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Work-related back discomfort and associated factors among automotive

maintenance mechanics in Eastern Nigeria: A cross sectional study

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Work 53 (2016) 813–823 813
DOI:10.3233/WOR-162247
IOS Press

Work-related back discomfort and

associated factors among automotive
maintenance mechanics in Eastern Nigeria:
A cross sectional study

PY
Ukachukwu Okoroafor Abaraogua,∗ , Charles Ikechukwu Ezemaa , S.E. Igwea ,
Afamefuna Victor Egwuonwub and Udoka Chris Okaforc
a Department of Medical Rehabilitation, Faculty of Health Science and Technology, College of Medicine,

CO
University of Nigeria, Enugu Campus, Enugu, Nigeria
b Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
c Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos,

Nigeria

Received 6 February 2014

Accepted 14 April 2015
OR

Abstract.
BACKGROUND: Back pain has been identified as a common cause of disability in the working population. Automotive
TH

mechanics habitually use awkward back posture in their course of manual activity and hence may be at risk of work-related
back pain.
OBJECTIVE: To investigate the prevalence, pattern and severity of back pain among automotive maintenance mechanics,
as well as the personal and job variables associated with or predicting occurrence of back pain.
METHOD: Using a cross-sectional design, information about self-reported back pain and the associated variables were
AU

collected among 684 randomly recruited automotive mechanics.

RESULT: Prevalence of back pain was 76.02%; with the majority experiencing low back pain. 63.3% of the workers reported
they limited their activity due to the back pain. Older workers (>50 years), daily work lasting ≥5 hours duration, no more
than primary education, being normal weight, frequent use of kneeling and sustained postures, and lack of knowledge of
ergonomic postures were associated with increased prevalence of back pain. Lack of job autonomy, inadequate task clarity,
heavy physical work load, manual material handling, strenuous posture, noisy environment, vibrations, work schedule and
inadequate auxiliary support were also associated with increased prevalence of back pain among the mechanics.
CONCLUSION: Work-related back pain is prevalent among automotive maintenance mechanics. Work-related back pain
is high among automotive maintenance mechanics. Workstation policy and legislation on reduction of risks with combined
health literacy and ergonomic education programs in this occupational group are imperative.

Keywords: Musculoskeletal risk, back pain, manual handling, automobile servicing and repair

1. Background of the study

∗ Address for correspondence: U.O. Abaraogu, Department of
Back pain is a common cause of disability in
Medical Rehabilitation, Faculty of Health Science and Tech-
nology, College of Medicine, University of Nigeria, Enugu
the working population [1–3], and its total costs
Campus, Enugu, Nigeria. Tel.: +234(0)8063582105; E-mails: have been estimated to be among the highest for
uabaraogu@yahoo.com; Ukachukwu.Abaraogu@unn.edu.ng. disease for which economic analysis is available

