The prevalence and management of low back pain among high school children in Nyamasheke District, Rwanda
Low back pain among high school children is perceived to be uncommon in the clinic setting. However, previous studies have suggested that it may be an important and increasing problem to be managed in this age group. The overall aim of this study was to determine the prevalence, the predisposing factors and management of low back pain among high school children in Nyamasheke district in Rwanda. A cross– sectional descriptive study was conducted using a combination of quantitative and qualitative research methods. The study included a population of 10 330 high school children aged 13- 21 years old registered in high schools of Nyamasheke district. In addition, 13 service providers involved in addressing low back pain were included in the study. The study was conducted in ten schools selected randomly, four schools from nine urban schools and six schools from 15 rural schools. The sample size included 1 000 participants selected by a simple random sampling method and six service providers selected by purposive sampling method. A self-administered questionnaire was given to high school learners. Semi-structured interviews amongst service providers were conducted to validate information given by high school learners. The software SPSS version 19.0 for windows and Microsoft Excel package 2010 were used to analyze the quantitative data. Descriptive statistics using frequencies, percentages, means, and standard deviations and inferential statistics using chi-square and correlation tests were calculated to examine the association between variables. For qualitative findings, audiotaped interviews were transcribed and translated from Kinyarwanda into English, and the expressed ideas were coded and reduced into themes and categories. Permission to conduct this study was obtained from the Senate Research Grants and Study Leave Committee at the University of the Western Cape, and the concerned authorities in Rwanda. Individual participants and their parents/guardians were informed of the study through an information sheet and written informed consent or assent was then obtained from the participants. The mean age of the quantitative study sample was 17 years, and 48.2% were females compared to 51.8% of males. The response rate was 96.2%. The low back pain prevalence was found to be 66.1%. The mean age of the first occurrence of low back pain was 14.5(SD = 2.28). One year prevalence was found to be 25.4% whereas the one month prevalence was 13.7%. Males were the most to report low back pain comparatively to females with 53.1% and 43.9% respectively. There was significant relationship between age group and low back pain (p = 0.000). High school children from the rural region were the most to report low back pain in comparison to those from urban region with 61.5% against 38.5% respectively. Regarding the predisposing factors to low back pain, a strong relationship was found between low back pain and posture (sitting and standing position) (p=0.000) with 83.2%. The findings of the interviews conducted among service providers showed that the main predisposing factors for low back pain could be posture/position in class and psychological factors. The study found that most of the participants do not attend medical services. The study highlighted that the impact of low back pain included medical costs, missing class when attending medical services and difficult to perform normal usual activities. It was found that the level of education in health promotion as preventive measures of low back pain is still at low level.