Faculty of Health Sciences
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Item The epidemiology of low back pain in construction workers in the eThekwini Municipality of KwaZulu-Natal(2024) Moodley, Verushan; Pillay, Julian DavidBackground Low back pain (LBP) is a significant musculoskeletal disorder and a major occupational health concern globally. In developing countries, occupational LBP remains a major public health crisis, with high levels of LBP reported, resulting in high levels of absenteeism, disability, and a loss of productivity. Construction workers are involved in one of the most physically demanding occupations, making them exceedingly susceptible to LBP. They are also exposed to a variety of demographic, lifestyle, and occupational risk factors that may further predispose them to LBP. In South Africa, research on LBP amongst construction workers is currently lacking. The aim of this study was, therefore, to determine the epidemiology of LBP in construction workers in the eThekwini Municipality of KwaZulu-Natal. Methodology This study adopted a cross-sectional survey design. Participants were recruited from the two largest construction companies in the eThekwini Municipality. A sample size of 256 construction workers was used and questionnaires were provided to the participants at their respective companies. The questionnaire was divided into four sections, namely demographic factors, lifestyle factors, occupational factors, and LBP history. IBM SPSS version 28 was used to analyse the data. Descriptive statistics, such as mean, standard deviation and range, were used to summarise continuous data. Frequency counts and percentages were used to summarise categorical data. Risk factors for LBP were assessed for those who reported LBP. Pearson’s chi-square tests or Fisher’s exact tests were deemed as appropriate and were used to assess categorical factors, while t-tests were used to assess mean differences for continuous variables. A p-value of <0.05 was used to indicate statistical significance. Results A total of 256 construction workers in the eThekwini Municipality were investigated in this study. The mean age of the male participants was 34.2 ± 9.2 years, while the female participants were 37.5 ± 8.1 years. The mean BMI of the men was calculated as 24.1 ± 3.9 kg/m2 and for the women it was 32.0 ± 10.1 kg/m2. The females had a mean weight of 78.7 ± 18.7kg and the men had a mean weight of 69.8 ± 9.9 kg. The males had a mean height of 1.7 ± 0.1kg and the females had a mean weight of 1.6 ± 0.1 kg. The point and period prevalences were 16.8% (n=43) and 26.2% (n=67) respectively. The study reported that 54.3% of the participants experienced LBP on both sides of the lumbar spine, 43.2% experienced it daily, and 48.1% had mild pain. Factors such as height (p=0.507), weight (p=0.657), and BMI (p=0.657) were not significantly associated with LBP. It was noted that age (n=81; p=0.124) was marginally non-significantly higher in those with LBP. No association between LBP and sex was noted (p=0.517) and LBP was equally likely in men and women (31% in men and 37.5% in women). A longer duration of smoking (p=0.015), a higher number of cigarettes smoked per day (p=0.047), the presence of work-related stress (p=<0.001), personal stress, or both, were significantly associated with LBP. The general workers (43.2%; n=16), followed by the erectors (33.3%; n=6), were most likely to have LBP. The most frequently used treatment was getting advice from a general practitioner, 56.7% (n=17), followed by self-medication, 30% (n=9). Conclusion LBP continues to be a major health burden on construction workers, impacting their daily activities and causing disability. The prevalence of LBP reported in the study was similar to some of the previous studies, whilst it varied from others. Notwithstanding this, LBP in construction workers is a concern requiring urgent attention. A joint intervention strategy between health professionals and the construction industry is required. This will reduce absenteeism, stress, decreased productivity, and activity limitations.Item An epidemiological investigation into musculoskeletal pain in KwaZulu-Natal orchestral musicians(2024) Muhondo, Linley; Thandar, Yasmeen; Kell, ColetteBackground Non-communicable diseases pose a significant health threat worldwide. Of those diseases, musculoskeletal diseases are most responsible for a significant portion of occupational injuries in all job-sectors, including the musical sector. Musicians are prone to suffering from musculoskeletal injuries, more so than other populations. These injuries are termed playing-related musculoskeletal diseases (PRMDs). There are several risk factors associated with acquiring PRMDs including being of the female gender, age, and