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Abstract
Objective This study aimed to assess the prevalence of low back pain and associated factors among professional taxi drivers.
Design Community-based cross-sectional study.
Setting and participants A Modified Nordic Musculoskeletal Questionnaire was used to collect data. Through a simple random sampling technique, 371 taxi drivers were selected in Gondar City, Ethiopia.
Data analysis SPSS V.22 was used for data analysis. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with low back pain. A p value less than 0.05 and an adjusted odds ratio (AOR) with 95% CI were used to declare statistical significance.
Result A total of 371 respondents, with a response rate of 95.4%, have participated. The past 1 year and week’s prevalence of low back pain among taxi drivers was 85.7% (95% CI 82.5 to 89.2) and 53.4% (95% Cl 48.0 to 58.5), respectively. Overweight/obese (AOR=0.33, 95% CI (0.14 to 0.80)), alcohol drinking (AOR=4.77, 95% CI (1.16 to 19.5)), job dissatisfaction (AOR=4.58, 95% CI (1.39 to 15.2)), prolonged working hours per day (AOR=2.64; 95% CI (1.02 to 6.08)), not using the adjustable seat with back support (AOR=6.38, 95% CI (2.39 to 17.01)) were associated with low back pain among taxi drivers.
Conclusion The prevalence of low back pain among taxi drivers was high. Being overweight/obese, alcohol drinking, job dissatisfaction, prolonged working hours per day, and not using adjustable seats with back support, were factors associated with low back pain among taxi drivers. Therefore, ergonomic and behavioural-related awareness training is recommended to minimise the burden of low back pain among taxi drivers.
- Back pain
- Musculoskeletal disorders
- Elbow & shoulder
- Bone diseases
- Foot & ankle
- Adolescent
Data availability statement
Data are available upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The study has focused on one of the most potential workforces affected by low back pain.
A standardised Nordic Musculoskeletal Questionnaire was used to measure low back pain.
To control cofounder variables, multivariable logistic regression model was used.
The cross-sectional nature of the data in this study does not reveal a causal association.
Data were obtained based on the self-report of the respondents, and not based on clinical diagnosis.
Introduction
Low back pain (LBP) is the pain limited to the region between the lower margins of the 12th rib and the gluteal folds.1 Globally, LBP is a common musculoskeletal problem.2 It can be acute (lasting less than 6 weeks), subacute (lasting between 6 and 3 months) or chronic (lasting more than 3 months).3 LBP can limit activity all around the world, placing a significant economic impact on individuals, families, communities, industries and governments.4 Due to LBP, more than one hundred million working days are lost each year with an estimated cost of more than US$100 billion in the USA.5 The prevalence of LBP among African countries is higher than the global prevalence, and the burden would be greater in lower and middle-income countries (LMICs) including Ethiopia.6
Lower back pain is very common among truck, bus and taxi drivers and is one of the most commonly reported occupational health problems among professional drivers.7 The magnitude of LBP among taxi drivers has been reported in different studies, such as Iran, 51.2%,8 Ghana, 34.3%,9 Taiwan, 51%,10 Saudi Arabia, 60.7%,11 Cameron, 72.8%,12 China, 54%,13 Hungary, 61.36%,14 Turkey, 49.7%,15 Addis Ababa, Ethiopia, 64.2%,16 Tigray, Ethiopia, 27.9%.17
A number of studies have identified a wide range of factors associated with LBP in taxi drivers. Among these were vibration,7 frequent bending/twisting while driving,11 long hours of driving per day and week and long work experience11 18 were reported as major risk factors. Other factors such as violence, body mass index (BMI),15 unhealthy eating habits, smoking,19 20 chat chewing, drinking alcohol,19 21 22 gender,18 employee drivers,9 mental stress,14 job stress, night shift and job dissatisfaction9–11 15 were also noted to be factors for LBP. On the other hand, vehicle ergonomics and lumbar support on the driver’s seat,15 physical activity13 15 and more health breaks during work11 and longer sleep duration13 were reported as decreased risk of LBP.