1051-9815/16/$35.00 © 2016 – IOS Press and the authors. All rights reserved
814 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics
[4]. Associations between working environment and
musculoskeletal symptoms (MSS), including back
pain, have been reported, and ergonomic factors such
as awkward working postures, static load and task
invariability are among the most important risk fac-
tors for MSS [5, 6]. Occupations involving manual
handling and physical workload are known to pre-
dispose to musculoskeletal disorders, including low
back pain [7].
Automotive maintenance mechanics mostly work
standing, kneeling or half kneeling, in forward flex-
ion, and on a hard floor. Individuals who continuously
adopt these working positions are more likely to
suffer from back pain [8]. European and Asian stud-
ies have reported that this group of workers suffers
from various work-related health complaints, includ-
ing back pain [8, 9], with higher reported prevalence
CO
compared to workers in other occupations [9–11].
The prevalence of work-related MSS, including back
pain, may be even higher in developing countries like
Nigeria, due to the absence of effective work injury
prevention programs [12, 13].
This is so given that similar manual handling
occupational groups in Nigeria have reported higher
OR
prevalence of musculoskeletal disorders compared to
developed countries [14–17] indicating that Nigeria
workers maybe at higher risk to work-related mus-
culoskeletal disorders. In order to effect ergonomic
interventions among this group either by industry
TH
or government policies, epidemiological investi-
gation into the level prevalence and risk exposure
would be the first step. No study has investigated
the prevalence of back pain among automotive
maintenance mechanics in Nigeria. Also there is
AU
no literature on the specific correlates, determinants
or predictors of back pain in this group among
African populations. This study therefore aimed to
investigate the prevalence, pattern and severity of
self-reported back pain and associated personal and
job-related characteristics; and to predict occurrence
of back pain among this group of workers.
2. Materials and methods
This study is focused on automotive maintenance
mechanics in Enugu and Nsukka metropolises of
Enugu State, Eastern Nigeria who have in the past 12
months worked in direct mechanic activity. Enugu is
the capital of the Enugu state Nigeria and according
to the 2006 Nigerian census the Enugu metropoli-
tan area has an estimated population of 722,664.
Nsukka is a town and Local Government Area in
Enugu South-East Nigeria. Nsukka LGA has an area
of 1,810 km² and a population of 309,633 at the 2006
census [18].
2.1. Method
The study employed a cross-sectional descrip-
tive design, with 684 participants between May and
August 2013. A multi-stage sampling technique was
used. First, a list of all local government areas
in Enugu and Nsukka metropolises was compiled
PY
(n = 5). This was followed by a list of every layout in
each of the local governments, yielding a total of 87
layouts (10, 12, 14, 16, 18, 10 in A, B, C, D and E local
government areas). Altogether, a total of 64 mainte-
nance sites were identified each having between 3
and 26 mechanics, giving a total of 1048. Physical
examination and subjective assessment of the work-
ers, as well as discussions with the mechanic workers,
were done in order to rule out those who did not meet
the inclusion criteria into the study. Exclusion criteria
were congenital spinal problems, spinal deformity or
previous spinal surgery, lower limb length discrep-
ancy or any foot deformity that could impact on back
function. Sixteen people were ineligible for partic-
ipation in the study due to evidence suggestive of
scoliosis; 102 were excluded because they have back
pain dating before commencing mechanic work or
that their back pain were traceable to specific inci-
dence of trauma outside their work. Another 7 were
excluded because of limb length discrepancy. A fur-
ther 117 mechanics refused to participate; the reason
cited being mostly ‘not feeling like it’.
A list of eligible automotive mechanics was made
for each of the sites, giving a total of 806. We aimed
to sample at least half of the mechanics with a near
to equal representation, according to the number of
mechanics in each work station. We also aimed for a
fair representation of urban and semi-urban situated
stations. A proportional sampling was used to allo-
cate the number of mechanics to be included from
each site, layout and local area, according to the pop-
ulation of mechanics who met the eligibility criteria
described.
2.2. Participants
A total of 693 automotive mechanics between the
ages of 15 and 64 years, drawn from 64 workstations
in Enugu and Nsukka metropolis, Nigeria and who
met the inclusion criteria, participated in the study.
