A cross sectional study to determine the prevalence and risk factors of low back pain among public technical institute staff in Kurdistan Region, Iraq

Introduction

Low back pain (LBP) has become one of the major public health issues in recent years. It is one of the most prevalent work-related musculoskeletal disorders, about 70% of adult in United Kingdom experienced at least one episode of LBP in their life, which lead to modifications in their work and lifestyle¹. The burden of LBP can be defined as a pain or discomfort located below the margin of the 12th rib and above the inferior gluteus fold, with or without leg pain². The economic loss due to LBP does not only affect the quality of a workers’ social life, but also the organisation and society as a whole due to reduction of working capacity, decreased production, and early retirement³. Estimates of frequency, a measure of the proportion of a population with LBP during a specified period, differ between developing and industrially developed countries, between industrially developed countries, and within industrially developed countries, according to diverse studies and across diverse regions within countries⁴. Many international studies among university staff have reported high prevalence of LBP⁵. It has been well-known that LBP is amongst the most common cause of physical disability in the European adult population. At any one time, eight in every ten adults experience LBP⁶, accounting for long periods of absence from work, and the greater this period the lower the chances of going back to work⁷.

According to Mehra et al. (2011), every year about 3.6 million outpatient visits in the United States are attributed to LBP, and it is responsible for the second most common neurological disease, as well as the fifth most common cause for physician visits⁸. Demographic, occupational and individual factors are recognised as important risk factors associated with an increasing burden of LBP^9–11. In Koya Technical Institute (KTI; Koya district, Erbil Governorate, Iraq), different job positions exist; academicians, administrators, cleaners, bus drivers, and secretaries, as well as various levels of support staff. In the different positions, workers spend much time on their work, which requires standing and sitting for a long time to teach, using computers, driving, lifting heavy loads, etc. Due to the activities the workers engage in, the prevalence of LBP has increased. For instance, being a member of academic staff does not only involve teaching students, but also preparing lessons, evaluating and grading students' coursework, examinations, laboratory work, undertaking personal research projects and actively contributing to the institution's research profile, writing up research paper and arranging it for publication, supervising student’s study activities, and managing administrative tasks associated to the department (such as new student admissions, and at a senior level this may involve the role of head of department). Furthermore, the administrative staff of KTI are exposed to a prolonged use of computers, which predisposes the employees to static work posture and awkward body posture, and prolongs sitting; this is because the Kurdistan government has applied the use of computer in most daily tasks, especially among office workers. Until now no studies have been carried out concerning the relationship between factors associated to LBP in a representative sample of institute staff in Kurdistan Region, Iraq. Thus, it is clear that there is a need to identify the risk factors associated with LBP in this country.

KTI has a labour force of approximately 77 academic and non-academic staff, belonging to different areas of specialization in different departments. These employees in their different areas of specialization may be exposed to a number of occupational, individual and psycho-social factors, which may result LBP. Whereas a significant body of research has discovered the association between working in office and university with LBP in developed countries, there is still limited study with regards to the institute population in Iraq especially about LBP. With this rationale, the present study was undertaken among public technical institute staff that aimed to determine the prevalence and risk factors of LBP among workers.

Methods

Results

Quantitative data (frequency, percentage, median, inter quartile range [IQR]) of participants are listed in Table 1. Out of 80 self-administrated questionnaires which were distributed, 70 of them agreed to participate, giving an 87.5% respondent rate. Median cut-off points were used to dichotomize the continuous variables. In total, 50% of respondents who participated in the study were ≤37 years and 50% were >37 years, with a median of age of 33.5 years (IQR,12 years). In all, 54.3% were female, 31.4% had an education level up to college diploma or equivalent, 78.6% were non-smokers, and 82.9% were academic (as opposed to supportive) staff. A total of 48.6% had a duration of employment of >6 years (median, 6; IQR, 6), 52.9% stood for ≤3 hours/working day (median, 3; IQR, 2), and 57.1% sat for ≤2 hours/working day (median, 2; IQR, 2).

The prevalence of LBP among KTI staff in the past 12 months was 61.4%. The distribution of socio-demographic characteristics and working conditions for the groups with LBP and without LBP are shown in Figure 1. The statistical analysis revealed that there was significant association between smoking, job tenure and LBP (P <0.05). However, age, gender, education level, type of job, standing and static work posture was not significantly associated with LBP.

