Introduction

Work-related musculoskeletal disorders (WRMSDs) are musculoskeletal disorders caused by occupational exposure. They can affect muscles, joints and tendons, ligaments, nerves, or localized body circulation systems that are aggravated primarily by work and the effects of the immediate environment. Most Musculoskeletal disorders (MSDs) develop over time and can be episodic or chronic, progressing from mild to severe disorders [1, 2]. MSDs are a group of degenerative and inflammatory conditions that affect the blood vessels, nerves, joints, ligaments, tendons, and muscles. MSDs are the leading cause of disability, impaired body functions, decreased work capabilities, and decreased quality of life, resulting in significant economic implications for the nation [3–6]. MSDs occur when the body structure is repeatedly abused and forced to endure a workload that the body is unable to tolerate [7, 8].

MSDs are the second greatest cause of years lost to disability, according to the Global Burden of Disease 2017 report, even though years of life lost are falling in Sub-Saharan Africa. Furthermore, as the Sub-Saharan population ages, the burden of MSD will continue to increase [9–11]. MSDs are less prioritized in low-middle income countries (LMICs), particularly in Ethiopia, due to a focus on more pressing and life-threatening health issues such as infectious diseases. According to a previous comprehensive review done in Africa, the prevalence of MSDs ranged from 13 to 92% in South Africa and Ghana, respectively [12]. Evidence suggests that genetic diversity; differences in social structure, economics, and other factors may all have a role in the reported difference in the prevalence of MSDs among Africans. Furthermore, musculoskeletal issues remain a major global health concern and a significant burden for LMICs such as Ethiopia, where health funding is already limited and devoted to life-threatening conditions. According to research, the prevalence of musculoskeletal pain among Ethiopia’s working population is between 35% and 75% [13–15].

The vast majority of work-related deaths, injuries, and illnesses are preventable. However, there are approximately 2.78 million work-related deaths worldwide each year. Moreover, work-related deaths accounted for 5% of all deaths worldwide [16]. Every day, it is estimated that over 7,500 people die as a result of occupational accidents. The number of fatal occupational accidents has slightly increased. The estimated number of non-fatal occupational accidents is 374 million, a significant increase from 2010. Asia was the largest contributor, accounting for roughly two-thirds of global work-related mortality, followed by Africa (11.8%) and Europe (11.7%) [17].

Weaving is one of the world’s oldest surviving crafts, and it is the second largest source of rural employment after agriculture. Weaving is a significant cottage industry in developing countries such as India, Pakistan, Bangladesh, Iran, Turkey, and China, where traditional weaving methods are still widely practiced. Weaving is a largely unorganized industry in developing countries [18]. Informality harms workers’ rights, including fundamental principles and rights at work, social protection, and adequate working conditions [19]. Weaving involves a variety of activities that involve repetitive movement of upper and lower limbs to operate pedals and shuttles, with arms raised away from the body. As a result, weaving and other handloom activities have become high-risk occupations for developing musculoskeletal disorders [20]. MSDs are painful conditions caused by overuse of the body’s muscles, joints, nerves, tendons, and soft tissues. Because of the impact on worker health and productivity, MSDs are considered one of the most expensive occupational disorders [21]. Furthermore, previous studies on weavers have revealed a widespread prevalence of MSD among workers, which is mostly attributable to working conditions and exacerbated by work-related stress [22].

A variety of factors influence the occurrence of MSDs in various professions. Working postures are influenced by the shape, arrangement, size, and placement of the tools used as well as their operating methods. Unnatural body positions and non-ergonomic ways of working for an extended period can result in a variety of health issues for employees. Working in the same position for an extended period whether standing or sitting will cause discomfort [23]. Working postures such as sitting for an extended time without any adjustment can soften the abdominal muscles, causing spine curvature and causing respiratory and digestive organ disorders [24]. Furthermore, a poor ergonomic workstation has been shown to increase muscular load and activity, increasing MSD [25]. Physical factors or loads on the biomechanical system are thought to cause tissue damage and inflammation, leading to MSD [26]. However, there is still conflicting evidence that there is a link between workstation configuration and MSD [27, 28].