 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics
Nine eligible mechanics were excluded because the
forms on which measurements were written were not
filled in completely. Therefore, data for 684 partic-
ipants are reported. Ethical approval was obtained
from the University of Nigeria Teaching Hospital
Ethics and Research Committee. Participants were
fully informed about the data collection procedures
and protocol, after which informed consent was
obtained from those who volunteered to participate.
Only those who volunteered to participate in the study
were recruited. To be included, an individual had
to be an automotive mechanic, have worked con-
sistently for at least one year before the start of the
study, comprehend written English or Igbo language,
and not have any musculoskeletal symptoms (defined
as ache, pain, discomfort) of the back region not
related to work exposure. Worker were excluded if the
CO
responded that their back problem had stated before
they commenced automotive work or if their problem
is traceable to traumatic events outside auto mechanic
duty. Mechanics with congenital spinal deformities
were also excluded.
2.3. Measurement
OR
2.3.1. Background and demographics
A series of background and demographic items
including age, marital status, highest education
attainment, work experience, hours of mechanic
TH
activities per day were evaluated using a question-
naire.
2.3.2. Exposure assessment
Work exposure assessment (e.g. job characteris-
AU
tics, physical and psychosocial stresses of works,
constraints of workplace and tools, and hazards of
physical environment) was carried out using the
Nag’s multi-method ergonomic checklist [19] as
described by Vyas et al. [20]. This multi-method
check list is a 25 item check list and sought responses
to information such as job characteristics, physical
and psychosocial stresses of work, constraints of
workplace and tools, and hazards of physical environ-
ment. Following the methodology earlier described
by Vyas et al. [20], workers were asked for their
responses about their perception of the work aspect to
be strenuous. Responses were given on a single digit
score, on five point likertscale, from strong disagree-
ment (1) to strong agreement (5), where lowest score
indicated that a worker perceived the absence of a
problem. The relative loading of scores for each sec-
tion of the checkpoints was arrived at from the ratio
815
of the summated score value for that section to that
of maximum cumulative scores possible under that
section in line with earlier literature [20]. Accord-
ingly, relative loading of scores for each section were
such that values greater than 0.5 was considered as
a stressor. A reliability coefficient of 0.84 has been
reported for the ergonomics checklists [20].
2.3.3. Outcome variables
Outcomes were back pain at any region of the back,
knowledge of ergonomics, personal and work char-
acteristics, and stressors. Back pain outcomes were
PY
assessed with a series of questions adapted from mod-
ified Nordic Musculoskeletal Questionnaire (NMQ)
[21]. Apart from questions about back pain, the mod-
ified NMQ questioned further on the exact location
of the back pain (i.e. upper, mid or lower back). We
further modified the Nordic questionnaire to assess
severity of pain. Both the English and Igbo language
versions of the NMQ were available. The Igbo version
was administered only to those who did not com-
prehend written English. Cross-cultural translation,
validation and reliability of the Igbo language version
have been reported elsewhere [14]. The primary out-
come variable was the 1-year prevalence of back pain
(BP). A complaint of back pain was established with
the question “Have you had any pain at the back dur-
ing the past 12 months that you believe to be related
to your work?”
2.4. Data analysis
An analysis was carried out to determine the
minimum sample needed for the study, using the
prevalence of back pain reported by Vyas et al.
[20] and based on the minimum sample calculation
for infinite population [22], a 95% level of confi-
dence and a precision of 5% [22, 23]. Based on this
analysis, a minimum sample of 619.6 participants
was required. Data analysis was performed using
Statistical Package for Social Sciences version 15
(SPSS Inc., Chicago, IL, USA). Descriptive statis-
tics of frequency were used to analyze the report of
demographics, anthropometric and job history data,
as well as prevalence of back pain, knowledge of
ergonomics and pattern, and severity of pain. Associ-
ation of personal and job characteristics with back
pain prevalence were assessed by Chi-square, and
Tukey Post Hoc was used to delineate the specific
point of differences in prevalence among the multi-
nomial variables that showed significant association.
Kolmogorov-Smirnov Test with Lilliefor’s correction
816 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics

