Introduction

Back pain is a significant public health issue globally, affecting millions of individuals and posing substantial economic burdens due to lost workdays and medical expenses. Among the various occupational groups, baggage handlers are particularly vulnerable to back pain due to the physically demanding nature of their job, which often involves repetitive lifting, bending, and twisting movements. These activities, if not performed correctly or without adequate ergonomic interventions, can lead to musculoskeletal disorders, including back pain. [1]

In Nigeria, the aviation sector is a critical component of the national economy, providing both employment and essential services for international and domestic travel. Baggage handlers at airports like the Port Harcourt International Airport play a crucial role in the smooth operation of this sector. However, their occupational health, particularly concerning back pain, has not been extensively studied. This research aims to fill this gap by examining the prevalence of back pain among baggage handlers at Port Harcourt International Airport, Nigeria.

The high prevalence of back pain among baggage handlers can be attributed to several factors. Firstly, the physical demands of handling heavy luggage, often in awkward postures, place significant strain on the lower back. [2] Furthermore, the lack of proper lifting techniques and ergonomic training exacerbates the risk of injury. [1] Studies have shown that manual handling tasks, if not performed ergonomically, can lead to cumulative trauma disorders. [3]

Additionally, psychosocial factors such as job stress and lack of job control have also been identified as contributing factors to the development of back pain. [4] In the context of Nigerian airports, these factors are compounded by often inadequate infrastructure and resources, leading to increased physical and mental strain on workers.

Recent studies have highlighted the importance of ergonomic interventions and proper training in reducing the incidence of back pain among workers involved in manual handling. [5] However, the implementation of such interventions in developing countries like Nigeria faces numerous challenges, including limited awareness, resources, and regulatory enforcement [6].

Moreover, the cultural context and attitudes towards occupational health and safety in Nigeria can also influence the prevalence and reporting of back pain among baggage handlers. In many cases, workers may continue to work despite experiencing pain due to economic pressures and fear of job loss. [7] This underreporting of symptoms can lead to a lack of accurate data on the true extent of the problem, further complicating efforts to address it effectively. Given these complexities, it is important to conduct comprehensive studies to understand the prevalence and determinants of back pain among baggage handlers in Nigerian airports. Such research can inform the development of targeted interventions and policies to improve the occupational health and safety of these workers, ultimately enhancing their well-being and productivity.

Materials And Methods

Study Design

This study employed a cross-sectional survey design to investigate the prevalence of back pain among baggage handlers at Port Harcourt Airport, Nigeria. This design is appropriate as it allows for the collection of data at a single point in time to assess the prevalence of a health outcome in a specific population.

Study Area

Port Harcourt International Airport is an international airport located in Omagwa, a suburb of Port Harcourt, Rivers State, Nigeria. The airport consists of a single terminal with separate facilities for international and domestic flights. Omagwa Airport, which has one runway that is 9846 feet (3001 meters) long, is located in the Greater Port Harcourt city in Ikwere Local Government Area, along the Port Harcourt – Owerri road. The geographical coordinates are 5 degrees, 0 minutes, 56 seconds North (5.015494), 6 degrees, 56 minutes, 59 seconds East (6.949594), and 87 feet (27) above sea level. In 2009, the airport served 1,081,587 passengers, making it the third busiest airport in Nigeria.

Study Population

The study population includes airport baggage handlers – both males and females aged 20 to 60 years. The airport has at the time of this study only four functional airlines and two cargo handling companies, namely: Aero Contractor, Med-View, Arik Air, Dana, Naco and Savcol.

These companies are in turn, responsible for the baggage of their customers, which is the duty of their luggage handling staff.

Inclusion Criteria

All persons handling baggage and cargo for airline companies within the airport.

Exclusion Criteria

Passengers, flight attendants and all other staff were not included in the above criterion.

Sample Size Determination

Using a prevalence of low back pain among baggage handlers as P = 62%⁴⁷

Margin of error tolerated was set at e = 5%, and a confidence level 0f 95%

Sample size (n) = ^{pq/[e/1.96]2,} where q = (100-p), = 62(100-62) / [5/1.96]²

Therefore n = 362

Percentage attrition would be set at 5%

= (5/100) x 362 = 18

The adjusted sample size will be 362 + 18 = 380

Therefore n = 380 baggage handlers.

Sampling Method 

The number of respondents in the study area was not up to 200, so we sampled every baggage handler in the airlines and baggage handling companies.

Data Collection

The baggage handlers met during weekdays between the hours of 12:00 noon and 3:00 pm, during which period there were no flight departures or arrivals when most of them were found at the baggage handlers’ office sections of the airlines and the baggage handling companies. Questionnaires were administered to the respondents by the researchers, while others were given to the managers of the baggage handling companies for those who could not be directly reached by the researchers.