the type of instrument played. While most literature on musicians’ has been documented in countries abroad, there is a paucity of literature looking at the risk factors and attributes of African, and specifically South African, musicians. This is notable, as African musicians may have different characteristics to their international counterparts. The aim of this research was to examine orchestral musicians in Kwa Zulu-Natal from all sections of the orchestra to determine the prevalence of musculoskeletal injuries and the potential risk factors for these injuries, as well as their musculoskeletal injury profile. Methodology This study was a quantitative, cross-sectional descriptive study based on a self administered questionnaire. The questionnaire was piloted electronically and the necessary alterations were made. The final questionnaire was administered to members of 2 orchestras in Kwa Zulu-Natal, namely the Pietermaritzburg City Orchestra (25 members) and the Durban City Orchestra (30 members), making the targeted sample 55 musicians in total. All musicians who met the inclusion criteria were invited to participate in the study. The anonymously completed questionnaires were placed into marked boxes after completion to ensure musician anonymity. The data was analysed using IBM SPSS version 28. Association between specific risk factors and 12-month prevalence of MSK was assessed using Fisher’s exact 2-sided tests for categorical risk factors, and t-tests for continuous risk factors. A p-value of <0.05 was taken as statistical significance. Results Of the 55 musicians targeted, 30 of them participated, resulting in a response rate of 54.5%. Majority of the respondents were female (n=20). The data showed that the annual prevalence of PRMDs in the two orchestras was 46.7%. The point and one month prevalence were both 40%. The most injured section of the orchestra were the strings, followed by the woodwind section. The string section also reported the highest number of average affected areas in the orchestra (n=4). The most frequently injured anatomical sites of the body were the shoulders and wrists. There was no statistical significance found between the risk factors and injuries acquired. However, the results showed that females were injured more than the males (55%). Most of the respondents that reported musculoskeletal injury fell within the 18-24 age range and majority of the injured musicians fell in the overweight BMI body category. Most of the music teachers and the single career musicians in the study reported suffering from PRMDs and playing instruments for more than 16 hours a week on average. Conclusion The prevalence of playing-related musculoskeletal disorders among musicians was relatively high among the orchestral musicians in Kwa Zulu-Natal. Though not statistically significant, factors such as instrument played, age, and female gender were the factors that had the greatest influence on injury rates. The pain experienced was mild in nature and felt worse after playing their instruments. While the pain did not affect their activities of daily living, it did cause a few to change their way of playing or stop playing entirely for a period of time due to their pain. Majority of the players were aware of musician’s playing related health problems, and acknowledged that they are a problem, but none of them had received formal methods of education regarding them. The COVID-19 pandemic was a phenomenon that also affected the musicians in various ways.Item Determinants and acceptability of HIV self-testing among vulnerable groups in sub-Saharan Africa : a scoping review protocol(BMJ, 2024-01-29) Anyiam, Felix Emeka; Sibiya, Maureen Nokuthula; Oladimeji, OlanrewajuHIV self-testing (HIVST) is where individuals collect their specimens and perform the HIV test privately. HIVST has improved testing uptake and coverage, especially among vulnerable groups of sub-Saharan Africa (SSA). Vulnerable groups include key populations such as men who have sex with men, sex workers, people who inject drugs, lesbian, gay, bisexual and transgender persons and young women. However, little is known about the determinants and acceptability of HIVST among these groups in SSA. Therefore, this scoping review aims to explore the determinants and acceptability of HIVST among vulnerable groups in SSA.Methods