was used for normality checks, and distribution of Table 1

the data for most variables was found to be normal Personal and job characteristics of participants (n = 684)
(p > 0.05). To understand the effects of work stressors n (%)
on the prevalence of back pain, we used a multivari- Age (years)
ate analysis using binary logistic regression model <20 128 18.71
20–29 191 27.92
with backward elimination method. In the regression 30–39 154 22.52
model, variables such as specific perceived work fac- 40–49 118 17.25
tors were fed as continuous variables (0. 1), whereas 50–59 71 10.38
≥60 22 3.22
personal and job characteristics variables that showed
Experience (years)
association with prevalence were applied as categor- 1–5 159 23.2
ical covariates; such factors included age ≥30 years 6–10 182 26.7
or <60 years, working experience <10 years, work- 11–20 148 21.6
21–30 142 20.8
ing for ≥5 hours per day, formal education ≤ primary

PY
≥30 53 7.7
school, and having no knowledge of ergonomic pos- Daily working hours
ture. All the variables were applied simultaneously 1–4 27 3.90
in a backward logistic regression model, to derive the 5–7 340 49.7
≥8 217 46.3
effect of each work stressor on the prevalence of back Marital status

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pain. Married 290 42.4
Single 339 49.6
Separated 21 3.1
Divorced 19 2.8
3. Result Widowed 15 2.2
Highest Level of Education
3.1. Personal and job characteristics of None 68 9.9
participants Primary 415 60
OR
Secondary 160 23.4
Tertiary 41 6.0
A total of 684 automotive maintenance mechanics BMI (kg/m2 )
aged 15–64 in Enugu state Eastern Nigeria par- <18 Underweight 77 11.3
18–25 Normal weight 467 68.3
ticipated in the study. Table 1 shows the personal
>25 Overweight 140 20.5
characteristics of the participants. All the mainte- Task Performed by Workers
TH

nance mechanics were males and most were about Panel Beating 63 9.21
middle age, single, with primary education or less Vulcanizers/Wheel Alignment 115 16.81
Electrician 74 10.82
and of normal weight. Daily working hours were pre- Spray Painting 81 11.84
dominantly 5–7 hours, with most of the mechanics Welding 92 13.45
having 20 years or less of work experience in automo- Repairing 107 15.64
AU

tive maintenance. Tasks performed by the mechanics Cleaning 93 13.60

Servicing 59 8.63
ranged from vulcanizing, wheel alignment, welding Most common adopted postures
and cleaning to repair and servicing, and the main (rated in termsof frequency and duration)
work postures adopted were squatting, standing and Standing 99 14.5
sustained postures. Sitting 45 6.6
Kneeling 108 15.8
Bending 89 13.0
3.2. Report of back pain Squatting 113 16.5
Lying 50 7.3
The prevalence, severity and pattern of distribu- Sustained reaching/posture 106 15.3
Repetitive movement 44 6.4
tion of back pain, as well as activity limitation by Overhead reaching 30 4.4
back pain, are shown in Table 2. A total of 76.02%
(520) mechanics reported had at least one episode
of back pain in the last 12 months, most of whom
experienced the pain in the low back. About half of mainly from seminars or workshops, and health
participants had been prevented from doing activity personnel). The most commonly reported health or
by back pain in the last 12 months. Fewer than one in treatment seeking behavior or choice was treatment
five responded that they had knowledge of ergonomic chemist/over the counter drug, and this was closely
posture (those that had such knowledge gained it followed by resorting to self-management.
 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics 817

Table 2 Table 3
Prevalence, pattern, severity, and activity limitation by back pain Association of personal, job characteristics, task performance
and knowledge of ergonomic posture and postures with back pain
n % Variable n % Chi-square p
Prevalence Age (years)
Yes 520 76.02 <20 100 68.13
No 164 23.98 20–29 136 71.20
Pattern 30–39 109 70.78 14.264 0.014
Upperback 66 12.7 40–49 95 80.51
Midback 73 14.0 50–59 64 90.14
Lowerback 381 73.3 ≥60 16 72.73
Severity (Numerical pain rating scale) Experience (years)
(1–3)Mild 103 19.8 1–5 108 67.92
(4–6) Moderate 88 16.9 6–10 144 79.12 8.231 0.083
(7–10) Severe 329 63.3 11–20 117 79.05

PY
Activity limitation 21–30 112 78.87
Yes 262 50.4 ≥30 39 73.58
No 258 49.6 Daily working hours
Knowledge of ergonomic posture 1–4 20 74.07
Yes 130 19.01 5–7 289 95.07 30.665 0.000
No 554 80.99 ≥8 211 97.23

CO
Source of information Marital status
Seminar/Workshop 45 33.8 Married 231 79.66
Mass media 7 6.2 Single 259 76.40
Friends/Relatives 11 7.7 Separated 18 85.71 9.396 0.094
In-house safety training 25 19.2 Divorced 19 100.00
Health personnel 42 33.1 Widowed 14 93.33
When you have back pain how do most commonly manage it? Highest Level
Self-management 192 28.10 of Education
OR
Chemist/Over the counter drugs 241 35.20 None 68 100.00
Herbal remedy 73 10.70 Primary 389 93.73
See a Doctor 134 19.60 Secondary 57 35.63 320.892 0.000
See a Physiotherapist 44 6.40 Tertiary 6 14.63
BMI(kg/m2 )
<18 Underweight 39 50.65
18–25 Normal weight 379 84.79 34.798 0.000
TH

3.3. Association between personal and job >25 Overweight 102 72.86
characteristics and prevalence of back pain Task Performed by Workers
Panel Beating 54 85.71
Vulcanizers/ 84 73.04
The association between personal and job char- Wheel Alignment
acteristics, and prevalence of back pain is shown Electrician 49 66.22
AU

