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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 6  |  Page : 485-491  

The prevalence and health impact of musculoskeletal disorders among farmers


Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India

Date of Submission05-Mar-2018
Date of Acceptance05-Jul-2018
Date of Web Publication15-Nov-2018

Correspondence Address:
Yugantara Ramesh Kadam
Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_41_18

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  Abstract 


Context: Prevalence of musculoskeletal disorders (MSDs) is common among farmers as agriculture work is highly physically demanding. India's 54.6% of the population is engaged in agriculture and allied activities. There is a need for accurate measurement and assessment of the impact of musculoskeletal conditions for public health action. Hence, in order to obtain prevalence and health impact of these problems as well as to evoke interest of researchers in this area, this study was conducted. Aim: To study the prevalence and health impact of MSD among farmers. Subjects and Methods: Study settings: Village from Sangli district. Study design: This was a cross-sectional study. Study subjects: Farmers of both sexes. Exclusion criteria: Farmers having history of arthritis or having MSD due to accidents. Sample size and sampling technique: Calculated sample 1150 from randomly selected village. Study tools: (a) Pro forma developed by investigator, (b) Modified Nordic Questionnaire, and (c) Ovako Working Posture Analyzing System. Statistical Analysis Used: Frequencies, percentages, Chi-square test, and binary logistic regression analysis was done with the help of SPSS software. Results: A total of 964 (83.8%) farmers experienced MSD in the last 1 year. Knee was the most commonly affected body part. Weeding with squatting position was most common posture. MSDs were significantly associated with age, addiction, and associated diseases. Binary logistic regression analysis concluded age, weight, height, and body mass index as strong predictors of MSD. Duration of disability as a result of MSD ranged from 1 to 190 days. Mean expenditure on medication was Rs. 3040.82. Conclusions: Prevalence of MSDs in farmers was high. MSDs had affected farmers adversely in terms of long disability days resulting into economic loss in terms of failure to work to earn and expenditure on treatment.

Keywords: Agricultural workers, disability days, farmer, musculoskeletal disorders


How to cite this article:
Patil SA, Kadam YR, Mane AS, Gore AD, Dhumale GB. The prevalence and health impact of musculoskeletal disorders among farmers. Med J DY Patil Vidyapeeth 2018;11:485-91

How to cite this URL:
Patil SA, Kadam YR, Mane AS, Gore AD, Dhumale GB. The prevalence and health impact of musculoskeletal disorders among farmers. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2018 Dec 19];11:485-91. Available from: http://www.mjdrdypv.org/text.asp?2018/11/6/485/245427




  Introduction Top


Musculoskeletal conditions are found among all ages and gender groups, across all sociodemographic groups of community. Their impact is spreading in community and yet this is not widely recognized at the level of health policy and priority. Musculoskeletal conditions are a group of disorders with regard to pathophysiology but are related anatomically with body parts and by their association with pain and impaired physical function; encompassing a spectrum of conditions, including inflammatory diseases such as rheumatoid arthritis or gout; age-related conditions such as osteoporosis and osteoarthritis; common conditions of unclear etiology such as back pain and fibromyalgia; and those related to activity or injuries such as occupational musculoskeletal disorders (MSDs), sports injuries, or the consequences of falls and major trauma.

Agriculture work is a very highly physically demanding occupation.[1],[2] It contains mandatory heavy, stressful physical activity among all occupation. Among the many physical hazards and stressors in agriculture are lifting and carrying heavy loads; work frequently with the trunk flexed, frequent awkward posture; risk of accidents with machineries and during mechanical work, exposure to whole-body vibrations.[3] Every part of the body get involved in such type of work and because of these tasks, the prevalence of MSDs such as traumatic injuries, soft-tissue disorders, and degenerative joint disease of the hands, knees, and hips are common among farmers.[4] These injuries and illnesses have been consistently identified through epidemiological and community-based studies.[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14]

The growing awareness of the burden of MSD increases the need for accurate measurement and assessment impact of musculoskeletal conditions for public health action.[15] India is predominantly agricultural country, about 72% of population lives in rural area. India's 54.6% of the population is engaged in agriculture and allied activities (census 2011).[16] In India, huge numbers of females and children are involved in farming occupation.[17]

Although it is believed that MSDs are very common among farmers in rural population, the prevalence of musculoskeletal discomfort among Indian farm workers is not well documented.[18] Very few efforts have been made to find the prevalence of this problem. Particularly, researches regarding MSD in Maharashtra are very few. Hence, in order to obtain prevalence and health impact of these problems, this study was conducted.


  Subjects and Methods Top


A cross-sectional analytical study was conducted in a randomly selected village “Kameri” from Sangli district, Maharashtra. Only one village was sufficient for calculated sample size.