A scoping review will be conducted using the Arksey and O'Malley framework and further refined by Levac framework. The review will follow a six-step approach: (1) identifying the research question, (2) identifying relevant studies, (3) study selection eligibility, (4) charting the data, (5) collating, summarising and reporting the results and (6) consultation. A comprehensive search strategy will be developed, and the following electronic databases will be searched: MEDLINE, Embase, Global Health and the Cochrane Library. Grey literature will also be searched, including conference abstracts and reports. Eligibility criteria will include studies conducted in SSA, published between 2010 and 2023, focusing on vulnerable groups and exploring the determinants and acceptability of HIVST. Two independent reviewers will screen identified studies' titles, abstracts and full texts. Any disagreements will be resolved through discussion or consultation with a third reviewer. Data extraction will be conducted using a standardised form.Ethics and dissemination
This review, not requiring ethical approval, aims to inform policy and intervention design to boost HIV testing adoption within vulnerable communities. We plan to disseminate our findings via a peer-reviewed journal, policy briefs, conference presentations and stakeholder engagement.Item The epidemiology of work related back pain in full-time restaurant waitron staff within the eThekwini Municipality(2020-11-30) Wolff, Alexia Michaela; Haffejee, FirozaBackground Low back pain (LBP) is one of the leading causes of morbidity in high-, middle- and lowincome populations and is one of the most common and most expensive occupational health problems in developed and developing countries. This affects the working population as LBP has a detrimental effect on work performance, therefore it is an important clinical, social, economic, and public health problem affecting the population. Internationally, risk factors in the development of LBP in the working population include prolonged standing, awkward posture and incorrect lifting. There is limited literature on prevalence of LBP, the risk factors associated with LBP and its impact on waitrons in South Africa. This study aims to determine the prevalence, clinical presentation, risk factors and impact of work-related LBP amongst full-time restaurant waitron staff within the eThekwini Municipality. Methodology This study was a mixed methods study comprising qualitative and quantitative components. The quantitative research tool consisted of a previously validated selfadministered questionnaire whilst the qualitative component consisted of voice recorded semi-structured interviews using an interview guide to obtain information on low back pain from participants. The data collected from the questionnaires were entered into an Excel spreadsheet and thereafter analysed using SPSS. Descriptive statistics were used to describe categorical outcomes, whilst Pearson’s chi square or Fisher’s exact tests in the case of categorical variables, and t-tests for continuous variables were used to assess factors associated with LBP. The audio recordings from the qualitative interviews were transcribed verbatim and exported into a Microsoft Word document. Thereafter, thematic analysis was used to analyse the qualitative data to identify common themes and subthemes. Results Of the 340 questionnaires which were distributed, a total of 180 questionnaires were completed by waitrons in the eThekwini Municipality, resulting in a 52.9% response rate. The point, three-month period and annual prevalence was recorded at 50.0%, 62.2% and 78.2%, respectively. Within this population, LBP was associated with the ethnicity of the participants (p=0.002) where Indians had a 7.7 times increase in the odds of prevalent LBP compared with Black Africans (OR = 7.713; 95% CI = 1.273-46.718; p = 0.026) and Whites a 5.9 times increase in the odds of prevalent LBP than Black Africans (OR = 5.891; 95% CI = 1.429-24.289; p = 0.014). Low back pain was associated with the education of the participants (p = 0.002) where participants with high school education had an almost 12 times increase in the odds of prevalent LBP than those with tertiary education (OR = 11.967; 95% CI = 1.399-102.387; p = 0.023). Prolonged standing or walking during a work shift was associated with LBP (OR = 42.808; 95% CI = 2.346-780.985; p = 0.011). Onset of LBP was common during a long single shift or when working a double shift and pain sessions tended to last between one to two hours. The frequency of LBP experienced averaged two to three times a week, where pain was at its worst in the evenings. Low back pain in waitrons commenced gradually without injury and the severity of LBP was unchanged since it initially started. Low back pain resulted in moderate impact on the work of waitron staff, sometimes resulting in absenteeism and bed rest. Eight in-depth, qualitative interviews were conducted. Two main themes emerged from the data: low back pain characteristics and type of treatment. Interviewees discussed pain, onset and duration, and relieving factors as part of LBP characteristics, where they reported first experiencing LBP as young