in Table 3. Prevalence was high (over 67%), even Spray Painting 69 85.19 42.533 0.000
Welding 82 89.13
among those with only 1–5 years experience, and Repairing 86 80.37
there was no significant association between years of Cleaning 64 68.82
experience working in automotive maintenance and Servicing 32 54.24
prevalence. Most common
adopted postures
The prevalence of back pain was highest in the Standing 53 53.53
50–59 age group and lowest in the <20 age group. Sitting 36 80.00
Older age was significantly associated with higher Kneeling 102 94.44
prevalence (p = 0.014). Differing weight status was Bending 73 82.02
Squatting 82 75.57 113.174 0.000
also significantly associated with a prevalence of Lying 17 34.00
back pain (p < 0.001), and prevalence was highest Sustained reaching/posture 96 90.57
in those of normal weight and lowest in the under- Repetitive movement 37 84.09
Overhead reaching 24 80.00
weight. Similarly, increasing level of education was
Knowledge of
significantly associated with decreased prevalence, Ergonomic posture
with prevalence highest among those with no formal Yes 10 7.69
education and lowest among those with tertiary edu- No 510 92.06 411.142 0.000
cation (p < 0.001). The association between job tasks Significance at P ≤ 0.005.
and back pain was significant, with prevalence being
818 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics
highest among the welders and lowest among servic-
ing men. Similarly, knowledge of ergonomics was
significantly associated with decreased prevalence of
back pain, with prevalence lowest among those who
reported knowledge of ergonomic posture.
3.4. Post hoc analysis of association between
personal characteristics and back pain
Table 4 shows the post hoc analysis of the signifi-
cant association observed between age, daily working
hours, and levels of education, weight status, job
status, and most commonly adopted posture and
prevalence of back pain. For the post hoc of age,
the only significant results were those increase preva-
lence seen in those 50–59 years when compared to
20–29 years (p = 0.017), and 30–39 years (p = 0.019).
CO
There was a significant decrease in prevalence of back
pain for those who worked 5–7 hours compared to
those who worked at least 8 hours (p < 0.001). For
post hoc analysis of educational status and back pain,
higher education attainment was consistently asso-
ciated with lower prevalence of back pain, except
that those with no formal education and those with
OR
primary education had similar prevalence (p = 0.42).
Similar significant associations were seen in all
comparisons of weight status, except that between
those of normal weight and the overweight or obese
(p = 0.098).
TH
Post hoc comparison of association between job
tasks and prevalence of back pain were significant
between panel beaters and electricians (p < 0.001),
panel beaters and servicing men (p < 0.001), panel
beaters and vulcanizers (p = 0.001), panel beaters
AU
and painters (p < 0.004), panel beaters and welders
(p = 0.014), welders and service men (p = 0.015),
repair and service men (p = 0.003), and cleaners and
service men (p = 0.005). All other job task group com-
parisons were not significant. For post hoc analysis
of the association between self-reported most adopted
posture and prevalence of back pain, prevalence was
significantly different for those who adopted mostly
standing posture compared with those with sit-
ting (p = 0.006), kneeling, bending, sustained posture
(p = < 0.001s), squatting (p = 0.014), and repetitive
movement (p = 0.001). Those who adopted mostly
sitting posture differed in prevalence compared with
those who adopted mostly squatting (p = 0.001), or
lying (p < 0.001). Similarly, workers adopting mostly
squatting showed a significant difference from those
who adopted a lying (p < 0.001) or sustained posture
(p < 0.001) as did those who adopted lying pos-
ture compared to those who adopted a sustained
posture, repetitive movement or overhead reaching
(p < 0.001s).
3.5. Factors predicting back pain among
the participants
Multivariate analysis was done using a binary
logistic regression model with a backward elimina-
tion method, to understand the effect of different
job characteristics on the prevalence of back pain as
dependent variable, among the automotive mainte-
PY
nance workers, as shown in Table 5. The multivariate
analysis showed that the factors associated with back
pain among the automotive maintenance mechanics
were lack of job autonomy, inadequate task clarity,
noise in the environment, manual handling, strenuous
posture, heavy physical work load, vibration, work
schedule, and inadequate auxiliary support.
4. Discussion
4.1. Prevalence reports
To our knowledge, this is the first study in Nige-
ria investigating back pain in the automotive sector.
Our findings revealed that 12-month prevalence of
back pain among the automotive maintenance work-
ers was high, the low back being the most affected.
This prevalence is higher than the 64.5% or 64.8%
reported among professional drivers [16, 24], and the
65.6% among timber workers [14] in Nigeria. It is
also higher than the prevalence reported among some
automobile worker [25], including among Chinese
[26, 27], Iranian [28], automobile workers. Low back
was reported as the most affected body region with
pain in a Chinese study [26].
The high prevalence of back pain seen in this group
compared to other job settings in Nigeria, and to sim-
ilar job settings in other countries, raises a public
health issue. Certainly, the fact that about half the
participants have been prevented from activity in the
past 12 months by cases of back pain is cause for
concern, and may indicate relatively high exposure
to risk factors in these workers. Few of the workers
had knowledge of ergonomic posture, demonstrating
a need for awareness creation of work ergonomics
among this group. Particularly, seminars and work-
shops should be aggressively pursued; and clinicians
should include ergonomic education as a core compo-
nent of interventions during back pain management.
 Table 4
Post hoc of association of personal, job characteristics, task performance and postures with back pain (Tukey Post hoc HSD)
Age(years) <20 20–29 30–39 40–49 50–59 ≥60
<20 – 0.07 (0.71) 0.07 (0.70) –0.02 (1.00) –0.12 (0.40) 0.05 (1.00)
20–29 – 0.00 (1.00) –0.09 (0.42) –0.19 (0.017∗ ) –0.02 (1.00)
30–39 – –0.10 (0.41) –0.19 (0.019∗ ) –0.02 (1.00)
40–49 – –0.10 (0.66) 0.08 (0.97)
50–59 – 0.17 (0.54)
≥60 –

