|Year : 2016 | Volume
| Issue : 2 | Page : 152-158
Work-related musculoskeletal pain and health-seeking behavior among Nigerian sewing machine operators
Aderonke O Akinpelu1, Olufemi Oyeleye Oyewole2, Adesola C Odole1, Funmilayo D Ogunbamowo1
1 Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria
2 Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
|Date of Web Publication||5-Jul-2016|
Olufemi Oyeleye Oyewole
Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, PMB 2001, Sagamu
Background: Musculoskeletal pain (MSP) is the most common occupational health risk among sewing machine operators and their health-seeking behavior is not well understood. This study assessed the prevalence, pattern, and predictors of work-related MSP and health-seeking behavior among Nigeria sewing machine operators. Materials and Methods: Three hundred and twenty-five purposively selected registered sewing machine operators who have worked for at least a year without musculoskeletal trauma participated in this cross-sectional descriptive survey. Information on MSP and health-seeking behavior were collected through questionnaire interview. Results: Almost 69% (223/325) and 98% (318/325) of the participants reported the experience of MSP in the last 7-day and 12-month, respectively. Among those who reported the experience of pain, the most common pain site was low back, followed by the neck, while the elbow was the least common pain site. When the report of experience of pain was adjusted for sex, the same pattern of body regional distribution of pain was observed. Almost 36% (116/325) reported that MSP was due to a combination of work activities and position while 21% (69/325) reported that either work activities or position resulted in MSP. Majority (88%) of participants experienced limitation in daily activities as a result of MSP. The most sought after health-seeking behavior was self-medication (31.4%) followed by herbal preparations (17.8%). Only 3.7% (12/325) sought hospital treatment only and 2.5% sought hospital treatment in addition to other treatments. Only the factor "does pain limit activities" predicted MSP. Conclusion: Work-related MSP is prevalent among Nigerian sewing machine operators, and low back is the most common pain site. Only the factor "does pain limit activities" predicted MSP. Many of them engage in self-medication to alleviate their pain.
Keywords: Health-seeking behavior, musculoskeletal pain prevalence, Nigerian sewing machine operators
|How to cite this article:|
Akinpelu AO, Oyewole OO, Odole AC, Ogunbamowo FD. Work-related musculoskeletal pain and health-seeking behavior among Nigerian sewing machine operators. Trop J Med Res 2016;19:152-8
|How to cite this URL:|
Akinpelu AO, Oyewole OO, Odole AC, Ogunbamowo FD. Work-related musculoskeletal pain and health-seeking behavior among Nigerian sewing machine operators. Trop J Med Res [serial online] 2016 [cited 2019 Aug 20];19:152-8. Available from: http://www.tjmrjournal.org/text.asp?2016/19/2/152/185446
| Introduction|| |
Musculoskeletal pain (MSP) is one of the most common occupational health risks among sewing machine operators or garment making workers. , It has been recognized as the most common cause of pain and chronic disability which affects social functioning and mental health and diminishes the quality of life.  Among sewing machine operators/garment making workers, the neck, shoulder, back, and hand/wrist have been frequently affected by MSP. ,, This has been attributed to the overload of muscles, skeleton, and connective tissue system at work and monotonous hand movements.  Physical and psychosocial load, poor climatic conditions, and vibrations have also been reported to be responsible for increased MSP among sewing machine operators in the textile industry. ,
In general, the sewing operation has been reported to be characterized by a static sitting posture, a forward inclined posture of the head and trunk and relatively uncomfortable ankle and knee angles. It also includes simultaneous hand and arm movements, and the continuous operation of foot pedals.  Therefore, the working posture is constrained by the eyes for visual control of the work, the hands for directing the sewing material, and the feet for speed control of the work.  In a developing country, sewing machine operators/operators' activities have been observed to be characterized by the following: (i) Varying, poorly structured, and poorly organized jobs with respect to products, processes, and operations, performed both individually and in groups; (ii) repetitive and burdensome tasks; (iii) congested and limited workspaces, poorly designed sewing machines, and other equipment, resulting in uncomfortable, crouched, or forward leaning sitting postures; (iv) prolonged gripping and pinching with considerable forces; (v) tight schedules, often requiring hurrying in performing tasks; (vi) few and short rest pauses; (vi) frequent sharp neck and trunk bending among taller workers, or moderate bending among shorter workers; (vii) lack of control over work; and (viii) reluctance to report stressful or unsafe working conditions for fear of being dismissed.  In many other developing countries such as Nigeria, these characteristics would likely be observed in the work environment and job activities of sewing machine operators in self-employment or small scale textile industries.