Each interview started with an introduction and overview of the research, including the objectives of the study. The respondents were told that names were not required in the administered questionnaires. Explanations were given to respondents as required for the understanding of unfamiliar terms.

Data Analysis

Data collected was analyzed with a Microsoft Excel spreadsheet sheet and results were presented using a frequency distribution table.

Ethical Consideration

The study followed the principle guiding the use of human participants in research. Approval from the Department of Community Medicine, University of Port Harcourt, was obtained, as well as from the Federal Airport Authority of Nigeria, Port Harcourt branch. In addition, verbal informed consent was obtained from each respondent. All the respondents were informed that the survey was voluntary and that they did not have to participate if they chose not to or could withdraw at any time. Respondents were assured that the confidentiality of their responses would be maintained during and after the data collection. Only numbers were assigned to each copy of the questionnaire, and no name was required on the questionnaire. The numbers facilitated data entry and analysis, and no one can link the identity of the participants with the registration numbers.

Limitations of the Study

Obtaining a permit from the Federal Airport Authority in order to access the restricted areas of the airport and a similar permit from the baggage handling companies in order to allow the researchers to meet with the baggage handlers all posed a challenge.

The time for administering the questionnaires initially posed a challenge as we were unaware of when they were less busy. However, this was overcome by obtaining information from managers on when the baggage handlers were on break.

Also, getting the baggage handlers in one place posed a challenge as they worked in shifts, and some were assigned to some restricted areas regardless of their being on break. Thus, the questionnaires were administered through their managers. 

Results

The sociodemographic information of the participants in the study is presented in Table 1. The majority of participants were aged between 30-34 years, accounting for 51.9% of the total, followed by those aged 25-29 years at 22.5%. Only a small percentage were aged 46 years and above (1.6%). The sample was predominantly male (95.3%), with females representing only 4.7%. Most participants were married (62%), with single individuals making up 38%. Regarding religious affiliation, 96.9% identified as Christians, while 3.1% were Muslims. In terms of educational level, a majority had tertiary education (63.5%), followed by secondary education (32.9%), and a small percentage had only primary education (3.9%).

According to Figure 1, 72% of airport baggage handlers reported experiencing back pain, while 28% did not. The occupational history of baggage handlers shows varied durations of employment (Table 2), with the majority (70.5%) having worked for more than three years. A significant proportion (66.7%) reported illness due to their job, while 33.3% did not. Back pain was prevalent among 74.4% of the participants, with 82.3% of those experiencing it for one month or less, 11.5% for 1-3 months, and 6.2% for more than three months. The frequency of back pain occurrences was highest once in less than six months (63.5%), followed by once in a year (25%), once in two years (7.3%), and once in three years or more (4.2%).

The attitude of baggage handlers towards back pain (Table 3) revealed that 60.4% had been absent from work due to back pain, with most absences lasting less than three months (81%). A substantial majority (71.3%) knew about back pain prevention, and 80.6% had received weightlifting training. Regarding the frequency of weightlifting sessions, 35.6% were trained once every three months, 51.9% once every six months, and 12.5% once a year.

Table 1: Sociodemographic Information of the Participants

VARIABLE	FREQUENCY (n)	PERCENTAGE (%)
AGE (year)
20-24	8	6.2
25-29	29	22.5
30-34	67	51.9
35-39	12	9.3
40-45	11	8.5
≥46	2	1.6
Total	129	100
SEX
Male	123	95.3
Female	6	4.7
Total	129	100
MARITAL STATUS
Single	49	38.0
Married	80	62.0
Total	129	100
RELIGION
Christianity	125	96.9
Islam	4	3.1
Total	129	100
EDUCATIONAL LEVEL
Primary	5	3.9
Secondary	42	32.9
Tertiary	82	63.5
Total	129	100

Table 1: Sociodemographic Information of the Participants

Figure 1: Prevalence of back pain among Airport baggage handlers

VARIABLE	FREQUENCY (n)	PERCENTAGE (%)
DURATION OF OCCUPATION 0-6 MONTHS 1 year 11/2year 2 years >3years Total ILLNESS DUE TO JOB Yes No Total OCCURRENCE OF BACK PAIN Yes No Total DURATION OF BACK PAIN ≤1month 1-3 months >3months Total FREQUENCY OF BACK PAIN Once in <6 months Once in 1 year Once in 2 years Once in≥ 3 years Total	5 8 11 14 91 129   86 43 129   96 33 129   79 11 6 96   61 24 7 4 96	3.9 6.2 8.5 10.9 10.9 70.5   66.7 33.3     74.4 25.6     82.3 11.5 6.2     63.5 25.0 7.3 4.2