Working hours 1–4 5–7 ≥8

1–4 – –0.11(0.39) 0.08(0.64)
5–7 – 0.18(0.000∗ )
≥8 –

Highest Level of Education None Primary Secondary Tertiary

None – 0.06(0.42) 0.64(0.000∗ ) 0.85(0.000∗ )
Primary – 0.58(0.000∗ ) 0.79(0.000∗ )
Secondary – 0.21(0.001∗ )
Tertiary –

BMI(kg/m2 ) Underweight
AU Normal weight Overweight/Obese
Underweight – –0.31(0.000∗ ) –0.22(0.001∗ )
Normal weight – 0.08(0.098)
Overweight/Obese
TH –

Workers Tasks Panel Beat Vulca Elect Paint Weld Repair Clean Servicin
Panel Beating – 0.27(0.001∗ ) 0.34(0.000∗ ) 0.26(0.004∗ ) 0.23(0.014∗ ) 0.20(0.058) 0.19(0.12) 0.46(0.000∗ )
OR
Vulcanizers – 0.07(0.96) –0.007(1.0) 0.04(1.0) 0.07(0.89) 0.08(0.90) 0.19(0.09)
Electrician – –0.08(0.95) –0.11(0.64) –0.14(0.32) –0.15(0.53) –0.12(0.72)
Spray Painting – –0.04(1.00) –0.07(0.96) –0.07(0.96) 0.20(0.11)
Welding
CO – –0.03(1.0) –0.04(1.0) 0.23(0.015∗ )
Repairing – –0.006(1.0) 0.26(0.003∗ )
Cleaning – 0.27(0.005∗ )
Servicing
PY –

Most common adopted postures Standing Sitting Kneeling Bend Squat Lying Sustain Repet Overhead
Standing – –0.265(0.006∗ ) –0.41(0.000∗ ) –0.28(0.000∗ ) –0.19(0.014∗ ) –0.20(0.099) –0.37(0.000∗ ) –0.31(0.001∗ ) –0.27(0.035)
Sitting – –0.14(493) –0.02(1.00) 0.07(0.98) 0.46(0.000∗ ) –0.11(0.85) –0.04(1.00) 0.00(1.00)
Kneeling – 0.12(0.40) 0.22(0.001∗ ) 0.60(0.000∗ ) 0.04(1.00) 0.10(0.87) 0.14(0.69)
Bending – 0.09(0.75) 0.48(0.000∗ ) –0.09(0.85) –0.02(1.00) –0.02(1.00)
Squatting – 0.39(0.000∗ ) –0.57(0.000∗ ) –0.11(0.78) –0.07(1.00)
U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics

Lying – –0.57(0.000∗ ) –0.50(0.000∗ ) –0.46(0.000∗ )

Sustained reaching/posture – 0.06(1.00) 0.11(0.93)
Repetitive movement – 0.04(1.00)
Overhead reaching –
Data are presented as mean difference and (p) values. ∗ Indicates statistical significance (p < 0.05). Keys: Panel Beat = Panel beating, Vulcal = Vulcanizer, Elect = Electrician, Pain = Spray painting,
819

Clean = Cleaning, Servicin = Servicing.