Health-seeking behavior of people who are suffering from MSP varies from culture to culture. Cultural factors influence illness behavior in a number of ways, such as defining what is regarded as "normal" and "abnormal," determining the cause of illness, decision-making control in healthcare settings and impacting on health-seeking behavior.  Socioeconomic factors have also been reported to influence health-seeking behaviors among MSP sufferers in developing nations. ,,, In a Nigeria-based study on health-seeking behavior among occupational drivers with MSP, the occupational drivers were engaged in self-medication and alternative medicine in alleviating their MSP.  Few studies , have reported the prevalence of MSP among sewing machine operators in Nigeria and none has reported their health-seeking behavior in relation to MSP among this occupation group. Therefore, this study was designed to determine the prevalence, pattern, and predictors of work-related MSP and health-seeking behavior among sewing machine operators in Ibadan, South-West Nigeria.
| Materials and Methods|| |
This cross-sectional descriptive survey involved a purposive sample of 325 consented registered sewing machine operators (tailors) who have worked for at least a year without musculoskeletal trauma such as a fracture. Prior to data collection, a standard equation was used to determine the sample size. , The calculated minimum sample size was determined to be 113 to power the sample study. The questionnaires were administered at the venue of various zonal meetings of the sewing machine operators in Ibadan through interview by one of the authors. Due permission was obtained from respective zonal chairpersons after explaining the objective of the study. The research protocol was approved by the Joint Institutional Review Committee of University of Ibadan and University College Hospital, Ibadan.
Description of the instrument
Standardized Nordic questionnaire for analysis of musculoskeletal symptoms
The questionnaire was used to assess MSP.  It is interview administered and consists of two sections. Section 1 comprises forty forced-choice items identifying areas of the body causing musculoskeletal problems. Completion is aided by a body map to indicate nine symptom sites being neck, shoulders, upper back, elbows, low back, wrist/hands, hips/thighs, knees, and ankles/feet. Respondents are asked if they have had any musculoskeletal trouble in the last 12 months and last 7 days which have prevented normal activity. Section 2 consists of additional questions for obtaining further information on MSP in the neck, the shoulders, and the lower back. Twenty-five forced-choice questions elicit any accidents affecting each area, functional impact at home and work (change of job or duties), duration of the problem, assessment by health professional, and musculoskeletal problems in the last 7 days. The reliability and validity of this questionnaire have been shown to be acceptable. 
A self-developed questionnaire
A self-developed questionnaire was used to collect data on demographics (Section A), beliefs, and health-seeking behaviors of the participants (Section B). Section A collected data on demographics (age, sex, and working experience) while Section B comprised nine questions which elicited information on participants' beliefs about MSP and their health-seeking behavior. This questionnaire was content-validated for content relevance and coverage.
Descriptive statistics of mean, standard deviation, percent frequency distributions, and charts were used to summarize the data. Chi-square was used to investigate the association between sociodemographic factors and experience of MSP. Logistic regression was used to assess factors that predict MSP.
| Results|| |
Three hundred and twenty-five sewing machine operators aged 35 ± 10 years participated in the study. Two hundred and thirteen participants (65.5%) were females. Participants have been working as sewing machine operators for 14.2 ± 9.4 years with mean daily activity hours of 7.9 ± 2.2 h. Majority (71.2%) of the participants were involved in both sewing and cutting fabrics and 71.7% sit on stools without backrest to sew.
Prevalence of musculoskeletal pain
Most participants (98.5%) reported the experience of MSP at any time of their lives. Almost 69% (223/325) and 98% (318/325) of the participants reported the experience of MSP in the last 7 days and 12 months, respectively, prior to the study [Figure 1]. Among those who reported the experience of pain, the most common site of pain was low back followed by the neck while the elbow was the least site of pain in both 7-day and 12-month prevalence [Figure 1]. When the report of experience of MSP was adjusted for sex, the same pattern of body regional distribution of pain was observed [Figure 2]. Among male participants, 7 days prevalence was higher than the 12 months prevalence except for shoulder and elbow regions while in females, it was 12 months prevalence that was higher in all regions of the body [Figure 2]. The report of experience of MSP was highest among 28-37 years (28% and 39.7%) followed by 18-27 years and least for 68-77 years (0.6% and 0.9%) age group in both 7 days and 12 months prevalence, respectively [Figure 3].
