Iris Publishers - Current Trends in Clinical & Medical Sciences (CTCMS)
Musculoskeletal Pain among Rural Homemakers and their Health Seeking Behaviors
Authored by Md Mahmudul Hasan
Introduction
Musculoskeletal pain is one of the
modern epidemic health problems. This problem responsible for a high proportion
of impairment, loss of productivity and substantial use of health and social
services [1]. Several epidemiological studies have demonstrated the evidence of
a causal relationship between physical exertion at work and work related
musculoskeletal pain (MSP) [2]. Both professional and informal work at home or
outside require physical strains that can produce musculoskeletal pain(MSP) as
a result of inflammatory conditions in muscles, nerves, tendons, cartilage,
spinal discs or other soft tissues. MSP is found throughout all generations,
identities and social group [3]. Although previous studies suggest that
prevalence rates of musculoskeletal pain were higher for women than for men
[4]. WHO reported that women constitutes 42% of the global work force and they
are more likely to work in the informal economy sector (domestic work,
agricultural laborers, handicrafts industry, etc.) [5].This trend is common in both
developed and developing countries. Middle-income counties like Hong Long and
Lebanon shows that fulltime homemakers experiences MSP over the different
region of the body as a result of household chores [6,7]. Homemakers in
developed countries like Italy get MSP because of housework. [8]. In
Bangladesh, women typically spend less than an hour on their self-care work; in
contrast, they spend 14-20 hours a day as the main person responsible for
finishing family activities [9]. A recent study in Bangladesh shows that 68.49%
women reported having pain on different parts of their body during the last 12
months and 50.68% of the respondents were prevented from normal daily
activities due to musculoskeletal symptom [10]. It is evident that the
prevalence of low back pain is higher in rural women than urban women [11].
This study is aimed at identifying MSP in different parts of the body as a
result of housework among homemakers in Bangladesh as very little is known
about it so far.
In contrast, woman shows little
concern about their health. Despite suffering and withdrawing from work due to
domestic work, very few women seek health care in this regard in Bangladesh
[12].This is due to the influence of traditional gender norms where women are
forced to participate in daylong household tasks as homemaker and men (husband)
act as family breadwinner. Rural women rarely report their musculoskeletal
problems at the right time. This habit aggravates the situation vulnerable and
leading to disorder. Full-time homemakers were 40% less likely to report
musculoskeletal symptoms than working women [13]. Moreover, as living with pain
for a prolonged time without stopping their household activities, they are very
much prone to develop the physical disability. This study will highlight the
hazards of this unpaid occupation and the health-seeking behavior of the
ill-fated women engaged in it.
Literature Review
Pain can be classified based on
its duration and location of body systems. If the pain stays for less than six
weeks and/or between six weeks to three months and/or more than three months is
called acute, sub-acute, or chronic pain respectively [14]. On the other hand,
various physical and physiological regions of the body are affected by the
pain. Of these, musculoskeletal region has become a public health priority as a
major cause of pain and a decreased quality of life. International Association
of Study of Pain (IASP) described musculoskeletal pain as a known consequence
of overuse, repetitive and work-related musculoskeletal disorders [15].
Work-related disorders may evolve in the workplace due to the physical tasks
with which people carry out their normal work activities. Domestic work is
regarded as one of the daily activities. Studies show that women are considered
as the main responsible person in the family to complete the household chores.
Household activities are one of the causes of many musculoskeletal risks such
as lower and upper back, spine, shoulder, wrist, neck and knee pain which can
later lead to temporary and permanently disabled conditions [16].
Musculoskeletal problems of housewives not only affects them by significantly
impairing their activities of daily living [17] , but also affects the other
members of the family as they have to spent additional hours to complete
household duties [18]. Along with individual and familial domain, housework and
musculoskeletal symptoms among homemakers has relationship with social (low
income) and demographic (age, education, number of children) factors [13,19].
In addition, the economic burden of musculoskeletal pain is ranked as second to
that of cardiovascular disease [15].
Pain can be classified based on
its duration and location of body systems. If the pain stays for less than six
weeks and/or between six weeks to three months and/or more than three months is
called acute, sub-acute, or chronic pain respectively [14]. On the other hand,
various physical and physiological regions of the body are affected by the
pain. Of these, musculoskeletal region has become a public health priority as a
major cause of pain and a decreased quality of life. International Association
of Study of Pain (IASP) described musculoskeletal pain as a known consequence
of overuse, repetitive and work-related musculoskeletal disorders [15]. Work-related
disorders may evolve in the workplace due to the physical tasks with which
people carry out their normal work activities. Domestic work is regarded as one
of the daily activities. Studies show that women are considered as the main
responsible person in the family to complete the household chores. Household
activities are one of the causes of many musculoskeletal risks such as lower
and upper back, spine, shoulder, wrist, neck and knee pain which can later lead
to temporary and permanently disabled conditions [16]. Musculoskeletal problems
of housewives not only affects them by significantly impairing their activities
of daily living [17] , but also affects the other members of the family as they
have to spent additional hours to complete household duties [18]. Along with
individual and familial domain, housework and musculoskeletal symptoms among
homemakers has relationship with social (low income) and demographic (age,
education, number of children) factors [13,19]. In addition, the economic burden
of musculoskeletal pain is ranked as second to that of cardiovascular disease
[15].