The driving profession involves routine strenuous effort, awkward sitting postures, prolonged working hours and exposure to whole-body and hand-arm vibration. They are further exposed to biomechanically labour-intensive activities such as manual load handling and lifting, bending and twisting. As a result, the work tasks and environment put drivers at risk for LBP.23
Gondar City has one of the largest urban populations in Ethiopia and taxis are the most used means of transportation in the city, and road features, including geography, maintenance and type, are expected to influence the prevalence of LBP in the study area.24 Although few epidemiological studies have been studied and reported on LBP among drivers, there is a dearth of up-to-date information about the extent of the problem and its predictors among taxi drivers, and almost none in Gondar City.
Determining the prevalence and associated factors of LBP among taxi drivers is needed to ensure a sufficient allocation of healthcare resources and to address its growing public health problem regarding back troubles. Therefore, this study aimed to assess the prevalence and factors associated with LBP among taxi drivers in Gondar City, Ethiopia.
Method and materials
Study setting, design and period
A community-based cross-sectional study was conducted in Gondar City from March to May 2021. Gondar is one of the historical towns in Ethiopia. During the study period, Gondar City had a total population of 378 000 and based on the transport and logistics office of the Gondar City administration, about 502 taxis drivers provided service in Gondar City, and taxi transportation is the major means of transportation in the city.
Source and study population
The source population for this study included all taxi drivers in Gondar City, and all participants were male drivers with at least 1 year of taxi-driving experience, no history of traumatic road or work accidents, and were aged 18 or older.9
Sample size and sampling procedure
The sample size was calculated using single population proportion formula, and the following assumptions were considered; the prevalence of LBP among taxi drivers in similar studies conducted in Ethiopia, 64.2%,16 95% CI (Za1/2=1.96), and 5% (d) margin of error.
n=Z2 p (1−p)/d2, n=(1.96)2×(0.642) (0.358)/(0.05)2=353.89= 354.
After adding a 10% non-response rate, the final sample size for this study was 389. Moreover, for associated factors, sample size was done using Open EPI info V.7 by considering the following assumptions: power 80%, 95% CI, ratio, 1:1 and crude OR for factors significantly associated with LBP in the previous study such as work experience, alcohol drinking and taking rest breaks with a sample size of 94, 282 and 286, respectively. Therefore, the final sample size for this study was 389, which is calculated for the first objective (for prevalence). Study participants were selected using a random sampling technique and to avoid double sampling, the driving license and identification number of the taxi were recorded.
Operational definition
Low back pain
Refers to a self-reported pain, ache, numbness or discomfort in the lower back region for all or at least one symptom during the 12 months preceding the completion of the questionnaire.25 It is measured by asking the question ‘Have you at any time during the last 12 months had trouble (ache, pain, discomfort, numbness) in your lower back? Yes/No’.
Body mass index
Is the body weight in kilograms divided by the value of the body height in metres squared (kg/m2), and it was categorised as underweight (<18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2.26 However, finally for analysis, BMI was dichotomised into BMI<25 kg/m2 (normal) and≥25 kg/m2 (overweight/obese).
Job stress
A score measured using the generic job stress scale as Yes, 21 and above, and No, lower than or equal to 20.27
Job satisfaction
A score measured using the generic job satisfaction scale as yes, 32, and above, and no, below 32.
Cigarette smoking
It is the practice of smoking cigarettes by taxi drivers for at least one stick of cigarette per day.26
Physical exercise
Performing any kind of physical exercise at least two times per week and for 30 min.28
Alcohol drinking
The consumption of any kind of alcohol by taxi drivers at least two times per week.26
Data collection procedure
The reliability of the tool was assessed by conducting a pretest on 5% of the total study participants. After the pretest, some misinterpretations and ambiguous words were corrected. Data were collected by five environmental health professionals through an interviewer–administered questionnaire. A simple random sampling technique was used to select study participants using driver’s licenses and plate numbers of taxis obtained from the Gondar City transport administration office. The participants in this study were contacted while they waited their turn to serve passengers at the taxi terminals.
