Authored by Md Mahmudul Hasan*
Abstract
Background: Homemakers use their time & strengths to provide service to make their house a home. This routine and compulsory household maintenance task often leads them to musculoskeletal pain (MSP).
Purpose: The aim of this study was to identify the areas of musculoskeletal pain in different parts of the body as a result of household work among rural homemakers in Bangladesh and in this case to detect their health-seeking behaviors.
Materials and Methods: Three hundred and forty one randomly selected married homemakers’ living in the rural area of Barishal division of Bangladesh who has experienced any type of musculoskeletal pain at least once in life due to household work participated in this cross sectional study. Data were collected by pretested semi-structured questionnaire through face to face interview.
Results: The one year pattern of MSP among respondents were lower back (80.46%), followed by knee (24.4%), neck (19.13%), upper-back (11.3%), shoulder (5.3%), hips/thighs (5.46%), ankle/feet (4.8%), wrist/hand (4.4%), and elbow (3.4%). Lower back pain had an association with lifting heavy objects, number of children, educational qualification, age and awkward/faulty postures (p<0.05). Total working experiences more than 10 years was associated with upper back pain (p<0.05).Further, pain in the wrist/hand and knee (P <0.05) was linked with awkward position and spending more than 8 hours a day doing homework. In addition, there was a relationship between repetitive work and wrist/hand pain (p<0.05). In contrast, three-fourth received treatment for their pain. Of these, 54.9% sought treatment from the para-professional health service providers.
This study shows that housework exposed musculoskeletal pain on the different sites of the body. Although sufferers sought treatment in this regard, it is necessary to improve policies & intervention for reducing possible risks of musculoskeletal pain among homemakers.
Keywords: Musculoskeletal pain; health seeking behavior; Rural homemaker
Introduction
Musculoskeletal pain is one of the modern epidemic health problems. This problem responsible for a high proportion of impairment, loss of productivity and substantial use of health and social services [1]. Several epidemiological studies have demonstrated the evidence of a causal relationship between physical exertion at work and work related musculoskeletal pain (MSP) [2]. Both professional and informal work at home or outside require physical strains that can produce musculoskeletal pain(MSP) as a result of inflammatory conditions in muscles, nerves, tendons, cartilage, spinal discs or other soft tissues. MSP is found throughout all generations, identities and social group [3]. Although previous studies suggest that prevalence rates of musculoskeletal pain were higher for women than for men [4]. WHO reported that women constitutes 42% of the global work force and they are more likely to work in the informal economy sector (domestic work, agricultural laborers, handicrafts industry, etc.) [5].This trend is common in both developed and developing countries. Middle-income counties like Hong Long and Lebanon shows that fulltime homemakers experiences MSP over the different region of the body as a result of household chores [6,7]. Homemakers in developed countries like Italy get MSP because of housework. [8]. In Bangladesh, women typically spend less than an hour on their self-care work; in contrast, they spend 14-20 hours a day as the main person responsible for finishing family activities [9]. A recent study in Bangladesh shows that 68.49% women reported having pain on different parts of their body during the last 12 months and 50.68% of the respondents were prevented from normal daily activities due to musculoskeletal symptom [10]. It is evident that the prevalence of low back pain is higher in rural women than urban women [11]. This study is aimed at identifying MSP in different parts of the body as a result of housework among homemakers in Bangladesh as very little is known about it so far.
In contrast, woman shows little concern about their health. Despite suffering and withdrawing from work due to domestic work, very few women seek health care in this regard in Bangladesh [12].This is due to the influence of traditional gender norms where women are forced to participate in daylong household tasks as homemaker and men (husband) act as family breadwinner. Rural women rarely report their musculoskeletal problems at the right time. This habit aggravates the situation vulnerable and leading to disorder. Full-time homemakers were 40% less likely to report musculoskeletal symptoms than working women [13]. Moreover, as living with pain for a prolonged time without stopping their household activities, they are very much prone to develop the physical disability. This study will highlight the hazards of this unpaid occupation and the health-seeking behavior of the ill-fated women engaged in it.