Materials and Methods
This cross sectional study used a
sample of 341 randomly selected married homemakers from 8 wards of 4 unions of
2 upazials of Barishal district. Wards were selected through the quasi
multistage process. Inclusion criteria for homemakers were age (18-45 years),
marital status (married for at least a year), and living place (within the
study place for one year) and experience of any type of MSP at least once in
life. Visually, hearing, cognitive and mentally impaired, and pregnant woman as
well as those had history of trauma in last 12 months, taking tuberculosis
drugs and trauma were excluded the study population. Prior to data collection,
a standard equation was used to determine the sample size [23]. The minimum
sample size to be calculated was set at 331, but 10 more were added to adjust
if any non-responded data were found during the data analysis. The study period
was lasting from January, 2019 to December, 2019. The questionnaires were
administered at the home of selected participants in the Barishal division
through the interview by the first author. Due permission was obtained from the
Upazilla Health and Family Welfare after explaining the objective of the study.
A pre-test of questionnaire was conducted as soon as the research protocol was
approved by the approval committee of the National Institute of Preventive and
Social Medicine (NIPSOM), Bangladesh.
Description of Instrument
After necessary modification and
correction, the final questionnaire included four domains to meet the study
objectives. The first domain was designed for obtaining socio-demographic
information (age, education, income, marital status, family type, number of
family members and children, job experience, and income). The second domain
captured information related to their household activities and additional house
activities, ergonomic risk factors include force, lifting and carrying heavy
loads, repetitive movements, awkward posture , total work experiences ( in
years), and work hours per day. The third domain captured information on
Work-related musculoskeletal disorder (WRMSDs), including site of pain by body
regions, effect of WMSDs on work performance, visit to health professionals and
information on medication. Prevalence of WMSDs for each body region was
determined by the Nordic Musculoskeletal Questionnaire- Extended (NMQ-E) tool.
The investigation covered nine body regions: neck, shoulder, upper back,
elbows, wrists/hands, lower back, hips/thighs, knee, and ankle/feet. The fourth
domain contained information regarding health seeking behaviors of respondents
for the management of pain. The questionnaire and NMQ-E was translated into
Bangla (local language).
Data Analysis
Descriptive statistics of
frequency, percentage, means, medians, mode, standard deviation, tables and
graphs were used to summarize the data. The association between WMSDs factors
and ergonomic parameters was analyzed using the chi-square (χ2) test. All P
values presented are two-tailed and a P-value of<0.05 were considered as
significant.
Discussion
This cross sectional study was
carried out to determine the musculoskeletal pain in different anatomical site
of the body of rural homemakers as a result of household activities and also
identify their health seeking behaviors. The major finding of the study was
that the prevalence of musculoskeletal pain was considerably high in almost all
of the body regions of the homemakers, with the most reported symptoms were in
the lower back, knees, neck, upper back, hips/thighs, wrists/ hands,
respectively. This implies that any area of the body can be individually or
collectively affected by pain due to indoor activities. On average, 80.46%
suffered from low back pain in last 12 months, whereas 24.4% for knee and
19.13% for neck pain. The lowest complaint area was the elbow which was
complained by only 3.4% of participants in the last 12 months. Interestingly,
data on lower back pain are very similar to data from two other studies
conducted in Bangladesh and India [24, 11]. In addition to this study, several
studies [25, 19] have shown that lower back pain is associated with the number
of children, age, and educational level, work experience of more than 10 years,
awkward postures and weight lifting.
In this study, some household work
related factors (total daily hours on household activities, total year of
involvement in regular household activities, repetitive work, awkward posture
and lifting heavy object) were analyzed to see whether there is any association
with the pain in different site of the body during last 12 months. The mirror
study of Lebanon reported about women involved in household activities for
46–65 hours per week were 2.5 times more likely to report pain than those who
involved in household activities [13]. In parallel, there is significant
association between total daily working hours with wrist/ hands and knee pain
in this study. Further, the ergonomic risk factors such as repetitive movement
were significantly associated with wrist/ hands pain. On the other hand, this
study found that more than 10 years of work experience is associated with upper
back pain. Further, the awkward position of doing family activities can result
in knee and wrist/hand pain. In addition, this study found the relationship
between pain and participants’ age, educational level, and number of children.
Studies conducted in Bangladesh and India support this statement [26, 27]; a
research report however showed a zero relationship between MSP and education
[10].
To determine a proper intervention
plan for the detection and therapy of musculoskeletal pain (MSP) in rural
homemakers, their health seeking behavior in this regard was investigated. In
this research, taking medication with or without a prescription, visiting
health professionals, and taking prevention with or without the advice of
health professionals, stopped doing housework have been identified as
consequences of MSP. In this present study, 75% (n = 253) received treatment for
musculoskeletal complaints, in contrast to the treatment-seeking patterns study
in Australia 86% [28]. However, other studies in asian countries namely
Indonesia and India showed 73% and 79% participants respectively had sought
care for it [20, 26]. The difference may be due to the socio cultural
differences in asian and other countries. Further, the number of subjects who
received treatment from paraprofessional was higher than the subjects who
received treatment from professional allopath doctor in this study. This
finding is similar to the results of prior studies of Indonesia [20]. Unlike
the findings of a previous study from India [26, 28], the present study found
only a few subjects (16.6%) sought home remedy for pain management. Strangely,
most of the respondents (92.9%) were unaware about physiotherapy treatment for
management of pain. Lack of education and availability of physiotherapy
professionals and treatment both at the government and private health services
settings may be responsible for this condition. In addition, less or nil
empowerment or lack of knowledge or a patriarchal social system may compel
women to give the opportunity to other family members to choose health-care
services for them. Further, participants probably showed a tendency to take
affordable treatment due to poverty.
The study is not without
limitation. This study used NMQ-E scale to collect information on pain, but
working category checklists were not given. Along with this, BMI and
psychosomatic pain were not assessed. Furthermore, this study was conducted in
only one district of Barisal, so the results cannot be generalized to rural
domestic workers in the whole of Bangladesh
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