Study participants were the farmers of both sexes. Definition of farmers adopted for this study was “who works daily in the farm for at least 1 year and not involved in any other occupation.”

Farmers having history of arthritis or having MSD due to accidents were excluded.

Sample size and sampling technique

Calculated sample size was 1150 (P = 13%,[19] d = 15%, α = 5%). First house was selected randomly using house numbers and then houses in sequence were visited. All the eligible farmers present in the house were interviewed. Houses were visited till sample size was satisfied.

Study tools

Study tool included five parts.

  1. General information such as date of interview, name, age, and gender
  2. Information on sociodemographic factors, history of other illnesses, and addictions (tobacco/mishri, smoking and alcohol)
  3. Anthropometric measurements such as height and weight were recorded and body mass index (BMI) was calculated
  4. Modified Nordic Questionnaire:[19] is a standardized instrument used widely for analyzing musculoskeletal symptoms in relation with occupational health. This questionnaire is used as screening tool. It collects information on pattern and duration of work and discomfort felt in different parts of body in the past 1 year. Questionnaire also included items regarding the history of treatment received for MSD, any hospitalization, and expenditure or money spent on treatment of MSD. Information was collected on the source of medication, that is, whether self-medication or physician
  5. Ovako Working Posture Analyzing System (OWAS) includes stick diagrams of various postures adopted by a farmer to carry out different work such as weeding, carrying seeds/crops, planting seeds, spading, sprinkling water, and picking crops required for agricultural work.[1],[20] We added the stick diagram of squatting posture to OWAS as this is one of the most commonly adopted postures seen in Maharashtrian farm workers. Printed copy of these stick diagrams was shown to the farmers and asked them to choose the posture/s causing MSD.


Part A and B were prepared by investigators. Modified Nordic Questionnaire (Part D) was translated in Marathi by the investigators. Validity was assessed by the subject experts who are well verse with both the languages. Pilot study was conducted in farmers from other village. Appropriate changes were made as per the suggestions from experts and findings from the pilot study.

Study procedure

After getting Institutional Ethical Committee clearance, a village was selected randomly, that is, “Kameri” from Sangli district, Maharashtra. Permission was sought from appropriate authority, the Sarpanch of village for the survey.

Investigator himself collected data using interview technique after taking consent. At least three visits were paid to interview study participants, who were not present in the house during the previous visit. Background information was collected using Part A and B of pro forma. Height and weight were measured using standard procedures and recorded. History of MSD in the last 1 year, body part affected by it, duration and episode of illness, history of any medication and it's source, and history of hospitalization were asked using Modified Nordic Questionnaire. Most common posture causing pain was identified with the help of OWAS having stick diagrams.

Statistical analysis

Data were entered in Excel sheet. Statistical analysis was done using SPSS 22 software (IBM Corp, Armonk, New York, USA) with the help of statistician. Frequency and percentages were calculated for MSD, MSD according to body parts, postures. Chi-square test was used to find out the association of MSD with sociodemographic factors (age, sex, weight, height, BMI, and type of family). Logistic regression: Binary logistic regression with the backward enters method to find out the significant predictors of MSD.


  Results Top


A total of 1150 farmers were interviewed. Out of which, 439 (38.17%) were female and 711 (61.82%) male. Range of age was 30–60 years with mean age 47 ± 8.43 years.

Height ranged from 135 to 188 cm with mean 159.77 ± 7.55 cm. Minimum weight was 40 kg and maximum 90 kg. Mean weight was 59.34 ± 8.62 kg.

Mean farm size was 0.7648 ± 1.715 hectare. Mean duration of working time in farm was 5.11 ± 1.928 h/day and mean working days per week was 6.30 ± 1.226 days. Main crops for this region were sugarcane, rice, wheat, jowar, and several oilseeds including groundnut, sunflower, and soybean.

The most common family type was nuclear (626, 54.43%) followed by joint family (524, 45.56%).

A total of 330 farmers had tobacco addiction. Out of that, 12 were smokers while remaining 318 were addicted to smokeless tobacco, that is, tobacco chewing. For analysis purpose, small group of smokers was included in the group of tobacco chewers.

Twenty-eight farmers were suffering from diabetes mellitus (DM) and 112 from hypertension (HTN). Two farmers suffered from pulmonary tuberculosis.

A total of 964 (83.8%) farmers experienced MSD in the last 1 year. Out of 964, 373 (38.69%) were female and 591 (61.30%) were male.