adults. Their onset of LBP was common during a long single work shift or when working a double shift. They re-iterated that prolonged standing and lifting or carrying heavy objects aggravated their LBP. Various therapies were used by interviewees to relieve the pain which included analgesics, antiinflammatories, heat therapy and topical gels. Type of treatment included chiropractic. There was good knowledge of the services offered by chiropractors and various types of chiropractic treatment available. Conclusion The prevalence of LBP amongst waitron staff within the eThekwini Municipality was high. Work-related factors were associated with the onset of LBP. These included prolonged standing, constant walking for long periods of time, carrying heavy loads and falling. Low back pain negatively impacted on their work due to absenteeism as bed rest was required. Various treatment options, including chiropractic were utilized. Participants had some knowledge of what constitutes chiropractic treatment and the types of services offered.Item The epidemiology of musculoskeletal injuries in competitive lifesavers in KwaZulu-Natal(2020-11-30) Billson, Carmel Beth; O'Connor, Laura; Clifton, Stuart RonaldLifesaving is a multidimensional sport which can lead to injury and a high likelihood of overuse-related injuries. The environment within which lifesaving occurs is unique, with the soft beach sand and unpredictable nature of the ocean. It is difficult to assess the effects that injuries may have on the training and competitive performance of lifesavers as the incidence and severity of these injuries have not previously been studied in South Africa. Thus, this study investigated the epidemiology of lifesaving induced musculoskeletal (MSK) injuries in competitive lifesavers in KwaZulu-Natal. Lifesavers are under-investigated, yet the growth and development of the sport requires that athletes are assessed for injury. This study could aid in educating federations, coaches and athletes regarding MSK injuries sustained by lifesavers, thereby assisting athletes to be more competitive at national and international competition levels. Method: A quantitative, descriptive, cross-sectional epidemiological survey was used to collect data from 100 competitive lifesavers in KwaZulu-Natal. The questionnaire was pre-validated and hand delivered to the lifesaving clubs that agreed to participate, where the lifesavers selfselected to participate. Informed consent was obtained. The survey contained questions related to demographics, activity participation, psychosocial factors and the occurrence of lifesaving related musculoskeletal pain. Results: The respondents were male (65%, n=65) and had a mean age of 28.6 years (±SD 14, range 16-73). The lifetime prevalence of MSK injury from lifesaving was 72% (n=72), with a total of 177 injuries being reported with shoulder pain being the most prevalent (38%). The 12- month prevalence showed 133 injuries were sustained whereas for current prevalence there were 86 injuries. Lower back pain was most frequently reported over these periods (26% and 22% respectively). The board race was the most popular event participated in at 76% (n=76), followed by surf ski 69% (n=69) and thirdly surf swim 67% (n=67). Seventy-four percent (74%) of board paddlers, 68% of surf ski paddlers and 67% of beach sprint and flags participants had experienced MSK pain related to lifesaving. Of the 72 competitors that experienced lifesaving MSK injuries more than half reported that it negatively affected them psychologically either in training, competition or overall. Injuries cause athletes to miss training sessions, which result in loss of fitness and falling behind the other athletes, this could cause a lack of confidence, lack of self-belief and lack of motivation to continue training and competing. The worst injury that the respondents had sustained occur mostly due to running (44%), was overuse related (43%), occurring in season (70%) and was described as a sharp, shooting severe pain with a constant and recurrent nature. It affected the athlete’s participation in the sport (75%) and required them to seek medical attention (89%). The only factor found to be related to MSK injuries was the number of rest days, which was significantly lower in those who suffered injuries (p=0.04). All other demographic, health, lifestyle and lifesaving activity participation factors were not associated with MSK lifesaving injuries (p < 0.05). Conclusion: This is the first study to document MSK injuries in lifesaving athletes in South Africa. The high prevalence of injuries necessitates that mechanisms are put in place to prevent injury. In addition, the mechanics of running on sand requires further investigation to understand its impact on injury