 Table 2: Occupational History of Baggage Handlers

VARIABLE	FREQUENCY (n)	PERCENTAGE (%)
ABSENCE FROM WORK DUE TO BACK PAIN Yes No Total DURATION OF ABSENCE FROM WORK < 3 months ≥ 3months Total KNOWLEDGE OF BACK PAIN PREVENTION Yes No Total WEIGHT LIFTING TRAINING Yes No Total FREQUENCY OF WEIGHT LIFTING SESSIONS Once in 3 months Once in 6 months Once in one year Total	58 38 96   47 11 58   92 37 129   104 25 129   37 54 13 104	60.4 39.6     81.0 19.0     71.3 28.7     80.6 17.4     35.6 51.9 12.5

Table 3: Attitude of Baggage Handlers Towards Back Pain
Discussion

Back pain is a significant occupational health issue, particularly among baggage handlers who are frequently required to lift and carry heavy loads. This study investigates the prevalence of back pain among baggage handlers at Port Harcourt Airport in Nigeria, examining their attitudes, knowledge, and practices regarding back pain prevention.

The sociodemographic profile of the baggage handlers at Port Harcourt Airport reveals several key characteristics. The majority of the participants are in the age group of 30-34 years (51.9%), with a substantial proportion also in the 25-29 years age range (22.5%). This indicates a relatively young workforce, which aligns with the physically demanding nature of baggage handling that typically attracts younger individuals.

Male participants dominate the sample (95.3%), reflecting the gender distribution commonly observed in physically intensive occupations such as baggage handling. This is consistent with findings from other studies in similar occupational settings where male workers are predominant. [1,8]

In terms of marital status, the majority of the workers are married (62%), which might suggest the need for stable employment to support families. This demographic feature is similar to findings by Yeung et al., who reported higher back pain prevalence among married workers due to additional domestic responsibilities that contribute to overall physical strain. [9]

Regarding religion, the overwhelming majority of the participants are Christians (96.9%), which mirrors the religious demographics of the region, where Christianity is the dominant religion. This factor, however, does not have a direct implication on back pain prevalence but provides a contextual understanding of the workforce.

Educational level data show that the majority of the participants have tertiary education (63.5%), followed by secondary education (32.9%). This is somewhat unexpected given the nature of the job, which typically does not require advanced educational qualifications. However, this might reflect the broader economic and employment context in Nigeria, where higher educational attainment does not necessarily translate to jobs that match the educational level due to limited opportunities.

The results of this study reveal a high prevalence of back pain among baggage handlers at Port Harcourt Airport, Nigeria, with 72% of the surveyed individuals reporting back pain and only 28% without back pain (Figure 1). This significant prevalence highlights the occupational hazards associated with baggage handling and aligns with the global trend observed in similar studies.

The findings of this study are consistent with several previous studies that have documented a high prevalence of musculoskeletal disorders, particularly back pain, among airport baggage handlers. For instance, a study conducted by Behrens et al. [10] reported that 74% of baggage handlers experienced back pain, a figure remarkably similar to our findings. This consistency underscores the widespread nature of back pain in this occupation and suggests that the issue is not unique to Port Harcourt Airport but is a common occupational health problem globally.

Moreover, Punnett and Wegman highlighted that manual handling tasks, repetitive movements, and awkward postures are significant risk factors for developing back pain. [2] Baggage handlers frequently engage in these activities, thereby increasing their risk of musculoskeletal injuries. Our study reinforces this understanding by demonstrating a high prevalence of back pain in a population engaged in such tasks.

In another study, Robb and Mansfield investigated the prevalence of musculoskeletal disorders among baggage handlers in the United Kingdom and found that 68% of participants reported back pain. [11] While slightly lower than our finding of 72%, the difference can be attributed to variations in working conditions, baggage handling techniques, and ergonomic interventions available at different airports.

Similarly, a study by Jensen et al. reported a high prevalence of musculoskeletal disorders among airport baggage handlers in Denmark, with back pain being the most common complaint. [12] Similarly, research by Chaffin et al. highlighted the significant risk of back pain due to the physical demands of baggage handling tasks. [13]

In Nigeria, Akinbami et al. investigated back pain among workers in various occupations and found that manual labourers, including baggage handlers, were particularly susceptible to back pain due to repetitive lifting and awkward postures. [14] This aligns with our findings, reinforcing the occupational health risks associated with baggage handling.

The occupational history of the baggage handlers at Port Harcourt Airport provides important insights into the prevalence and characteristics of back pain within this population, as presented in Table 2. The majority of baggage handlers (70.5%) have been employed for more than three years. A smaller proportion of workers reported working for durations less than three years, with 5 (3.9%) working for 0-6 months, 8 (6.2%) for 1 year, 11 (8.5%) for 1.5 years, and 14 (10.9%) for 2 years. The extended duration of employment suggests that many workers are exposed to occupational hazards for long periods, potentially increasing their risk of developing musculoskeletal disorders, including back pain.