Knee was the most commonly affected body part followed by lower back and least affected part was elbow [Table 1]. Prevalence of MSD affecting knee was 34.0% (391) and nearly 40.56% of out of 964 farmers suffering from MSD. MSDs affecting all other parts except the neck and upper limb were common in males. In women neck was significantly affected by MSDs (χ2 = 19.766 d.f., P = 0.000) and in males lower back (χ2 = 4.639, P = 0.031) and elbow (χ2 = 4.177, P = 0.041).
Table 1: Distribution musculoskeletal disorders according to the body part

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While farming, farmers have to work with different body postures. MSD was most commonly associated with weeding with squatting position followed by picking crops. Least discomfort was associated with carrying crops. In majority, 690 (71.6%) out of 964 farmers, weeding with squatting posture was the main reason for MSD, followed by carrying crops on the head in 455 (47.2%) [Table 2].
Table 2: Musculoskeletal disorder in relation with postures during farming

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There was significant increase in the number of participants suffering from MSD as age advances. Its prevalence was highest in 51–60 years of age group and lowest in 31–40 years age group. MSD was significantly more common in farmers above 50 years of age (χ2 = 14.524, P = 0.001). Prevalence of MSD was high in females, however, the observed difference was not significant [Table 3]. MSD involving ankle/foot was significantly common in 31–40 year age group and the prevalence decreased with increasing age (χ2 = 24.355, P = 0.000).
Table 3: Musculoskeletal disorder in relation with some variables during farming

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There was a marginally significant association present between BMI and MSD with MSDs more common in underweight farmers (χ2 = 5.741, P = 0.057). Prevalence of MSD decreases with increasing BMI [Table 3]. BMI and body part-wise distribution of MSD were also studied. All three lower limb joints were involved significantly more common in underweight and less in overweight, that is, hip joint MSD: in underweight 18 (26.5%), in normal weight 159 (21.4%), and in overweight 36 (10.7%) (χ2 = 20.724, P = 0.000); knee joint MSD: in underweight 32 (47.1%), in normal weight 257 (34.5%), and in overweight 102 (30.2%) (χ2 = 7.466, P = 0.024); and ankle 1 joint MSD: in underweight 7 (25.0%), in normal weight 150 (20.2%), and in overweight 34 (10.1%) (χ2 = 19.279, P = 0.000).

Majority of the family (583, 50.69%) comprised 5–8 members and 71 families had members 9 and above, remaining 496 (43.13%) families were of 2–4 members. Maximum families belonged to nuclear type (626, 54.43%). MSDs were independent of total number of family members and type of family (χ2 = 5.687, P = 0.058 and χ2 = 0.855, P = 0.377).

MSDs were significantly common in participants with tobacco addiction 318 (96.40%) (χ2 = 53.657 d.f., P = 0.000) and in 83 (91.20%) alcoholics (χ2 = 3.973 d.f., P = 0.046).

Binary logistic regression analysis concluded age, weight, height, and BMI as strong predictors of MSD.

Duration of disability as a result of MSD ranged from 1 to 190 days which had an impact on the farmer's daily work. MSD were troublesome more during farming activities than their other activities, such as daily chores. MSDs affecting knee (3.1%) was the most common reason for the maximum duration disability while the shortest duration of disability was with the elbow (0.2%).

Out of 964 farmers, 763 (79.1%) required medical consultation for receiving treatment. A total of 763 (79.1%) farmers out of 964 required medication to get relieved from pain. There were 754 (78.2%) farmers who took medications after consulting physicians. Self-medication was observed in 127 (13.2%) of farmers.

Hospitalization was required for 375 (38.9%) farmers. Expenditure on the treatment ranged from Rs. 20 to Rs. 30,000. Mean expenditure was Rs. 3040.82 and median Rs. 1000 with SD Rs. 4307.56.


  Discussion Top


The present study was conducted in a village to study the prevalence of MSD in farmers and risk factors associated with it. Mobed et al. stated that, health problems affecting socioeconomic and general health status of farming population are directly due to the occupational hazards of farm work.[4]

Prevalence of musculoskeletal disorders

A total of 1150 participants were studied. Out of which, 964 (83.8%) had MSD affecting at least any one part of body in the last 1 year. This seems to be very high. However, 79.1% out of these MSD affected farmers have received some kind of treatment and more than one-third of them required hospitalization which indicates severity. From this, it can be presumed that high prevalence is a real one and not because of overreporting. This high prevalence was also observed and mentioned by a South Korean study. In their study, musculoskeletal pain was present in 91.3% of farmers. Prevalence reported in one Indian study by Gupta G and Tarique was 60%.[18] Another Indian study has reported the prevalence of 7.2%. This is very low as this study included both urban and rural farming population.[21]

High prevalence of discomfort was due to the performance of heavy manual task in the agricultural fields in awkward postures for prolonged periods of time. Similar conclusion is quoted in another Indian study.[1]

Prevalence of musculoskeletal disorders according to sociodemographic factors

Finding of significant association of increasing age with MSD is also reported by Banerjee et al. and in other study by Xiao et al.[21],[22] Age-related changes in bone and joints, muscle strength, cumulative effect of activities, and injuries may be the reason.