820 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics

Table 5
Stepwise logistic regression for disclosing perceived work place stressors responsible for back pain
95% Confidence Interval
Variable Regression Co-efficient Lower Upper Odd ratio p–value
Lack of job autonomy 1.36 1.7 8.04 3.9 0.01
Inadequate task clarity 1.12 0.98 12.6 3.57 0.04
Heavy Physical work load 1.57 0.71 16.31 4.3 0.042
Manual material handling 1.6 1.4 13.9 7.2 0.011
Strenuous posture 0.7 0.8 4.25 6.9 0.016
Noise in the environment 0.57 0.9 4.5 2.7 0.007
Vibrations 0.9 0.98 5.75 5.4 0.008
Work schedule 1.8 1.2 6.1 6.3 0.03
Inadequate auxiliary support 1.8 1.5 20.2 5.8 0.004
Significance at P ≤ 0.005.

PY
Back school is a particular area that may benefit these this is the case or are these time periods related to
workers. aging generally. In terms of the relationship between
Among the different specialties of automotive increasing age and prevalence of back pain, several
work, welders had the highest prevalence. This can authors [11, 30, 31] have shown evidence of this
be attributed to the fact that welding entails bending,
sustained static posture or a combination of several
unsound postures. This is further corroborated by the
fact that kneeling and sustained posture were the most
COoccurring in the general population.

4.3. Association with daily working hours

adopted posture among the workers. This finding is
in line with NIOSH [29], in which a relationship
OR
between these postural factors and back pain has been
established. About three quarters of the respondents
tried to mitigate their pain with over-the-counter
drugs, self-medication or herbal treatment, and only
about one quarter sought treatment from either a med-
TH
Our findings demonstrated that longer daily
working hours (≥5 hours) in automotive mechanic
maintenance tend to lead to a rise in the prevalence
of back pain. In a related job setting, Vyas et al. [20]
found that workers who had worked for lengthy peri-
ods were at a higher risk than those who worked for
shorter durations. This may be associated with fatigue

ical doctor or physiotherapist. Similar observations related to long working hours, which may increase the
were reported by Burton et al. [30], among children risk of injury [31].
and youths aged 10–19 years. What could explain
this care seeking behavior among these workers even 4.4. Association with weight status
when majority (63%) reported that their back pain
AU

