Bag pack weight and Musculoskeletal discomfort among school children

Transcription

1 Bag pack weight and Musculoskeletal discomfort among school children Keywords Bag pack weight, school children, musculoskeletal discomfort, heavy bag Deepti George, Baby S. Nayak, Sheela Shetty Abstract : Injuries and back strain caused by carrying too heavy back packs is a new form of injury in school age children and teens. A school based cross sectional study was carried out among 1000 school students aged between 10 1 years attending 5th- 7th standard with the objective to assess the back pack weight and musculoskeletal discomfort and their association with selected variables. The study was conducted at eight randomly selected schools of Udupi District, Karnataka. Cluster sampling technique was adopted for selecting the children. Weights of the bags were assessed using calibrated weighing scale and musculoskeletal discomfort was assessed using Standardized Nordic questionnaire (Kuorinka et al, 1986). The findings of the study showed that among 1000 children, 860 (86%) had musculoskeletal discomfort and 910 (91 %) children were carrying heavy bag pack. Children studying in fifth standard, aged 11 years, studying in English medium school and under CBSE stream had reported presence of musculoskeletal discomfort more than the other children. Children aged 10 years, studying in fifth standard, English medium school and under CBSE stream were carrying heavy bag than the other children. The study concluded that primary school children were carrying heavy bag pack compared to recommended weight. Musculoskeletal discomfort is independent of bag pack weight. However, carrying heavy bag pack may lead to musculoskeletal abnormality in later life. Correspondence at Dr. Baby S. Nayak Professor Department of Pediatric Nursing Manipal College of Nursing, Manipal Introduction In today's competitive world, educational system expose children to the problems resulting from heavy back packs. Children studying in different types of education levels use back packs for carrying 1 their books and other education instruments Viewing many problems and discomforts faced by the young shoulders of school going children due to back pack weight, developed countries started remedial Nursing and Midwifery Research Journal, Vol-11, No. 3, July

2 measures to solve this problem. But in developing country like India, this kind of problem still exists without any adequate measures for heavy back pack weight. Very few studies can be seen in India related to children school bag packs and musculoskeletal discomfort. Increased number of extra co-curricular activities in school such as musical instruments, sports activities, skating etc has led many children carry school bag more than quarter of their body weight throughout the day. The bones are more tender and soft and postural changes happen more in this age group; still the prevalence of this issue regarding school bag pack weight and musculoskeletal discomfort remains unclear. So the study was conducted with the objective to assess the bag pack weight and musculoskeletal discomfort among school children and their association with selected variables. Material and Methods A survey approach with a school based cross-sectional design was adopted for the study. The required sample size was calculated based on findings of pilot using the formula, n = α pq/d,where, n = sample size, α = 1.96 (constant value),p = expected proportion from pilot study (83%), d = allowable error (3%), 5% non-response and considering sample design effect for cluster sampling of 1.5, required sample size was 1000.Study was conducted at selected schools of Udupi district. Udupi District has three taluks, Udupi, Karkala&Kundapur. Udupi taluk was selected by convenient sampling. Udupi zone comprised of total th th th 148 schools with 5, 6 & 7 standard and the list and permission were obtained from the district educational officer (DDPI)of th Udupi district. Among 148 schools with 5, th th 6 and 7 standard, eight schools were selected randomly for the study. Cluster of th th children studying in 5 7 standard in these schools were selected as sample. The data collection tools used were demographic proforma, Standardized Nordic questionnaire for analysis of musculoskeletal symptoms (Kuorinka et al, 1986) and weight of the bag pack was measured in kilograms using calibrated wighing scale.standardized Nordic questionnaire for analysis of musculoskeletal symptoms" (Kuorinka et al, 1986) had total nine items were present which consisted of questions regarding presence of discomfort in any of the nine body part areas such as neck, shoulder, upper back, elbow, wrists & hands, hips/ thigh & buttocks, knees, ankles/feet for past one year. Ethical clearance was obtained from ethical committee of the institution. Formal administrative permission was obtained from the DDPI and school authorities. Consent was obtained from parents and assent was obtained from children. Data was collected from 1000 children from randomly selected eight schools of Udupi district, Karnataka. After obtaining the assent, instructions were given to students regarding how to fill the questionnaire. After completion of the questionnaire, they were instructed to be in queue for measuring weight of the bag pack. Calibrated digital weighing machine was kept ready till the students filled the questionnaire. To avoid error, weighing machine was switched off and on in between till 0.00 kg was displayed on the digital weighing machine, while measuring bag pack weight.after completion of data collection, instructions related to proper bag carrying techniques was taught to children. The SPSS statistical package (16.0) was used for analysis of data. Nursing and Midwifery Research Journal, Vol-11, No. 3, July

