African Journal of
Medical and Health Sciences

  • Abbreviation: Afr. J. Med. Health Sci.
  • Language: English
  • ISSN: 2384-5589
  • DOI: 10.5897/AJMHS
  • Start Year: 2017
  • Published Articles: 54

Full Length Research Paper

Back and upper body musculoskeletal pain and associated factors among medicine and nursing practicing students at university of Gondar, Ethiopia

Getasew Yirdaw
  • Getasew Yirdaw
  • Department of Environmental Health, Faculty of Health Science, Debre Markos University, Debre Markos, Ethiopia.
  • Google Scholar
Yonas Lamore
  • Yonas Lamore
  • Department of Environmental Health, Faculty of Health Science, Debre Markos University, Debre Markos, Ethiopia.
  • Google Scholar
Abate Lette
  • Abate Lette
  • Department of Public Health, Faculty of Health Science, Madda Walabu University, Bale Goba, Ethiopia.
  • Google Scholar
Sintayehu Daba
  • Sintayehu Daba
  • Department of Environmental and Occupational Health and Safety, Faculty of Health Science, University of Gondar, Gondar, Ethiopia.
  • Google Scholar

  •  Received: 02 July 2019
  •  Accepted: 02 June 2021
  •  Published: 31 July 2021


Musculoskeletal pain are common problems for nursing and medicine students especially in developing countries. The study aimed to assess the prevalence and associated factors of back and upper body musculoskeletal pain among nursing and medicine students at the University of Gondar. Institution based cross-sectional study was conducted. Stratified simple random sampling technique and structured self-administered questionnaires were used for data collection. All questionnaires were entered into EPI™ version-7 then exported to SPSS™ version-20. Bivariate and multivariate logistic regressions were employed to ensure further significance with subsequent use of odds ratio to show the strength of the association with 95% (CIs). Magnitude of musculoskeletal pain in different body parts was 54% back pain and 36.7% neck pain. Sex difference (AOR: 0.607, 95% CI [0.062, 0.935]), alcohol consumption (AOR: 1.821, 95% CI [1.002, 4.130]), and sufficient rest break (AOR: 0.494, 95% CI [0.044, 4.202]) has significant association to back pain. Also, department (AOR: 3.399, 95% CI [1.340, 3.418]), year of study (AOR: 1.912, 95% CI [1.001, 5.349]) and sleep hours per day (AOR: 1.670, 95% CI [1.507, 4.801]) have significantly associated with neck pain. The overall magnitude of back pain and neck pain in medicine and nursing students were high. Therefore, interventions on organizational factors as well as personal factors should be done to reduce the burden of lower back and upper body musculoskeletal disorders.

Key words: Back pain, neck pain, musculoskeletal pain, upper body, university students.


Currently musculoskeletal pain is the major morbidity causing element across the world. Work-related musculoskeletal pain (MSP) has been described has one of the occupational hazards and it has significant global health problems (Lette et al., 2018; Bernal  et  al.,  2015).  According  to  the  United States  (US) Bureau  of  Labor  Statistics  (BLS),  suffering  and  pain  is  experienced  in  addition  to economic  burdens  incurred  due  to  this problem (Castro, 2006). Work-related MSP affects workers’  quality   of   life   and   capacity    of   productive (Hagberg et al., 2012; Dorman, 2012).  Across the employees the cost of occupational work-related MSP, is also important for employers and societies (Amin et al., 2014). In developed countries about 2% of the gross domestic income is gone for the expenditure of work-related musculoskeletal pain (MSP) not calculating the productivity losses and social costs. According to global bank (GB) estimation, MSP has been the case for million days’ work absenteeism due to sickness annually (Linaker et al., 2011; Lette et al., 2019) and it is one of the major cause for hospital nursing practices.

Comparatively nurses showed 30% more sickness absenteeism than other occupants (Abedini et al., 2015). Studies indicated that because of work-related MSP nurses are going to leave their profession, that is why the current profession shortage across the world worldwide (Trinkoff et al., 2003; Strong et al., 1990; Mehrdad et al., 2010; Taylor et al., 2007; Lette et al., 2019). Studies indicated that health professional affected about 4.5 times more than other engineering and manufacturing field professionals by work-related musculoskeletal pain (MSP) (Mehrdad et al., 2010; Kilbom, 1998; Hinmikaiye et al., 2012). The annual incidence of work-related musculoskeletal pain (MSP) among United Kingdom nurses were ranges from 40-85% (Chetty, 2010). The problem is also high among U.S nursing population as 2011 survey (Labriola, 2008). Studies from Iran showed that, the lower back pain is the most common work-related musculoskeletal pain (MSP) among nurses with a one year prevalence rete of 30-62% (Trinkoff et al., 1990; Mehrdad et al., 2010; Karahan et al., 2009). Neck and shoulder prevalence ranged from 36-54% cited as common cases in nurses and varies 46-88% for hospital nurses (Amin et al., 2014; Trinkoff et al., 2003; Smith et al., 2006;  Luxembourg, 2004; Mehrdad et al., 2010; Nyland and Grimmer, 2003).