were severe? We did not investigate health believes
in terms of seeking remedy among these group, nei-
ther did we asked question regarding accessibility to
health services; or the level of satisfaction with their
treatment choices. The question to also ponder is do
these workers have enough health literacy to navi-
gate the health system so as to access optimum care?
These need to be answered by future research in this
group.
4.2. Association with age
In this study, reported experience of back pain
among the participants increased significantly with
advancing age up to the 50–59 years old. This may
suggest that these age groups are critical to back pain
incidence among automotive mechanics workers;
prospective research is needed to determine whether
Our study showed that weight status was not signif-
icantly associated with back pain. However, normal
weight individuals had the highest prevalence while
the underweight had the lowest prevalence. The lack
of association between overweight and back pain was
surprising, given the overwhelming evidence of the
effect of increasing weight on the mechanical load-
ing of the spine. The effects of decreasing loading
intensity on back biomechanics have been examined,
but whether being underweight confers an advantage
in terms of predisposition to back pain is not known.
Nevertheless, the high prevalence of back pain in the
normal weight or low prevalence in the underweight
may be connected to some other intervening vari-
ables outside weight status. Particularly, the weight
back pain interactions reported were not gender and
age specific as this objective is outside the scope of
the present research.
 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics
4.5. Association with level of formal education
This study found an association between level of
education and prevalence of back pain among the auto-
motive maintenance workers. The highest prevalence
of 12-month back pain was found among those with
no formal education, and the lowest among those with
tertiary education. Level of education has been shown
to be inversely associated with work-related muscu-
loskeletal discomforts [32], and use of traditional folk
remedies of complementary and alternative medicine
[33]. We did not study the relationship between level of
education and remedy-seeking trends, but in a previ-
ous study it was found that increased level of education
has a direct effect in health literacy, which in turn influ-
ences exposure to disease risks and health-seeking
behaviours [34]. It could be suggested, therefore that
CO
people in this sector, comprising mainly individuals
with primary education or less and with little knowl-
edge of health issues, are at increased risk of exposure
to work-related musculoskeletal disorders, particu-
larly back pain, and are thus more likely to resort to
unconventional remedies to treat back pain, as seen
in our findings. Certainly, this triad is another public
OR
health issues in terms of wider determinants of indus-
trial health.
4.6. Perceived work place stressors responsible
for back pain
TH
The study found that workers who lacked job
autonomy, received inadequate task clarity or auxil-
iary support reported higher prevalence of back pain.
Evidence of work psychosocial stressors and relation-
AU
ship with psychosocial stress symptoms including
work-related musculoskeletal disorders are well doc-
umented in literature [35–38]. One possible link
between lack of job autonomy and back pain could be
through a complex interaction with physical factors.
Davis and Marras [39] suggest that physical fatigue
is significantly increased during manual work under
suboptimal conditions and the degree of interaction
with psychosocial stressors including suboptimal job
autonomy is highly predictive of pain. Supporting
this theory, Clays et al. [40] stated that baseline low
decision latitude (low control) correlated with the
incidence of low back pain. Similarly, inadequate
task clarity could put the worker at higher mental
and psychological stress invariably eliciting the same
cascade as would do inadequate auxiliary support.
These were corroborated by Golabadi and colleagues
in their findings [41].
821
And talking about physical stressors, in this study
workers who had noise in the environment were at
increased risk of back pain as do those with heavy
physical work load, involved in manual handling or
strenuous posture. Exposure to vibration and tighter
work schedule were also found to be responsible for
the reported back pain. How could be the possible
links between these physical stressors and back pain
in this occupational group? Individuals with high
exposure to awkward trunk postures or an overall
physically demanding job had a higher likelihood of
incident LBP [42]. Also tighter work schedule among
PY
these worker mean higher tendency for fatigue related
symptoms [41] thereby could prepare a pathway for
back pain vulnerability. This assertion is valid consid-
ering emerging biological link between fatigue and
MSDs [39, 40].
These findings have wide implications, in that
automotive maintenance industries in Nigeria are
largely non-formal and poorly organized, and lack
injury-prevention policies. Workers predominantly
carry out maintenance tasks in the highly unsound
conditions as seen during visits to this sites. Many
who are undergoing apprenticeships are subjected to a
heavy work load with rigid deadlines and inadequate
job clarity. Additionally, the use of noise protective
devices is lacking among Nigerian automotive main-
tenance workers, who are often exposed to noise in
the workstations.
Much remains to be done. Legislation on mini-
mum workstation safety standards, including wearing
of appropriate industrial protective aids, is among
the priority areas in this group. Also, occupational
safety seminars and work shops for all those work-
ing in the automotive maintenance industry should
be compulsory, while continuing education on safety
precautions at work places should be an ongoing exer-
cise for this group of workers.
5. Conclusion
The prevalence of back pain among automo-
bile mechanics is higher compared to that of many
countries. Majority of these workers do not seek con-
sultation with a Doctor or a Physiotherapist even
when majority of pain is severe and limit activity.
Also knowledge of ergonomics is low in these work-
ers. Factors associated with the back pain include
strenuous work postures, lack of job autonomy, inad-
equate task clarity, heavy physical work load, noise
in the environment among others. We suggest that
822 U.O. Abaraogu et al. / Work-related back discomfort among Nigerian automotive maintenance mechanics
health education programmes and measures directed
towards prevention of occupational diseases would
help to improve the health of automotive maintenance
mechanics, particularly in decreasing the prevalence
of back pain. Specifically, seminars and workshops
should be aggressively pursued; and clinicians should
include ergonomic education as a core component
of interventions during back pain management. Back
school is a particular area that may benefit these work-
ers.
5.1. Limitations
First, the 12 months prevalence as well as the self-
report prevalence of back pain implored in our study
may be prone to recall bias. Also, social desirability
bias may be a problem affecting the accuracy of the
data due to the utilization of self-reported question-
naires as a major method of data collection. Again,
the cross sectional design of our research at best
explained associations; and a cause and effect relation
between the factors and back pain cannot be inferred.
Interpretation should be done in light of these limita-
tions.
OR
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