3 Results Demographic characteristics Of 1000 samples nearly half 466 (46.6 %) of children were 1 years of age, one third of them i.e. 357 (35.7%) were from seventh standard. With regard to gender, 539(53.9%) were males and 461 (46.1%) were females. Almost two third 656 (65.6%) were studying in English medium and maximum number of children 786 (78.6%) were studying under state syllabus. The height of upper primary school children was ranged between 170 cm and 115cm with mean height and standard deviation of 14.5cm (± 9.44), the weight was ranged between kg and 18.80kg with mean weight of 3.8 and S.D. ± 8.86.The mode of transport to school for591 (59.1%) children was by vehicles like Ankle/Feet school bus, car, private bus, auto-rikshaw, bike etc Knee whereas only 361(36.1%) of children were going to school by walking. Hips/Thighs Description of bag pack The weight of the bag pack Lower Back ranged from 1 to 6 Kg1.80 Kg with mean bag pack weight 5.44 and standard deviation of Upper Back ± 1.58 kg. If the bag pack was more than the 10% of body weight, bag pack was Wrist considered heavy and 910 (91%) of children were Elbow carrying heavy bag pack. Further the content of bag pack was observed and it was Shoulder found that other than school note and text book children were also carrying tuition Neck books, key chain, wallets, story books, lunch box and water bottle. Prevalence of musculoskeletal discomfort Standardized Nordic Questionnaire (Kuorinka Et al 1986) was used to assess musculoskeletal discomfort and 860 (86%) of children reported the presence of discomfort in any one area of body. Discomfort in the shoulder was reported by 355 (35.5%) of children. The region wise prevalence of discomfort is shown in figure1. Among 1000 children, 34 (3.4%) of children reported pain in the neck, 94 (9.4%) in ankle/feet, 86 (8.6%) in knee, 30 (3%) in elbow, 07 (0.7%) in upper back, 16 (16.%) in hips/thighs and the least discomfort were shown in lower back 156 (15.6 %). 16.0% 15.60% 0.70% 19.10% 3% 9.40% 6.60% 35.50% 3.40% Figure.1: Prevalence of musculoskeletal discomfort among children Nursing and Midwifery Research Journal, Vol-11, No. 3, July

4 However the findings of the study revealed that musculoskeletal discomfort was not statistically associated with carrying heavy bag pack ( (df) = 0.06(1), p = 0.80). Association between bag pack weight and selected variables. The data presented in table 1 shows the significant association between bag pack weight and age ( (df) = 30.78(), p<0.001), standard of study ( (df) = (), P<0.001), educational medium ( (df) = (1), p <0.001), stream of education ( (df) = 15.09(1), p <0.001) and mode of transport to school ( (df) = 17.69(), p <0.001). Thus it is interpreted that children aged of 10 years, studying in fifth standard, English medium school and in CBSE stream were carrying heavy bag than the other participants. However gender ( (df) =.18 (1), p= 0.454) of the child was independent of carrying heavy bag pack. Table -1 Association between bag pack weight and selected variables ( n=1000) Sample characteristics Subjects (f) Bag pack weight df p-value Normal bag Heavy bag pack weight F(%) pack weight F(%) 1.Age in years (.4) 04 (97.6) <0.001* (4.9) 309(95.1) (13.5) 403 (86.5). Standard of study Fifth standard () 95 (98.0) * Sixth standard 34 6 (7.6) 316(9.4) Seventh standard (14.6) 305 (85.4) 3. Gender Male (7.8) 497 (9.) Female (9.1) 419 (90.9) 4.Educational medium English (6.1) 616 (93.9) <0.001* Kannada (9.1) 300 (87.) 5. Stream of education CBSE 14 4 (1.9) 10 (98.1) <0.001* State syllabus (10.) 706 (89.8) 6.Mode of transport to school Walking (13.3) 313 (86.7) <0.001* Bicycle 48 3 (6.) 45 (93.8) Other vehicles (5.6) 558 (94.4) Nursing and Midwifery Research Journal, Vol-11, No. 3, July

