ethics Committee (SOMREC) (REC REF 2022-366). Administrative clearance was sought from the four different study sites. Written Informed consent was obtained from all study participants before enrollment into the study. There was no conflict of interest. During the process of completing questionnaires, participants were assigned identification numbers each. No participant names were used on the questionnaires.

Consent for publication: Not Applicable

Availability of data and materials: The dataset(s) used and analyzed during the current study is (are) available from the corresponding author on reasonable request at [email protected]

Competing interests: The authors declare that they have no competing interests.

Funding: No funding was available for this study.

Author’s contributions: JN conceptualized the idea, designed the study, collected data, analyzed it and wrote the manuscript. PS and TMK contributed majorly to the writing by substantively reviewing the work from conceptualization to final write up. JKN guided the entire process and contributed majorly to the conception, design, analysis, interpretation of data and writing. All authors read and approved the final manuscript.

Acknowledgements: I would like to acknowledge my research assistant for the good work done.

Author’s information: JN: Makerere University, School of medicine, Clinical epidemiology unit. TMK: Department of surgery, Mulago Hospital. JKN: Head of department, Clinical epidemiology unit, school of medicine, Makerere University. PS: Senior lecturer, department of orthopedics, Makerere University.

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No competing interests reported.

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Work Related Musculoskeletal Disorders Among Staff at Selected Laboratories in Kampala

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Background

Methods

Results

Description of study participants:

Factors associated with Work related musculoskeletal disorders (WMSDs)

Discussion

Prevalence:

Risk factors:

Study Limitations:

Conclusion

Abbreviations

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