Sociodemographic, psychosocial and patient positions like sleeping and siting conditions have an association along with nurses’ activities to develop musculoskeletal pain (Lette et al., 2018; Bernal et al., 2015; Qin et al., 2014; Choobineh et al., 2006; 24.  Brink, 2008; Lee et al., 2013; Dawson et al., 2009; Strong et al., 1990; Swain et al., 2003; Oosthuizen and Ehlers, 2007; Schultz et al., 2005; Yelin et al., 1986; Karwowski and Marras, 2003; Mody and Woolf, 2003).    

In Ethiopia, very little study has been done on work-related MSP specifically among nurses and medicine practicing students. The objective of this study was to assess back and upper body musculoskeletal pain among health science practicing students at GC campus.  


Study setup 

An institutional based cross sectional study was employed from April to May, 2017. The University of Gondar is very senior in the country. It had  about  43,000  students  in  five  campuses   named  as  Teddy,  Maraky,  Fasil,  Melese zenawe  and  GC campuses which are  found in Gondar town. The town far 725 km from capital of the country. GC alone encompasses about 6888 medical and health science students at 12 different department. About 2,193 were medicine and nursing students.

Sample size determination

Single population proportion formula was used to determine sample size. Assuming 50% proportion since there was no similar study conducted across the country. 95% of confidence interval and 5% of marginal error were used by considering 10% for non-response rate to get a total sample size of 422.    

Sampling techniques

A stratified sampling technique was used for department selection. The participants were stratified based on their respective departments and year of study. Then, simple random sampling, lottery method was used to select respondents and allocating sampling proportional to the total population of each stratum was made.

Data collection tools and procedures

Pre-tested and structured questionnaire was used to collect data through self-administered method. Two days training was given for data collectors and supervisors before the actual data collection.

Data quality control

The data quality was assured by proper design and 5% non-participant pre-test. Training was given for data collectors and supervisors before the actual data collection.  Every day after data collection, there was questionnaire review and completeness check by supervisors and principal investigator. Necessary feedback would be offered to data collectors in the next morning. For  error control 10%  of  the  questionnaire  would  be  double  entered  into  the software during  data  analysis.

Data processing and analysis

Visually checked questionnaire was coded and entered into Epi-info™ version7 before exporting to SPSS™ version 20 software for analysis. The data was analyzed using logistic regression to determine the effect of various independent factors. The results was presented using descriptive statics. The degree association of variables was assessed using odds ratio of 95% confidence interval.

Operational definitions

Upper body musculoskeletal pain

Self-reported musculoskeletal symptoms in  the  neck, shoulders, elbows, and hands or wrists were defined by aches, disorder, or discomfort during the 12 month preceding completion of the questionnaire.

Back musculoskeletal pain

Self-reported  musculoskeletal  symptoms  in  the  lower  and upper back were defined by aches, disorder, or discomfort during the 12 month preceding completion of the questionnaire.

Body mass index

Weight in kilograms divided by the square of the height in meters (kg/m2). Underweight= BMI <18.50, Normal range= BMI b/n 18.50-24.99, Overweight = BMI b/n 25.00-29.99, and Obese= BMI =30.00.


A score measured using the generic satisfaction scale as yes (26 - 45) and no (26 or less). 


A  score measured using  the  stress  scale  as yes  (24  to  40)  and  no  (lower  than  or equal 23).

Health and safety training

A student who has got any kind of training in one year period through any kind of media about health and safety rule implemented in the campus. 

Cigarette smoking

It  is  a  practice  of  smoking  cigarette  by  students  for  at  least  one  sticks  of cigarette per day.

Alcohol drinking

it is a consumption of any kind of alcohol by students at least for two times per week for different purpose.

Physical exercise

Performing any kinds of physical exercise at least two times per week and for 30 min.

Ethical consideration

An ethical clearance letter was obtained from Ethical Committee of the University of Gondar College of Medicine and Health Science. Participants gave consent before data collection. The purpose of the study was clearly explained for the participants. Anonymous questionnaires were used to assure the confidentiality of the information obtained from participants. The consent form, focus group confidentiality binding form information sheet and questionnaires were  available  in  English.  Participants  were  also informed  to  their  rights  to  withdraw  from  the study at any stage without  prejudice.