5 Association between musculoskeletal discomfort and selected variables The findings of the study reported in table shows a significant association between musculoskeletal discomfort and standard of study ( (df) = 6.196(), p = 0.45), educational medium ( (df) = 8.105(1), P = 0.004), stream of education ( (df)=11.051(1), p=0.001). The prevalence of musculoskeletal discomfort is found to be more among children aged 11 years, studying in fifth standard, studying in English medium schools and under CBSE stream than the other participants. However age of the child ( (df) = 1.367(), p =0.505, gender ( (df) = 0.01(1), p=0.91 and mode of transport to school ( (df) = (), p=0.189), did not have any significant effect on musculoskeletal discomfort. Table - Association between musculoskeletal discomfort and selected variables ( n=1000) Sample characteristics Subjects (f) Musculoskeletal Discomfort df p-value Absent F(%) Present F(%) 1.Age in years (13.9) 180 (86.1) (1.3) 85 (87.7) (15.) 395 (84.8). Standard of study Fifth standard (10) 71 (90) Sixth standard (14.9) 91 (85.1) Seventh standard (16.5) 98 (83.5) 3. Gender Male (14.1) 463 (85.9) Female (13.9) 397 (86.1) 4.Educational medium English (11.7) 579 (88.3) * Kannada (18.3) 81 (81.7) 5. Stream of education CBSE (7.0) 199 (93) * State syllabus (15.9) 661 (84.1) 6.Mode of transport to school Walking (13.6) 31 (86.4) Bicycle (.9) 37 (77.1) Other vehicles (13.5) 511 (86.5) Nursing and Midwifery Research Journal, Vol-11, No. 3, July

6 Discussion Children studying in different education level use back packs for carrying their books and other educational materials. In the present competitive world, educational system promote the children to carry heavy back pack, which will expose the children for many health problems, specifically musculoskeletal discomfort. In the present study 91% of children were carrying bag pack more than 10% of their body weight. These findings are consistent 3 with findings of Al Hazzaa in 005, reported, 50% of Saudi boys were carrying back packs more than 10 % of their body 4 weight. Limon S et al, reported 30% and 54% of elementary school students carried back packs of > 15% of their body weight. However researcher could not trace research related literature on bag pack weight of Indian children. Exploration in this area should be of prime importance in the department of health, primary and secondary education sectors. In the present study 86% of children have reported musculoskeletal discomfort in any of the nine areas depicted in standardized Nordic Questionnaire. These findings are consistent with the findings 4-7 reported in different literature. However in this study musculoskeletal discomfort was independent of bag pack weight, this could be because of bag pack was weighed only on one day of a week. However exploration needs to be done on average back pack weight of the children, considering different events and celebrations. The study concludes that majority of school children carry bag pack more than the recommendation. The musculoskeletal discomfort is also high among school children. The education department needs to develop policy on recommended weight of bag pack, to prevent the musculoskeletal disorders at early age.the findings is an alarm to the society and educational board, there need to develop immediate policies related to control of bag pack weight. If it is not established then the future generation will be prone for musculoskeletal complaints at an early age References 1. Negrini S, Carabalona, R, Backpacks on! Schoolchildren's perceptions of load, association with back pain and factors determining the load. Spine. 00, : Kuorinka I, Jonsson B, Kilbom A, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3): Al Hazzaa HM. School backpack. How much load do Saudi school boys carry on their shoulders? Saudi Medical Journal. 006 ; 7(10): Limon S, Valinsky LJ, Ben Shalom Y. Children at risk: risk factors for low back pain in the elementary school environment. Spine.004; 9 (6): Rodriguez- Oviedo P, Ruano- Ravina A, Perez- Rios M, Garcia FB Gomez Fernandez. D, Fernandez- Alonso A, Carreira Nunez I, Garcia- Pacios P, Turiso.J.School children's back packs, back pain and back pathologies. Archieves of disease in childhood. 01t; 97(8): Korovessis P, Koureas G, Papazisis Z. Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents. Journal of spinal disorders and techniques. 004; 17(1): Van Gent C, Dols JJ, dc Rover CM, Hirasing RA, de Vent HC. The weight of schoolbags and the occurrence of neck, shoulder, and back pain in young adolescents. Spine. 003; 8(9) : Nursing and Midwifery Research Journal, Vol-11, No. 3, July