|Figure 2: Seven-day and 12-month prevalence (%) of musculoskeletal pain by gender|
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|Figure 3: Seven-day and 12-month prevalence (%) of musculoskeletal pain by age group|
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The findings from this study showed that there was no significant association between age (χ2 = 4.409, P = 0.492), duration of daily activities (χ2 = 1.110; P = 0.577), years of working experience (χ2 = 2.298; P = 0.807), and the experience of MSP. Only one ("does pain limit activities") out of the seven factors (sex, age, years of working experience, daily working hour, type of stool to work, type of tailoring engaged in, i.e., cutting, sewing, or both and "does pain limit activities") entered into logistic regression was significant. The experience of pain limiting activities was three folds in last 7-day (odds ratio [OR] = 2.52, confidence interval [CI]: 1.27-5.00, P = 0.008) and 12-folds in the last 12-month (OR = 12.13, CI: 1.96-75.11, P = 0.007).
Predisposing activities to pain, duration of musculoskeletal pain and limitation of daily activities
About 27.1% (88) of the participants reported that their experience of MSP was as a result of the sitting posture assumed for a long period of time while sewing and not pedaling the machine [Table 1]. Twenty-one percent (69/325) reported that a combination of either activity or posture resulted into pain, while 35.7% (116/325) reported all the activities and position resulted in pain [Table 1]. Most participants reported a total length of time of 1-7 days with the most common body region of pain as the low back (63.1%) followed by the neck (60.6%).
|Table 1: Predisposing activities to pain, duration of musculoskeletal pain and limitation of daily activities |
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Two hundred and eighty-five (193 females and 91 males) participants experienced limitation in daily activities as a result of MSP, while only 41 (twenty males and 21 females) did not in the last 12 months prior to the study. Most (42.5%) participants reported that low back followed by the neck (34.2%) prevented them from performing their normal daily activities for the total duration of 1-7 days [Table 1].
Beliefs and health-seeking behavior of participants
Most participants (97.6%) attributed the cause of MSP to their tailoring job, while only 0.9% attributed it to other causes [Table 2]. The most sought after health-seeking behavior among participants was self-medication (31.4%) followed by herbal preparations (17.8%). Almost 4% sought hospital treatment only, while 2.5% sought hospital treatment in addition to other treatments. Most of the participants (81.8%) also reported achieving relief from MSP by assuming lying or recumbent position followed by sitting (16%) [Table 2].
|Table 2: Participants' beliefs of causes of musculoskeletal pain and their health-seeking behavior |
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| Discussion|| |
This study was aimed at determining the prevalence, pattern, and predictors of work-related MSP and health-seeking behaviors among Nigeria sewing machine operators. Majority of the participants reported the experience of MSP in the last 7 days (68.6%) and 12 months (97.8%), respectively, prior to the study. This prevalence of work-related MSP was high, which may be a reflection that MSP was a health risk among this occupational group. The 12-month prevalence of 97.8% was similar to a previous study from Nigeria which reported 95% among sewing machine operators from Lagos, Nigeria.  This corroborated the fact that there was a high prevalence of MSP among sewing machine operators in Nigeria. The 7-day and 12-month prevalence reported in this study was higher than that of Danish sewing machine operators who reported about 40% and 60%, respectively.  Though the same instrument was used to assess the report of MSP in both studies, the reason for the differences may possibly be that Danish sewing machine operators observe occupational safety more than their Nigerian counterpart (although the present study did not assess the workstations/environment of these sewing machine operators), this can only be supported from anecdotal evidence. A 1-month prevalence rate of about 58% prevalence of MSP was also reported among sewing machine operators in Los Angeles, California, which was lower than 7-day prevalence in this study.  The differences might be attributed to variations in the methods of assessing MSP or probably because the USA sewing machine operators are better informed about the occupational safety.
Among those who reported the experience of pain, the most common site of pain was low back followed by the neck, while the elbow was the least site of pain in both 7-day and 12-month prevalence. This observation was similar to findings from previous studies which reported low back as the most commonly affected body region by MSP among sewing machine operators. ,,, However, few studies reported that neck and shoulder followed by the upper back were the most commonly affected body regions. , These body regions-neck, back, and shoulders are frequently affected because the sewing operation is characterized by a static sitting posture, a forward inclined posture of the head and trunk, and relatively uncomfortable ankle and knee angles. 