From the total 422 distributed questionnaires 100% response rate was returned.

Socio-demographic characteristics of the study participants

The majority 270 (64.0%) were males. The mean age with standard deviation of the respondents was 23.15 ± 2.146 years and the age of the study participants range from 19 to 30 years. Among 422 respondents, 50 (11.8%) were nurses and 372 (88.2%) respondents were medicine students. Regarding to year of study, one thirds 122(28.8%) of the students were 3rd years (Table 1).

Environmental factors of the study participant

About one fourths 96(22.7%) of the study participants worked in demonstration/pre-clinical attachment. The majority 106 (74.88) of the students practiced for more than or equal to 20 h per week in average. About forty percent 161(38.3%) of the respondents used the chair which have arm rest and back support. Regarding the sitting position, 180(42.7%) of the students were sitting in a constant position for more than 2 h (Table 2).  

Behavioral factors of the study participant

About 144(34.1%) had a habit of doing physical exercise, 330 (78.2) were not smokers, 104(24.6%) had chewing behavior and 138(32.7%) consume alcohol. Around 78(18.5%) were reading 7 h per day, and 226(53.6%) were reading for more than 2 h continuously without a break. From the total respondents, the majority 405(96%) have a stress. Also more than one thirds 145(34.4%) of the respondents are unsatisfied (Table 3). About half 205(48.6%) of the study participants were read more than 6 times per week. One thirds 133(31.5%) of the students also read for 3 - 6 times per week (Figure 1).

Back and upper body musculoskeletal pain symptoms

Study finding indicated that 228 (54%) of the participants have been encountered by back  pain,  155(36.7%)  neck  pain  and  52(12.3%) shoulder  pain  in  the  last  12  months (Table 4).

Factors associated with back and upper body musculoskeletal pain

The multivariable logistic regression analysis determined sex, alcohol consumption and sufficient rest break were significantly associated with back pain. Regarding neck pain department, year of study and sleeping hours per day were showed significant association. Male students were  0.607  (AOR:   0.607,  95%  CI: 0.062, 0.935) times less likely develop back pain than female students. Also a student who have consumed alcohol 1.821(AOR: 1.821, 95% CI: 1.002, 4.130) times more likely affected with back pain compared with their counterparts. The students who have a sufficient rest break were 0.494 (AOR: 0.494, 95% CI: 0.044, 4.202) times less likely develop back pain compared with those who did not take sufficient rest break.

Medicine students were 3.399 (AOR: 3.399, 95% CI: 1.340, 3.418) times more likely developed neck pain than nursing students. Participants who sleep less than or equal to 7 h per day were 1.670 (AOR: 1.670, 95% CI: 1.507, 4.801) times more likely affected with neck pain than who sleep more than 7 h per day. Third year students were 1.912 (AOR: 1.912, 95% CI: 1.001, 5.349) times more likely affected with neck pain compared with six year (Table 5).

The prevalence of neck pain among medicine and nursing students were 36.7%. Department, year of study and sleeping hour per day were significantly associated with neck pain. The finding is in line with a study done in Iran among nurse (36- 54%) (Trinkoff et al., 2003). However, the overall prevalence of neck pain in this study is higher when compared with the study in Ghana (Moroder et al., 2011), Turkey (Bilge et al., 2014) and Norway (Hogg-Johnson et al., 2009). The magnitude of neck pain is lower than in New Zealand (57%), China (47.8%) and Saudi Arabia (55%) (Hogg-Johnson et al., 2009; Samotoi et al., 2008; Al Wazzan et al., 2001) studies. The observed variations could in part be due to differences in population (race and ethnicity), socio-economic status and availability of infrastructures, study design and sample size, and predisposing factors.

Campus stay year had significant associated with neck pain. This finding is in line with a study done in Malaysia (Muhammed  et   al.,   2015).   A   study   at   Washington University (USA) on medicine and health science students showed department as associated factor with neck pain. This is in line with our study result, medicine students were 3.399 times more likely affected with neck pain than nursing student (Deyo et al., 1998).


Findings show that the magnitude of back and neck pain in medicine and nursing students were high. High alcohol consumption and insufficient rest break can raise the back pain. Also department, year of study and sleeping hour were significantly associated with neck pain. Therefore, interventions of organizational factors like the quality of services given by the institution and design of the teaching and learning systems, personal factors like alcohol drinking behavior and reading style should be done on the  campus to improve the health and wellbeing of the students.


The authors have not declared any conflict of interests.


The authors appreciate the University of Gondar for supporting this study. They also thank the data collectors, medicine and nursing students for their collaboration.


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