Literature Review
Pain can be classified based on its duration and location of body systems. If the pain stays for less than six weeks and/or between six weeks to three months and/or more than three months is called acute, sub-acute, or chronic pain respectively [14]. On the other hand, various physical and physiological regions of the body are affected by the pain. Of these, musculoskeletal region has become a public health priority as a major cause of pain and a decreased quality of life. International Association of Study of Pain (IASP) described musculoskeletal pain as a known consequence of overuse, repetitive and work-related musculoskeletal disorders [15]. Work-related disorders may evolve in the workplace due to the physical tasks with which people carry out their normal work activities. Domestic work is regarded as one of the daily activities. Studies show that women are considered as the main responsible person in the family to complete the household chores. Household activities are one of the causes of many musculoskeletal risks such as lower and upper back, spine, shoulder, wrist, neck and knee pain which can later lead to temporary and permanently disabled conditions [16]. Musculoskeletal problems of housewives not only affects them by significantly impairing their activities of daily living [17] , but also affects the other members of the family as they have to spent additional hours to complete household duties [18]. Along with individual and familial domain, housework and musculoskeletal symptoms among homemakers has relationship with social (low income) and demographic (age, education, number of children) factors [13,19]. In addition, the economic burden of musculoskeletal pain is ranked as second to that of cardiovascular disease [15].
Pain can be classified based on its duration and location of body systems. If the pain stays for less than six weeks and/or between six weeks to three months and/or more than three months is called acute, sub-acute, or chronic pain respectively [14]. On the other hand, various physical and physiological regions of the body are affected by the pain. Of these, musculoskeletal region has become a public health priority as a major cause of pain and a decreased quality of life. International Association of Study of Pain (IASP) described musculoskeletal pain as a known consequence of overuse, repetitive and work-related musculoskeletal disorders [15]. Work-related disorders may evolve in the workplace due to the physical tasks with which people carry out their normal work activities. Domestic work is regarded as one of the daily activities. Studies show that women are considered as the main responsible person in the family to complete the household chores. Household activities are one of the causes of many musculoskeletal risks such as lower and upper back, spine, shoulder, wrist, neck and knee pain which can later lead to temporary and permanently disabled conditions [16]. Musculoskeletal problems of housewives not only affects them by significantly impairing their activities of daily living [17] , but also affects the other members of the family as they have to spent additional hours to complete household duties [18]. Along with individual and familial domain, housework and musculoskeletal symptoms among homemakers has relationship with social (low income) and demographic (age, education, number of children) factors [13,19]. In addition, the economic burden of musculoskeletal pain is ranked as second to that of cardiovascular disease [15].
Materials and Methods
This cross sectional study used a sample of 341 randomly selected married homemakers from 8 wards of 4 unions of 2 upazials of Barishal district. Wards were selected through the quasi multistage process. Inclusion criteria for homemakers were age (18-45 years), marital status (married for at least a year), and living place (within the study place for one year) and experience of any type of MSP at least once in life. Visually, hearing, cognitive and mentally impaired, and pregnant woman as well as those had history of trauma in last 12 months, taking tuberculosis drugs and trauma were excluded the study population. Prior to data collection, a standard equation was used to determine the sample size [23]. The minimum sample size to be calculated was set at 331, but 10 more were added to adjust if any non-responded data were found during the data analysis. The study period was lasting from January, 2019 to December, 2019. The questionnaires were administered at the home of selected participants in the Barishal division through the interview by the first author. Due permission was obtained from the Upazilla Health and Family Welfare after explaining the objective of the study. A pre-test of questionnaire was conducted as soon as the research protocol was approved by the approval committee of the National Institute of Preventive and Social Medicine (NIPSOM), Bangladesh.
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