Higher percentage of women reported the experience of MSP than men in the present study. This was in agreement with previous studies which reported higher prevalence among women. , This has been attributed to physiological structure and metabolic system of women with regard to their different life cycles like monthly menstrual periods and menopause causing porosity and weakness of the skeletal system.  However, the prevalence of work-related MSP decreases with age as suggested by the finding from this present study. This is not in agreement with the finding from a previous study where MSP was reported to increase with age.  The difference could be attributed to the age ranges that were included in both studies. The mean age of participants in the present study was 35 ± 10 years and the participants included only 12 who were above 57 years, while the other study included more participants who were above 56 years. It has been reported that people with longer years of working experience or people of older age in this occupation may be absent from work more often and experience more severe pain.  Unlike the findings of a previous study from Nigeria, the present study found no association between report of MSP and each of age and years of experience among sewing machine operators.  The reason for this could be due to the way age and year of experience were stratified in the two studies.
Prolonged sitting and standing while cutting/ironing were the most job risk factors reported by the participants. Similar observation was reported among sewing machine operators from Lagos, Nigeria.  The height of the furniture that most of these sewing machine operators do use was either above or below the recommended levels  and sitting on this furniture for long or stand to work with it may pose a strain on the posture and such had to be maintained throughout the work day, which could have been responsible for the development of pain in the neck, back, shoulders, the upper arm, and the forearm. The Nigerian sewing machine operators are fond of sitting on a high stool without backrest which forced them to bend their trunk and head toward the table to have a clear view of the point of operation.  As a result of excessive bending, majority of them complained of pain in the lower back, the mid back, the shoulders, and the neck.  More so, the stools used by the majority of the operators were not padded for their comfort when seated for long hours.  These could account for reasons while assuming the reported position could be a job risk for this occupation group in Nigeria. This calls for ergonomic education among sewing machine operators in Nigeria. It has been reported that garment workers may experience a decline in neck/shoulder pain if they are provided with adjustable height task chairs, especially if the chair has a forward curved seat pan. 
The finding that most participants (97.6%) believed the cause of their MSP was due to their tailoring job implies that the sewing machine operators had the correct idea about the cause of their MSP. The most sought after health-seeking behavior among participants was self-medication (31.4%) and herbal preparations (17.8%). This occupational group shared the same health-seeking behavior with occupational drivers in Nigeria.  Self-care has been reported to be predominant health-seeking behavior in developing countries for MSP.  It has been observed that in the developing world, medical pluralism, or the existence of several distinct therapeutic systems in a single cultural setting, is an important feature of health care. Indeed, a wide range of therapeutic choices is available, ranging from self-care to folk and Western medicine.  The type of symptoms experienced for the illness and the number of days of illness, socioeconomic status are major determinants of health-seeking behavior and choice of care provider. , In case of a mild single symptom such as fever or pain, home remedies, or folk prescriptions are used, whereas with multiple symptoms and longer period of illness, biomedical health provider is more likely to be consulted.  It has been suggested that people's perceptions of their illness may be an important explanation of the variation in their health-seeking behavior.
Only 3.7% of the participants utilized conventional hospitals or consults professionals for their MSP. This was similar to the observation among occupational drivers in Nigeria.  Although the utilization of a health care system, public or private, formal or nonformal has been shown to depend on sociodemographic factors (social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, and economic), political systems, environmental conditions, and the disease pattern and health care system itself. , It is likely that the socioeconomic status of these sewing machine operators was responsible for the low utilization of the health facilities or better still the level of pain they experience are not severe enough to consults professionals.
Giving the high prevalence of work-related MSP and low utilization of health facilities among Nigeria sewing machine operators, there is the need to intensify ergonomic and health education for this occupational group. The ergonomic education should include appropriate recommended furniture in terms of height, job organization, work environment setting, and micropause. They should be educated on the danger of self-medication.
This study is not without limitation. Like in any cross-sectional study, recall bias of experience of MSP may be present. The present study did not assess the workstations/environment of the sewing machine operators and thus, causal effect relation could not be drawn. However, the results of this study were consistent with previous studies in Nigeria.
| Conclusion|| |
Work-related MSP was prevalent among Nigerian sewing machine operators, and low back is the most common site of pain. Many of them engaged in self-medication to alleviate their pain. There is the need for more enlightenment programs on ergonomics to possibly reduce the menace of MSP among this occupational group.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]