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The objective is to compare the risk factors for MSDs among primary and secondary school teachers in Cotonou city. Cross sectional prospective study with a descriptive and analytical focus on 340 teachers: 170 in primary and 170 in secondary schools. Data collection was done using the standard Nordic MSDs questionnaire and a systematic physical examination. A logistic regression was done. Primary school teachers suffered more MSDs than secondary school teachers (80% vs. 69.4%, p=0.0025); scapulalgia (59.4% in primary school and 55.9% in secondary school) and neck pain (41.8% in primary school and 34.1% in secondary school) predominated in both categories. Factors associated with MSDs in both education sub-sectors were: seniority in employment (p=0.0006); stress (p=0.00135) and job dissatisfaction (p=0.0098). Job dissatisfaction and stress predominated among elementary school teachers (p<0.001). The prevalence of MSDs is higher among primary school teachers than among secondary school teachers. This may be related to the prevalence of psycho-social problems among primary school teachers. A revaluation of their working conditions is necessary to ensure their development at work and limit MSDs among them.
Keywords: Musculoskeletal disorders, Teachers
INTRODUCTION
Musculoskeletal disorders (MSDs) are a group of painful conditions associated with the overload of soft tissues in the periarticular, limbs and spine. They represent the most common cause of chronic pain and physical disability in the world [1] with more than 43,000 cases compensated in France in 2011, including 42% with sequelae [2]. These are multifactorial diseases involving individual susceptibility factors and work-related factors including stress and psychosocial factors. No socio-professional category is spared; neither are teachers. Indeed, the teaching profession requires the mobilization of physical, cognitive and emotional capacities, thus exposing students to many occupational diseases, including MSDs. While the literature traditionally describes the stress and burnout of teachers, there is little written about MSDs in teachers. This study aims to compare the factors associated with MSDs among elementary and secondary school teachers.
METHODS
This was a descriptive and analytical cross-sectional prospective study that took place from January to May 2015. The target population was teachers from public primary and secondary schools in the commune of Cotonou who met the following criteria:
· Has been a teacher for at least one year
· Work in the commune of Cotonou
· Agree to participate in the study
RESULTS
A total of 340 teachers, 170 from primary and 170 from secondary schools were selected as the size of our sample.
General characteristics
The population was predominantly male in both sub-sectors of education: 58.8% for primary and 74.1% for secondary. The average age was 39+9.5 (22-60 years) for primary and 35.6+8.3 (23-55 years) for secondary.
Primary school teachers had more seniority than secondary school teachers (12.8+8.9 years compared to 9.3+7 years) and a higher average weekly working time (36.9+16.1 h compared to 23+8.5 h). With respect to psycho-social factors, elementary school teachers felt more dissatisfied at work than those in secondary school (p=0.001). However, there was no significant difference in work-related stress between the two groups of teachers (p=0.12) (Table 1).
Comparative prevalence of MSDs in the two education sectors
The prevalence of MSDs was 74.7% for all teachers. It was significantly higher among primary school teachers at 80% compared to 69.4%; p=0.025. The most affected regions in the two education sub-sectors were shoulders (59.4% in primary and 55.9% in secondary), neck (41.8% in primary versus 34.1% in secondary) and lumbar spine (34.7% in primary and 33.5% in secondary) (Figure 1).
Factors associated with MSDs in both categories of teachers
Primary education was more associated with the risk of MSDs. Teachers with less than 5 years seniority did not suffer from MSDs; between 5 and 15 years seniority the risk of MSDs occurring was multiplied by 4. Job dissatisfaction doubled the risk of MSDs (odds ratio=2.3); stress multiplied the risk by five (odds ratio=5.5) (Table 2).
DISCUSSION
The overall prevalence of MSDs among teachers is 74.1%. It is similar to the 79.2% reported by Magdy et al. [5] among female teachers in Saudi Arabia; and to the 73.4% reported by Chong et al. [6] in Hong Kong among elementary and secondary teachers. Scapulalgia and neck pain predominated over other MSDs, our findings are those of Chong et al. [6] in Hong Kong, Phil et al. [7] in Estonia, Kormaz et al. [8] in Turkey; these results could be explained by the fact that writing on the board, preparing the cards and correcting the copies require keeping constraining postures (arms above the shoulders, neck bent and stretched) so a greater stress on the neck and shoulders, source of pain.
The prevalence of MSDs is significantly higher among elementary school teachers; this is the same as that of Chong et al. [6]. Primary education is the foundation of the education system, the acquisition of knowledge (language, writing...) by schoolchildren requires a greater physical and mental investment on the part of the teacher, which may explain this difference. Similarly, job dissatisfaction problems were more prevalent among elementary school teachers. The latter must teach all disciplines (French, spelling, mathematics...) to schoolchildren. They can only have one class at a time and are paid less than their high school counterparts who have only one subject and can teach in different colleges to improve their incomes. This may explain the job dissatisfaction problems reported by elementary school teachers and job dissatisfaction being correlated with the occurrence of MSDs, the higher proportion of MSDs among elementary school teachers observed in our study. Teachers with more seniority had more MSD problems; the cumulative effect of years of work can be a risk factor for MSDs [9]. Stress and job dissatisfaction are identified as causes of MSDs; our data confirm most of those in the literature [10,11] and show that in addition to biomechanical factors, psychosocial factors are also implicated in the occurrence of MSDs.
CONCLUSION
MSDs are a reality in education and prevalences are high, especially at the primary level. This article also highlights the disparities (related to mental and physical demands, job satisfaction problems) between the two categories of education. The prevention axes must take into account these psychosocial aspects for the development of teachers at work, which will ensure a more efficient education system.
1. Woolf A, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81: 646-656.
2. Roquelaure Y, Fouquet B, Descatha A (2014) Pathologies professionnelles musculo-squelettiques: Priorité à la prévention et à la coordination des prises en charge. La Revue du Praticien 64: 350-357.
3. Kuorinka I, Jonsson B (1987) Standardised nordic questionnaires for the analysis of musculoskeletal symptom. Appl Ergon 18: 233-237.
4. Kuorinka I, Jonsson B, Kilbom A (1994) Analyse des problèmes de l’appareil locomoteur: Questionnaire scandinave. DMT 58: 167-170.
5. Magdy A, DarwishShatha Z (2013) Musculoskeletal pain disorders among secondary school Saudi female teachers. Pain Res Treat 2013: 870-570.
6. Chong EY, Chan AH (2010) Subjective health complaints of teachers from primary and secondary schools in Hong Kong. Int J Occup Saf Ergon 16: 23-39.
7. Phil E, Matsin T, Jurimae T (2002) Physical activity, musculoskeletal disorders and cardiovascular risk factors in male physical education teachers. J Sports Med Phys Fitness 42: 466-471.
8. Korkmaz NC, Cavlak U, Telci EA (2011) Musculoskeletal pain, associated risk factors and coping strategies in school teachers. Scientific Research and Essays 6: 649-657.
9. Chiron E, Les TMS (2008) Maintien en emploi des salariés de 50 ans et plus: Un défi pour la santé au travail et la santé publique. Sante Publique 20: 19-28.
10. Bondoc RG, Garrovillas RA, Lo RD (2007) Prevalence of low back pain among public high school teachers in the city of Manila. Phil J Allied Health Sci 2: 34-40.
11. Abdulmonem A, Hanan A, Elaf A (2014) The prevalence of musculoskeletal pain and associated factors among female Saudi school teachers. Pak J Med Sci 30: 1191-1196.
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