A significant proportion of baggage handlers (66.7%) reported experiencing illness due to their job, while 33.3% did not report any job-related illness. This high percentage of job-related illnesses aligns with findings from other studies, which indicate that physically demanding jobs, such as baggage handling, are associated with various health problems. [2,15]

The occurrence of back pain among the baggage handlers was notably high, with 74.4% of workers reporting back pain. This prevalence is consistent with global trends in similar occupations. For instance, a study by Waters et al. found that the prevalence of back pain among baggage handlers was significantly higher compared to other occupational groups. [16] This can be attributed to the repetitive lifting, bending, and twisting movements required in baggage handling, which place substantial stress on the lumbar spine.

Among those who reported back pain, 82.3% experienced pain for ≤1 month, 11.5% for 1-3 months, and 6.2% for more than three months. The high percentage of workers with short-term back pain may suggest that while the pain is common, it may often be acute rather than chronic. However, the presence of chronic back pain in a significant minority highlights the need for ongoing ergonomic and medical interventions.

The frequency of back pain varied among the workers, with 63.5% experiencing it once in less than six months, 25.0% once a year, 7.3% once every two years, and 4.2% once in three or more years. This variability in frequency underscores the episodic nature of back pain in this occupation, where acute episodes can be triggered by specific work-related activities or events.

The prevalence and characteristics of back pain among baggage handlers at Port Harcourt Airport are consistent with findings from other studies worldwide. For instance, a study conducted by Kumar reported that manual handling tasks, such as those performed by baggage handlers, significantly increase the risk of low back pain. [17] Similarly, research by Waters et al. indicated that the rate of back injuries among baggage handlers was considerably higher than in other occupations due to the physical demands of the job. [16]

In terms of the duration and frequency of back pain, the findings align with those of Hoogendoorn et al., who found that workers in physically demanding jobs often experience recurrent episodes of back pain with varying durations and intensities. [18] This episodic nature of back pain highlights the importance of preventive measures, including ergonomic training and proper lifting techniques, to reduce the incidence and severity of back pain among baggage handlers.

The study revealed that 60.4% of baggage handlers reported absence from work due to back pain, while 39.6% did not. Among those who were absent from work, the majority (81.0%) reported an absence duration of less than three months, with 19.0% absent for three months or longer. This high prevalence of back pain-related absenteeism highlights the significant impact of musculoskeletal disorders on the workforce in this sector.

A considerable proportion of baggage handlers (71.3%) were knowledgeable about back pain prevention, whereas 28.7% lacked this knowledge. This finding is encouraging as it indicates a majority awareness of preventive measures, which is crucial for reducing the incidence of back pain. The majority of baggage handlers (80.6%) had received weight lifting training, while 19.4% had not. The frequency of weight lifting sessions varied, with 35.6% having sessions once every three months, 51.9% once every six months, and 12.5% once a year. Regular and proper training in weight lifting techniques is essential in preventing back injuries among workers in physically demanding jobs.

The prevalence of back pain among baggage handlers in this study is consistent with findings from previous research. For instance, a study conducted by Bos et al. found that baggage handlers are at a higher risk for back pain due to repetitive lifting and awkward postures. [19] Similar prevalence rates were reported in studies from other regions, indicating that back pain is a common issue among workers involved in manual handling tasks. [1,19]

Moreover, the high percentage of workers knowledgeable about back pain prevention aligns with findings from Smedley et al., who reported that increased awareness and training are effective in reducing the incidence of musculoskeletal disorders. [20] However, despite the high knowledge level, the substantial proportion of workers still experiencing back pain suggests that knowledge alone is insufficient without regular practice and adherence to preventive measures.

The importance of regular weightlifting training is emphasized in the literature. A study by Waters et al. highlighted that workers who undergo frequent and proper training sessions are less likely to suffer from back injuries. [16] The variation in training frequency observed in this study suggests that more standardized and frequent training sessions could further reduce the prevalence of back pain among baggage handlers.

Conclusion And Recommendations

This study highlights a significant prevalence of back pain among baggage handlers at Port Harcourt Airport, Nigeria, consistent with global trends observed in similar occupational settings. Addressing this issue requires a multifaceted approach involving ergonomic interventions, training, and organizational changes to enhance the safety and well-being of baggage handlers. To mitigate the risk of back pain among baggage handlers, several measures can be recommended based on our findings and existing literature. Firstly, the introduction of mechanical aids such as conveyor belts and baggage carts can reduce the need for manual lifting and carrying of heavy loads. Secondly, regular training programs on proper lifting techniques and ergonomics can help workers adopt safer practices. Lastly, implementing job rotation schemes can prevent prolonged exposure to repetitive tasks and awkward postures, thereby reducing the risk of musculoskeletal injuries