Figure 1.

Distribution of socio-demographic characteristics and occupational factors in staff with and without LBP. **P<0.05 by χ² test. LBP, low back pain.

Variables with P <0.05 in the bivariate analysis were analysed together by multiple logistic regression to determine how well the effects of independent variables on LBP were associated (Table 2). The results showed that KTI staff that smoke were 10 times more likely to have LBP (OR, 10.882; 95% CI, 1.301-90.995) than non-smoking staff. In addition, staff with job tenure of >6 years were 3 times more likely to develop LBP (OR, 3.159; 95% CI, 1.072-9.312) compared with staff with job tenure ≤ 6 years.

Discussion

This study found that the prevalence of LBP among KTI staff during the past 12 months was 61.4%. The reported prevalence of LBP among KTI in Kurdistan region (Iraq) was slightly higher compared to other study findings, which reported the prevalence of LBP among school teachers China in 2012 as 45.6%¹³. It is also much higher compared with results reported among Adam Hospital medical college staff in Ethiopia (41.4%)¹⁴, as well as a studies conducted in European countries (with a point prevalence of 21.5%)¹⁵ and among university staff in Thailand (22.3%)⁵. However, it is much lower than the annual prevalence of LBP reported among nurses (73.5%) in Nigeria¹⁶. The high prevalence of LBP might affect the working life of KTI staff through decreased productivity, absenteeism and increased medical cost. LBP have been found by numerous researchers to be related with various factors, both occupational factors (duration of employment, static work posture, awkward posture) and individual factors (smoking, obesity, exercise)^6,12.

According to this study, KTI staff who were smoke are 10 times more likely to have LBP compared with non-smoking staff. Similar outcomes have been demonstrated by a study conducted among school teachers¹⁷. This could be explained as scientists have shown that there is an association between cigarette smoking and musculoskeletal disorders. Firstly, cigarette smoking may cause a decrease in the amount of blood perfusion to bones and to almost all tissues of the human body, which leads to low production of bone-forming cells (osteoblasts)¹⁸. Another explanation is that cigarette smoking causes calcium deficiency by reducing the absorption of the quantity of calcium from diet, which the body needs for building strong bones¹⁹. Moreover, cigarette smoking has a negative effect on the growth of the lungs and it is also detrimental to the well-being of the lungs, such that it results in shortness of breath and a decrease in the quantity of oxygen made available to the muscles²⁰. In addition, KTI staff with job tenure >6 years were 3 times more likely have LBP than those who worked ≤6 years. Similar outcomes have been demonstrated by a study conducted among university workers²¹. This finding suggests that an increased risk of LBP occurs during advanced (after 6 years) employment in the institute. An association between LBP and job tenure was also reported in a study conducted by Noroozi et al. (2015)²² among medical sciences office workers of Ahvaz Jundishapur University. Thus, the longer staff work in KTI, the higher the risk of developing LBP. LBP is cumulative ailment and over time may result from frequent exposure to risk factors with insufficient recovery²³. The same body part is activated for long periods of time if the institute staff often repeat similar tasks for several months or years. As a result, internal tolerance of tissues is exceeded when accumulation of loading occurs, due to exposures of long duration²⁴.

The results also showed that there were not a significant association between LBP and age, gender, level of education, type of job, and static work posture. This study was a cross-sectional study where the association between risk factors and LBP at a particular point in time could be determined. The finding was relied on self-reported questionnaire and there was no medical test to confirm the presence of LBP. Recall bias may also have occurred, and information bias happened during the completion of the questionnaire, due to the different understanding of participants based on their opinion and judgment.

Conclusions

Overall, LBP was found to be common among staff at KTI. Thus, there is need for an awareness to be created among staff through strategic prevention programs. The workers should be educated on the effects of smoking not only as it relates to LBP but, also on all the whole body parts and how to quit it. This can be done through health promotion campaigns and programs sponsored by the university, in order to reduce the prevalence and prevent the risk of LBP among KTI staff.

Data availability

Raw datasets have not been made available at the request of the Ethics Committee in order to maintain participant confidentiality. This data is stored at the Department of Preventive Health, Koya Technical Institute and is available upon request. Please contact the first author Karwan Mahmood Khudhir (karwan85.mahmud@gmail.com) for further information.