Data collection tools
Data were collected using a modified Standardized Nordic Musculoskeletal Questionnaire. The questionnaire has four components: Sociodemographic characteristics, working conditions, behavioural, psychosocial factors and questions related to LBP symptoms. Perceived job satisfaction was assessed using 10-item generic job satisfaction scale questioners with 5 Liker scale responses (very dissatisfied=1, dissatisfied=2, neutral=3, satisfied=4 and very satisfied=5) and dichotomised into dissatisfied (total score less than 32=1) and satisfied (total score 32 and above=2),29 with their current jobs. Perceived job-related stress was assessed using 8-item generic job stress scale questioners with 5-Likert scale responses (never=1, rarely=2, sometimes=3, often=4 and very often=5) and the final score was dichotomised into less than 21=1 (not stressed) and a score of 21 and more=2 (stressed).27
Data quality control
To assure the quality of data careful design, translation and retranslation of the questionnaire, and pretests on 5% of the sample from other sites were done, and, accordingly, some correction was performed. The 2-day training was also given to data collectors. Proper categorisation and coding of the data were also done. Day to day data collection procedure was checked for its completeness and appropriate data collection by the supervisor and principal investigator.
Data management and analysis
The data were entered into EPI info V.4.6 software and exported to SPSS V.22 for further analysis. The descriptive statistics were computed. Bivariable and multivariable regression analyses were used to identify factors associated with LBP. Variables with a p value less than 0.2 in the bivariable analysis were exported to multivariable logistic regression analysis to control potential confounder variables. The reliability of Nordic Questionnaires was assessed using Cranach’s alpha (0.79). A p-value less than 0.05 and an adjusted OR with 95% CI were used to declare statistical significance.
Patient and public involvement
No patient was involved in the study.
Results
Socio-demographic characteristics of study participants
From a total of 389 eligible taxi drivers, 371 participated; giving a response rate of 95.4%. All (100%) of the respondents in this study were men. More than half (54.2%) of study participants were less than 34 years. Nearly three-fourth (69.0%) of study participants were orthodox Christians. Regarding the educational status of respondents above three-fourths (79.2%) of respondents had a secondary educational level (table 1).
Sociodemographic characteristics of participants in Gondar City, Northwest Ethiopia (n=371), 2021
Behavioural factors of study participants
In this study, more than half (50.1% and 57.2%) of the study participants were never a drinker and never smokers, respectively. Moreover, nearly one-fourth (70.9%) of the study participants did not engage in any type of physical exercise activity (table 2).
Behavioural factors of participants in Gondar City, Northwest Ethiopia (n=371), 2021
Coping strategy for LBP among taxi drivers in Gondar City
According to this study, 50.7% and 45% of study participants have experienced stress and are dissatisfied with their jobs, respectively. In this study, 30.3% of respondents used home take management as their primary coping technique for LBP, while 2.6% did not use any coping strategies at all (figure 1).
Different copying strategies for low back pain that used by taxi drivers in Gondar town, 2021.
Prevalence of low-back pain among taxi drivers in Gondar City
Based on this study, the past 1 year and 1 week prevalence of low-back pain among taxi drivers were 85.7% (95% CI 82.5 to 89.2) and 53.4% (95% CI 48.0 to 58.5) respectively (table 3).
Prevalence of low-back pain among taxi drivers in Gondar City (n=371), 2021
Factors associated with LBP among taxi drivers in Gondar City
Based on a multivariable logistic regression analysis, alcohol drinking habits, job-related dissatisfaction, being overweight/obese, prolonged working hours per day and not using adjustable seats with back support were significantly associated with LBP among taxi drivers.