MSDs were more common in females than males. Similar findings were reported by other studies also.[22] However, the observed difference in the present study was not significant. This marginally high prevalence of MSD in females may be as a result of additional burden of domestic chores.

It was observed that overall body part-wise distribution of MSDs was more common in male except neck and upper back. In women MSDs affecting neck were significantly more common than men. However, in “MICASA Study,” women reported a higher prevalence of MSD at all sites except knee.[22] According to body part, knee (36.0% for males and 30.8% for females) was the mostly affected or painful site in both sexes.

Presence of MSDs was irrespective of type of family.

Prevalence of musculoskeletal disorders according to body parts

In this study, most commonly affected body part was knee. However, low back pain is reported as a most common by Gupta[18] and in another study from S. Korea by Jo et al.[23] The Wuchuan Osteoarthritis Study mentions the high prevalence of knee osteoarthritis in a rural Chinese population in comparison to urban population.[24]

Banerjee et al. concluded the 12-month period prevalence of chronic pain for participants was the highest for back pain followed by knee pain.[21] This study includes both population with and without agriculture.

Posture and musculoskeletal disorders

Most commonly used position for doing work in the field reported was squatting position. Similar finding stated by Das et al., a squatting posture is one of the most awkward postures commonly adopted by farmers and prolonged working in this posture is common.[1] Squatting and kneeling as a part of occupation are the risk factors for knee osteoarthritis. This may be the reason why knee is most commonly affected body part by MSD.

Prevalence of musculoskeletal disorders according to anthropometry

Significant association found between MSDs and height and weight. BMI-wise MSDs were significantly more common in underweight farmers. However, other studies have found MSDs, especially affecting knee were more common in high BMI people.[25],[26] Reason may be undernutrition is associated with total food gap resulting into micronutrient, that is, mineral deficiency resulting into high prevalence of MSDs. Other important factor is most common working body position in this study found to be squatting, which is an important risk factor for knee MSD.

MSDs were signifi cantly common with illnesses such as HTN and DM. These illnesses are more common in higher age group and lowered physical fi tness because of these illnesses and aging may be the reasons [Table 4].
Table 4: Association of musculoskeletal disorder with noncommunicable diseases and addictions

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Prevalence of musculoskeletal disorders according to addictions

MSDs were significantly associated with both addictions alcohol and tobacco.

Association between MSD and smoking is controversial. Some studies found positive association while by some negative.[25],[26] But in this study, majority farmers addicted to tobacco were using smokeless tobacco, that is, tobacco chewing. MSDs were significantly common in tobacco chewer farmers [Table 4].

Duration of disability and musculoskeletal disorders

Knee was the main reasons for longest duration disability among farmers, followed by lower back, neck, shoulder, upper back, hip, foot, hand, wrist, and elbow. No study had calculated the body part wise distribution of disability day.

To get relief from MSD, 79.1% of farmers having MSD had received treatment from various sources including self-medication. More than two-third of farmers have consulted doctors. More than one-third of them required hospitalization. The mean expenditure was Rs. 3040.82 for medication and hospitalization. All these three evidence indicate the severity of MSDs and its direct economic impact on farmers.

India's 54.6% of the population is engaged in agriculture and allied activities (census 2011).[16] In spite of this, agriculture is considered to be part of informal economy and unorganized sector.[27] Hence, their occupational health problems have remained neglected. Mechanization of farming is still not widespread.

Age was the strong predictor of MSDs on binary logistic regression analysis [Table 5]. Farmers routinely work beyond the standard retirement age and frequently farm up to an old age. Injuries related with work exposure are enhanced due to age related musculoskeletal changes. Hence increasing the chances of having the MSDs & probably of high severity. Thus, at a time of physical diminishment, older farmers face increased vulnerability to injuries and illness and may continue to work in farm beyond their ability.[4]
Table 5: Binary logistic regression

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It indicates the situation is alarming and requires immediate multifaceted remedial actions.


  Conclusions Top


Prevalence of MSDs in farmers was high. MSDs had affected farmers adversely in terms of long disability days resulting into economic loss in terms of failure to work to earn and expenditure on treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Kang X, Fransen M, Zhang Y, Li H, Ke Y, Lu M, et al. The high prevalence of knee osteoarthritis in a rural Chinese population: The Wuchuan osteoarthritis study. Arthritis Rheum 2009;61:641-7.  Back to cited text no. 24
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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