The prevalance of and associated risk factors for low back pain in medical outpatients of a selected Umdoni Municipality health care clinic

Abstract

Background: Low back pain (LBP) can affect any population and is experienced by any race, gender or age group. The lifetime prevalence of LBP is reported to vary from 44.4% to 90% in different populations in Western countries and 36% to 70.9% in African countries. Studies have been conducted in developed countries, or urban areas of developing countries regarding LBP and they report the LBP prevalence to vary from 48% to 90%. However, very limited literature about LBP and its risk factors in rural areas exist. There are few studies that have been conducted in rural areas; however, none of these investigated a South African rural area and since the demographics and type of work of this population differs, it may affect the prevalence of LBP.

Aim of study: The aim of this study was to determine the prevalence of and associated risk factors for low back pain in medical out patients of a selected Umdoni Municipality Primary Health Care Clinic. Methodology:

This study design was a cross-sectional survey, set in a quantitative paradigm, in which data was collected by means of a questionnaire. This study was conducted in a primary health care clinic of the Umdoni Municipality. The convenience sequential sampling method was used to select the qualifying participants (as per inclusion/ exclusion criteria) from the patients in the waiting room of the clinic. Participants (n=400) were recruited by the researcher in the clinic waiting room / reception. All collected data was captured on an Excel spreadsheet and subsequently transferred to the statistical program for the Social Sciences (SPSS) version 23. A p value less than 0.05 was considered statistically significant. Pearson’s chi square tests and Fisher’s exact test were utilized in order to determine the association between low back pain and various factors. Odds ratios were calculated to determine risk factors for LBP. LBP was correlated with demographics as well as daily activities or chores.

Results:

A total of 400 questionnaires were completed by the participants in the form of an interview with the researcher. The lifetime and point prevalence of LBP was 79.3% (n = 317) and 32.5% (n = 130) respectively. LBP increased with an increasing age (p = 0.028). Similarly, LBP increased in people with higher BMI (p < 0.001). More females (83.4%, n = 231) suffered from LBP than did males (69.9%, n = 86, p = 0.002). The prevalence of LBP was not correlated with other demographic factors. More females (98%, n = 272) performed household chores than did males (78.8%, n = 97, p < 0.001). These chores included fetching firewood (p < 0.001), washing clothes (p < 0.001) and cooking (p < 0.001). Although there was no relationship between performing household chores and the lifetime prevalence LBP (p = 0.842), there was a relationship between performing these chores and the point prevalence of LBP (p = 0.004). More females (96%, n = 266) than males (65.9%, n = 81) fetched water (p = 0.001). Bivariate analysis indicated that LBP was increased with an increasing number of pregnancies (p < 0.001). The risk of LBP was increased in those who underwent a C-section (OR = 2,748, 95% CI: 1,108-6,819, p = 0.024). Similarly the risk of LBP was increased in those women who had an epidural (OR = 3.115, 95% CI: 1,355 -7,157, p = 0.005).

Almost a fifth of the participants lifted heavy objects for a prolonged period of time (19.5%, n = 78, p < 0.001). Lifting heavy objects was strongly associated with an increased lifetime prevalence of LBP (OR = 6.014, 95% CI: 2.131 - 16.976, P < 0.001). There was no correlation between physical activity and the prevalence of LBP (p = 0.084). However Pearson’s chi square test showed that those that walked experienced more LBP compared to those involved in other physical activities (p = 0.024). In addition, those who walked, were often walking to fetch water and this may have caused the LBP. Low back pain affected daily activities such as bending (30.5%, n = 122, p < 0.001) and lifting of objects (18%, n = 72, p < 0.001). It also resulted in absenteeism from work and loss of jobs. Knowledge of chiropractic was poor (1%, n = 4, p < 0.001) and 99% (n = 396, p < 0.001) of the participants had never been treated by a chiropractor.

Conclusion:

Low back pain prevalence was high in the Umdoni Municipality population. Activities related to life in poor socio-economic backgrounds, such as fetching water from the river, were highly associated with LBP. Participants were unaware of the field of chiropractic treatment and since chiropractors are involved in manually treating low back, it is recommended that chiropractic treatment be incorporated into the services provided at primary health care clinics in the area.