Work-related MSD problems are prevalent. They reduce the productivity and revenue of many Ethiopian weavers. Managing MSD provides for increased productivity and improved quality of life. Despite substantial studies on the effects of MSD on other occupations and the need to treat them, there is limited data on the weaving industry, and no equivalent research has been conducted. There are no published articles in this field in Ethiopia, there is a research deficit and a need for an integrated approach to MSD prevention. Weavers in this study may be able to close a knowledge gap by giving recorded proof of MSD prevalence and advocating for preventative steps to mitigate its impact. Moreover, Weaving provides a source of income and employment opportunities not only for weavers and their families, but also for traders, tailors, fashion designers, and soon. Weaving is very important in Ethiopia for the national economy and for enhancing the country’s cultural values [29]. Furthermore, musculoskeletal disorders continue to be a major global health issue as well as a significant financial burden for low- and middle-income countries such as Ethiopia, where health budgets are already stretched thin and devoted to life-threatening conditions. According to one systematic review, musculoskeletal pain affects anywhere from 35% to 74.5% of Ethiopia’s working population [30].

For centuries, Ethiopians have practiced traditional cotton weaving using both endogenous and exogenous technology. Cotton weavers work in small, cramped spaces under appalling working conditions. People working in the weaving industry are extremely vulnerable due to a lack of occupational safety and health services and poor working conditions because they are not supported by occupational safety and health services [29]. Even in modern times, weaving has cultural value, and weavers must be properly cared for and valued as artisans. This research is critical not only for the health of weavers but also for the aesthetic and cultural value of the weaving profession. Traditional cloth weaving is still practiced in many parts of Ethiopia. The occupation has contributed significantly to the economies of both the workers in the sector and the country as a whole. There is, however, a scarcity of information about the health issues that weavers face at work. As a result, the purpose of this study was to ascertain the prevalence of work-related musculoskeletal disorders and their associated factors among traditional cloth weavers in the Chencha district.

Methods

Result

Socio-demographic characteristics of the respondent

A total of 420 traditional cloth weavers were included in the study with a response rate of 99.29%. Four hundred and nineteen (99.8%) respondents were male weavers. Approximately 33.3% of the weavers had the education level of primary school and only (0.7%) of traditional cloth weavers had the educational level of university/college. Approximately 145 (34.5%) respondents were in the older age group (greater than 40 years of age) and the median age of the study subject was 30 ± 13.21 SD. The traditional cloth weavers’ work experience revealed that 198 (47.1%) had served for more than 10 years. In terms of monthly income, 196 (46.7%) weavers had a monthly income of less than 1950 Ethiopian Birr (< 2.15 U$D per person per day) with a median of 2000 Ethiopian Birr (Table 1). Those weavers are classified as poor by the WHO global poverty line.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Socio-demographic characteristics of traditional cloth weavers in Chencha district, Gamo Zone, Ethiopia, 2022.

https://doi.org/10.1371/journal.pone.0293542.t001

Prevalence of WRMSDs among traditional Weavers

Among 420(100%) respondents, 204(48.6%) of them reported WRMSDs after beginning weaving (95%CI: 44.1%, 53.6%). Approximately 197(46.9%) of the respondents with WRMSDs through their job career had WRMSDs during the last 12 months (95%CI: 41.7%, 51.9%). Among those weavers who reported WRMSDs in the last 12 months, 174(41.4%) of them felt WRMSDs during the previous seven days (Table 2).

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 2. Prevalence and characteristics of WRMSDs among traditional cloth weavers in Chencha district, Gamo Zone, Ethiopia, 2022.

https://doi.org/10.1371/journal.pone.0293542.t002

The number of hospitalizations for WRMSDs in the previous 12 months was 101(24%). Out of those cases, 39(9.3%) of them were hospitalized due to shoulder pain and 42(10%) weavers were hospitalized more than once during the previous 12 months. In terms of work absenteeism, 118(28.1%) of the respondents were absent due to WRMSDs and among them 102(48.1%), 58(13.8%) were absent for more than 30 working days consecutively during the previous 12 months (Table 2).