In this study, taxi drivers who were overweight/obese were about 67% less likely to experience low-back pain when compared with their counterparts (AOR=0.33, 95% CI (0.14 to 0.80)). The chance of developing LBP among alcohol drunker was about four times to develop LBP compared with those who do not drink alcohol (AOR=4.77, 95% CI(1.16 to 19.5)). The odds of developing LBP were about 4.58 times more likely among taxi drivers who dissatisfied with their job when compared with those who were satisfied with their job (AOR=4.58, 95% CI (1.39 to 15.2). Taxi drivers working more than 10 hours per day were 2.64 times more likely to have LBP than taxi drivers working less than 10 hours per day (AOR=2.64, 95% CI (1.02 to 6.08)). As per this study, taxi drivers with no adjustable seat had 6.38 higher odds of developing LBP than those who had adjustable seat with back support (AOR=6.38, 95% CI (2.39 to 17.01) (table 4).
Multivariable logistic regression and factors associated with low-back pain among taxi drivers in Gondar City (n=371), 2021
Discussion
The purpose of this study was to assess the prevalence of LBP and its associated factors among taxi drivers in Gondar City, Ethiopia. The past 1-year and 1-week prevalence of low back pain among taxi drivers was 85.7% (95% CI 82.5 to 89.2) and 53.4% (95% Cl 48.0 to 58.5), respectively. This high prevalence of LBP might be due to, driver’s profession need coordinate many complex muscular movements to control a vehicle, and sustained posture when controlling the steering wheel and the control pedals require static muscle activities that may affect the lower back.30
The result of this study was nearly comparable with those studies conducted among taxi drivers in Dhaka city, Bangladesh, with a 1-year prevalence of LBP, 78.0%,31 South Korea, Gimhae city, 81.9%32 and Nigeria, 73.5%.33 On the other hand, the current study found a higher prevalence of LBP than those studies in different regions, including Turkey (49.7%),15 Malaysia (48.5),34 Ghana(34.3%),9 Saudi Arabia (60.7%),11 China, (54%)13 and Addis Ababa, Ethiopia (64.2%).16 The possible reason for this difference could be due to differences in the awareness level of LBP and differences in the measurement of LBP, vehicle ergonomics7 and driving hours per day; for example, in Gondar, 28% and in Malaysia, 43.5% drivers work less than 10 and 8 hours/day, respectively.34 The other reason for this difference might be, during the data collection period around 12.6 km roads among the main routes of the city were under upgrading construction due to which roads were very rough and gravel and earth-made roads which are low-quality roads would expose drivers to whole body vibration35 and these exposures might contribute for higher LBP development.36 37
In this study, the odds of experiencing low back pain among taxi drivers were about 67% less likely among overweight/obese taxi drivers when compared with those with a normal range of BMI. This finding is in agreement with a previous study conducted in Iran, Zahedan city, which revealed that fat drivers with high BMI were found associated with the low level of lower back pain in lower back regions.38 However, there is evidence that indicates a strong association between abdominal obesity and LBP as central obesity increases lordosis and doubles the risk of LBP.39 40 There is also evidence that overweight/obesity is a risk factor for LBP41–44 However, other literature reported as the association of overweight/obesity with LBP remains controversial and inconsistent result.45 For example, findings in research outputs45–49 do not think that it is a risk factor for LBP, particularly in men. The peculiar finding in the current study might be explained as the use of BMI has been criticised for its inability to distinguish the difference between fat and lean mass, especially in men.50 51 Moreover, the study participants involved in the current study are only men and this may also play a role in the peculiar finding since few studies reported that the association between being overweight or obese and LBP is weaker in men compared with women.42 The other possible reason might be due to the difference in practicing physical exercise between drivers with normal and overweight/obese. For example, in this study, about 40% of overweight/obese drivers had physical exercise practice, whereas only 24.6% of drivers with normal BMI were doing physical exercise. There is the literature about the benefit of doing physical exercise in reducing neck and shoulder symptoms in sedentary workers.28
The other important predictor for LBP was job-related dissatisfaction and this study revealed that the odds of having LBP were more likely among dissatisfied taxi drivers when compared with those satisfied taxi drivers, and this finding is consistent with the studies conducted in Taiwan,10 Turkey,15 Ghana,9 and job dissatisfaction was significantly associated with higher prevalence of lower back pain among taxi drivers. The plausible reason might be that dissatisfied workers as a result of work will develop stress, and this induces higher muscular tension, which, in turn, is positively correlated with complaints in discs, tendons, ligaments and nerves in the lumbar spine.52 On the other hand, satisfied drivers could manage the job demand and control imbalance in a better way, and this lessens the likelihood to develop LBP than their counterparts.