Determinants of WRMSDs

Bivariate and multivariate logistic regression models were used to analyze socio-demographic, working conditions, and environmental, behavioral, and psychosocial determinants (factors). In the bivariate logistic regression analysis, working in an uncomfortable posture, working in the same posture for an extended period, making the same body movement, taking breaks, and resting time all had a statistically significant association with WRMSDs. WRMSDs were significantly associated with those weavers who had more than 10 years of work experience (AOR 5.05, 95%CI 1.23, 20.77) and those weavers who had a history of WRMSDs (AOR 8.34, 95%CI 2.23, 31.26) in the multivariate logistic regression analysis (Table 3).

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 3. Determinants of WRMSDs among traditional cloth weavers in Chencha district, Gamo Zone, Ethiopia, 2022.

https://doi.org/10.1371/journal.pone.0293542.t003

Discussion

Weaving is one of the most taxing occupations, with long hours of static work that leads to Musculoskeletal Disorders. WRMSDs were extremely common among weavers working in small-scale industries and the informal sector. Furthermore, socio-demographic factors, working conditions, and weavers’ behavioral and psychosocial characteristics were among the factors that contributed to the occurrence of WRMSDs [18, 36–38]. This Study determined the prevalence of WRMSDs and associated factors among traditional cloth weavers in Chencha, Gamo Zone, Ethiopia.

According to the findings of this study, the prevalence of WRMSDS among traditional cloth weavers was 204 (48.6%) after beginning their weaving career (95% CI: 43.6%, 53.6%). Among study participants, the 12-month prevalence was 197 (46.9%) (95% CI: 41.9%, 51.9%). The prevalence of WRMSDs in this study, however, is lower than in the study conducted in Varanasi, India. The Indian study found that MSDs were more common in different parts of the body in the previous year among handloom and power loom workers. According to the study, 96.13% of weavers, including both handloom and power loom workers, reported having a problem in different body regions [39]. The difference in the prevalence of WRMSDs could be due to differences in the working conditions of weavers in these two studies. In India, the study was conducted in well-organized workshops with a poor working environment, whereas this study was conducted in individual households with less organized working shops. Furthermore, there are differences in working conditions between handloom, power loom, and traditional cloth weaving.

Weavers with WRMSDs in the shoulder 76(18.1%), low back 64(15.2%), neck 56(13.3%), and upper back 1(0.2%). This study found that the shoulder is the most common WRMSD among traditional cloth weavers, which is similar to a study done among handloom weavers that found the shoulder to be the most prevalent region [36, 38]. However, this study contradicts the study done in India which reported that low back pain was the most common WRMSD among handloom weavers [37]. The possible difference may be the working condition in traditional cloth and handloom weaving is different. The Indian study focused on well-organized workshops with a poor working environment, whereas this study focused on individual households with less organized workshops. Furthermore, working conditions differ between handloom in India and traditional cloth weaving in Ethiopia.

In this study, weavers with a history of WRMSDs were more likely to develop WRMSDs. Weavers who had a history of WRMSDs were 8.34 times more likely to develop WRMSDs than those who had no history (AOR = 8.34, 95%CI: 2.23, 31.26). This study was consistent with a previous study conducted among healthcare workers and garment industry workers, which reported that participants with a history of musculoskeletal diseases were 6.585 and 6.6 times more likely to develop work-related musculoskeletal diseases than those without a history of MSD, respectively [40, 41]. This could be because when weavers are engaged in similar tasks, this could potentially aggravate the previous history of MSDs and also result in complicated health problems.

Weavers with more than ten years of experience were 5.05 times more likely to have WRMSDs than those with less than five years of experience (AOR = 5.05, 95%CI: 1.23,20.77). The findings are similar to those of a study among handloom weavers, which reported that working for more than ten years was a risk factor for WRMSDs [33, 39, 42]. The possibility is that weavers with more experience work for longer periods and are exposed to factors that may contribute to the occurrence of WRMSDs. Moreover, possible causes could also include aging, age-related degenerative changes, decreased tissue repair, cartilage thinning, and cumulative stress to various body structures as a result of workload. In contrast, an Indonesian study reported that more work experience significantly reduced the prevalence of WRMSDs [22]. The possible reason for the difference could be those Indonesian women weavers tend to take more rest, had reduced workloads, and improved working conditions compared to the weavers in this study.

Working hours per day, on the other hand, did not show a significant association with WRMSDs in this study. This study was consistent with studies conducted among handloom workers in India, Indonesia, and Bangladesh garment workers [43, 44]. The reason for this could be that daily working time in the weaving industry is not usually fixed; it varies depending on the situation and workload, and weavers’ motivation to earn more money causes them to work longer. However, this study contradicted studies conducted in Assam, Northern India, and Indonesia which found that long working hours affect the health of weavers who must spend a day weaving in looms. According to worker responses, as working hours increase, so does the health burden [42, 45]. The possible difference could be the weavers in this study are not formal sector weavers like the weavers in the North Indian and Indonesian studies which gives them the mandate to determine the working hours by themselves depending on whether they are feeling discomfort or not. The informality of the weavers in this study could have contributed to those weavers working less and suffering from MSDs.

Studies in various careers/professions revealed that working with prolonged sitting contributes to the occurrence of musculoskeletal problems in various body regions [22, 40, 42, 46]. Similarly, this study found that weavers who sat for extended periods were approximately 4.77 times more likely to report WRMSDs than those who did not sit for extended periods (AOR = 4.77, 95%CI: 1.37,16.62). The outcome is not surprising given that weavers used to weave for long periods while seated, with a stretched, extended body and repeatable movement [18]. The possible reason might be weavers sitting on an uncomfortable chair and table tends to develop stiffness and discomfort. This study was similar to a study conducted in Indonesia [22]. This is because the longer the working duration, the greater the exposure to risk factors. Long-term physical stress reduces muscle performance in areas with less mobility. The stresses will build up day by day for a long period, causing health concerns. However, this study contradicted a study conducted among carpet weavers in Iran, which found that prolonged sitting was not significantly associated with WRMSDs [27].

Another variable that was associated with WRMSDs was regular physical exercise. Weavers who did not engage in regular physical activities were 2.88 times more likely to develop WRMSDs than those who engaged in regular physical activities (AOR = 2.88, 95%CI: 1.43, 5.79). This study agreed with a systematic review of the effects of exercise on musculoskeletal disorders and a study done among school teachers in Ethiopia [13, 46]. The possible reasons may be exercise can enhance strength, flexibility, and pain tolerance, and make muscles and ligaments stronger to support various body parts without feeling discomfort.

Finally, this study found that weavers who were dissatisfied with their jobs were 2.41 times more likely to develop WRMSDs than weavers who were satisfied with their jobs (AOR = 2.41, 95%CI: 1.04, 5.55). This study was in line with studies conducted in Varanasi, India among weavers and emergency nurses in Iran, which reported job dissatisfaction increases the odds of having WRMSDs which could be contributed to physical and mental discomfort attributed to the working conditions in those professions [39, 47]. However, the result of this study contradicts studies done among nurses in Ethiopia [15]. The discrepancy could be related to the physical demands of weaving and nursing. Furthermore, it could be related to the disparity in earnings and working conditions between weaving and nursing jobs.

Conclusions and recommendations

This study discovered a high prevalence of WRMSDs among traditional cloth weavers, indicating the need for immediate public health intervention. WRMSDs were also linked to work experience, working with prolonged sitting, a history of musculoskeletal disorders, regular physical activity, and job satisfaction. The study implies that there must be measures aimed at the prevention and control of MSDs, such as the provision of health and safety training and a safe working environment for weavers. Moreover, ergonomically oriented weaving workstations are required because the majority of WRMSDs are caused by poorly designed workstations. As a result, even minor changes in working conditions, weaving tool design, and working methods can result in significant benefits, such as reduced bending, uncomfortable posture, and tasks that put a strain on weavers’ backs. Therefore, concerned stakeholders should intervene to prevent the occurrence of WRMSDs among weavers and to improve the productivity of the sector using the finding of this study. Other scholars could also conduct interventional studies that could potentially solve the MSD problem faced by those weavers due to different factors, particularly workstation-related factors.

Acknowledgments

We would like to express our gratitude to all data collectors, supervisors, study participants, and the Chencha district administrative office for their assistance in completing this study.