In this study, the chance of developing LBP among alcohol drunker was about four times more likely to develop LBP compared with those who do not drink alcohol. This finding is in agreement with different studies such as a systematic review reported that LBP was found among alcohol consumption dependence people.53 Moreover, this finding is consistent with studies conducted in Thailand,54 Ethiopia, among Barber workers,21 Addis Ababa and16 East Asia.55 This might be because drinking alcohol could result in dehydration and reduce the amount of water in the intervertebral discs, including the lumbar region. This loss of water in discs can lead to pain because of discs rubbing together or because it presses on nerves in the lower back.56
In our study, there is a significant relationship between prolonged working hours per day and LBP, and the odds of having low-back pain were more likely among taxi drivers working prolonged hours per day when compared with taxi drivers working less than 10 hours per day. This finding is similar to previous studies conducted among taxi drivers in Mekele, Ethiopia,17 Taiwan,10 Ghana,9 Saudi Arabia,11 Malaysia34 and Nigeria.33 This might be due to the reason that prolonged working hours per day will create cumulative load and physical stress on soft tissues in the lumbar region. This in turn leads to muscle tension, muscle spasm, nerve and ligament compression and consequent LBP.57
Furthermore, in this study, an association was observed between LBP and not use of an adjustable seats, and the odds of LBP were more likely among taxi drivers who did not use adjustable seats when compared with those who use an adjustable seat with back support, and this finding is supported by similar studies conducted in Mekelle,16 17 58 Turkey,15 Hungary, Central Europe.14 This finding is supported by different studies and sitting for long periods in uncomfortable seats with no back support and allowing inappropriate postures would cause increased postural stress, which in turn would lead to musculoskeletal problems such as LBP.59 60 This implies that during sitting in a vehicle, the driver should adjust the seat by keeping the ‘S’ shape of the spine. It should be taken care not to sit too high or too low from the steering wheel with the back of the head on the headrest with the chin level and shoulders back.61
Strengths and limitations of the study
This study adds an important understanding to the seldom studied topic of magnitude and factors for low back troubles among taxi drivers in Gondar City. The study was based on a cross-sectional study design, which hinders the temporal relationship between LBP and factors affecting its development. In addition, weight and height-related measures were assessed by self-reported, and as a result recall bias may have affected the observed associations.
Conclusion
The prevalence of low-back pain among taxi drivers was high as compared with other studies. Overweight/obese, alcohol drinking, job dissatisfaction, prolonged working hours per day and not using adjustable seats with back support were significantly associated with LBP among taxi drivers. Therefore, ergonomic and behavioral-related awareness training is recommended to minimise the burden of LBP.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by Review Committee at Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, University of Gondar with reference number EOHS/287/2021. Participants gave informed consent to participate in the study before taking part.
Acknowledgments
We authors would like to acknowledge data collectors, supervisors, and study participants.
References
Footnotes
Contributors GA initiated the research concept wrote up the research proposal, involved in presentation and interpretation process of results and discussions, and reviewed the final drafted manuscript document. DGY involved in the presentation and interpretation process of results and discussions, and reviewed the final drafted manuscript document. EAW analysed the data, presented the results and discussions, wrote up of the draft manuscript, reviewed and finalised the manuscript document and is the corresponding author. All the authors read and approved the final manuscript. GA is responsible for the overall content of the research as the guarantor
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.