An evaluation of low back pain among female brick field workers of West Bengal, India
Environ Health Prev Med
An evaluation of low back pain among female brick field workers of West Bengal, India
Banibrata Das 0 1
0 100 Biplabi Ganesh Ghosh Sarani , Post-Bhadrakali, Dist Hooghly 712232, West Bengal , India
1 & Banibrata Das
Objectives The purpose of the study was to determine the prevalence of low back pain (LBP) among brick field workers and to explore attributed causes of LBP, investigate the relationship between LBP and psychophysical and psychosocial factors and measure the impact of LBP. Methods A modified Nordic Musculoskeletal Disorder Questionnaire along with Body Part Discomfort scale were administered to brick field workers (N = 148). Working posture of the participants was assessed using Rapid Entire Body Assessment (REBA) method. Results The study showed that 70 % of the female workers reported LBP due to awkward working posture for prolonged period of time. This was mainly reported by brick moulders. 45 % reported LBP due to manual material handling (MMH) and 40 % due to awkward lifting of heavy objects (brick). The study shows that the LBP is more prevalent (OR 1.59 and 95 % CI 0.411-6.207). 78 % of the female workers want the job rotation to relieve from their job monotony. Conclusions LBP occurred among female workers due to awkward posture, repetitive work and MMH. This study also stated that psychosocial cause of LBP is inadequacy income, monotony work, job dissatisfaction. Working posture analysis REBA suggests that all the working postures are high-risk level.
Women; Low back pain; Psychosocial factors; Brick field workers; Psychophysical factors
Department of Physiology, South Calcutta Girls’ College,
University of Calcutta, Kolkata 700025, India
Women form a significant proportion of the workforce and
this proportion has been increased day by day throughout
the world. Women in the India, play a major role in shaping
the country’s economy in the developing countries. A
woman takes a vital role in the making of bricks in the
brick making industry in West Bengal. In India, female
brick field workers coming from low socioeconomic
conditions are habituated to heavy physical workload and they
performed different types of manual activities which
causes low back pain (LBP) among them.
Brick field industries are one of the largest and oldest
industries in India, in which millions of skilled and
unskilled workers from all over the country make their
]. In brick field industry, the female brick field
workers have to perform various types of hard and
strenuous work that leads to LBP in the body. Studies of the
epidemiology of LBP have implicated mechanical risk
factors, such as manual handling, carrying heavy loads and
work-related posture [
Low back problem is a major public health problem
with over 80 % of the world population reporting LBP at
some point in their life [
]. It is a disorder with much
possible etiology, occurring in different groups, and is also
a common health condition in working populations. Female
brick field workers are at a high risk of suffering from
occupational-related LBP because of high-risk activities
involved in different activities in brick production. LBP
and its associated disability continue to plague the brick
field industry. The prevalence of occupational-related LBP
among manual workers in the brick manufacturing
companies is believed to be due to high exposure to awkward
postures for long hours, heavy manual work and exposure
to whole-body vibration in the work environment [
is associated with major costs in terms of health resource
usage, work disability and absenteeism [
] and loss of
quality of life [
The main aim of the present study was to assess the
prevalence of LBP among the female brick field workers of
the Indian population and to investigate the role of working
posture in the reporting of back pain. This study also
investigates the relationship between LBP and personal and
work-related factors and measures the impact of LBP.
Through this study, local awareness regarding occupational
safety and health of workers working in unorganized
sectors can be increased to improve the present occupational
safety and health situation in India.
For this study 148 female brick field workers were
randomly selected from 20 main brick fields of Bhadrakali in
Hooghly district, India. This brick field is mainly situated
in the river side of Hooghly in Hooghly district of West
Bengal, India. Others female brick field workers were not
interested in participating in this study and thus their data
were excluded from this study. Among the selected female
brick field works, some of them are permanent workers
(n = 30) and some are casual workers (n = 118). The
inclusion criteria of this study were the workers should
have at least 3 years experience in this job.
Before conducting the study, written informed consent
was taken from the brick field workers. Prior permission
and ethical approval was also obtained from relevant
authorities before commencement of the study. Before
conducting the survey, a written permission on the project
was obtained from Institutional Human Ethical Clearance
Committee over the Indian Council of Medical Research
There are several activities were performed by the brick
field workers. Among these, the below stated activity was
performed by the female brick field workers.
Carrying the mud—The mud which was collecting
from the river bank is mainly accumulated in the
accumulation zone of the brick field by carrying
them with basket in the head of the workers. During
making the green bricks, the carriers, carries the mud
in their head to prepare the clay.
Preparation of raw bricks (moulding)—Preparation
of clay is mainly done by the machine with the help
of mud, water and several additives. After
preparation of clay, inserting of clay in the wooden dice
along with sand in squatting posture and particular
amount of clay is taken by the workers and put it into
the wooden dice; extra clay is removed by wire
cutter. Then lifting the wooden dice upward and
turning downwards the ground forcefully.
Carrying raw bricks from stacking area to kiln—
Generally brick carrier’s carry their raw bricks into
the kiln for burn. After reaching unloading of raw
bricks was done carefully. After unloading, the
workers generally used to arrange the bricks for
Loading of burn bricks—After burning the bricks the
kiln workers generally take off the burned bricks
from kiln. After picking the burns from the dust of
kiln, the female workers loaded the burn bricks in
Carrying burn bricks—After loading the brick
carriers have to cover long distance to store the bricks in
the brick field.
Unloading of burn bricks for storage—During
storing, the unloading of burn bricks is an important and
careful activity which was done by the brick carriers.
The modified Nordic questionnaire [
] was used in this
study. The questionnaire consists of a series of
objectivetype questions with multiple choice responses. The
questions were grouped into sections dealing with general
information of the workers, work organization and work
behavior, assessment of stress at work and detailed
question on work-related pain. The interview was taken in their
local language (Bengali and Hindi). Before conducting the
interview the experimental protocol was explained to the
brick field workers individually. Interviews were totally
confidential, undertaken just after working hours over.
Repetitiveness of work
Repetitiveness was determined by analyzing time spent in,
and motion involved in, the different brick making tasks
along with the total time for a particular job. Timing was
recorded with a stopwatch repetitive activity was
considered to an action that took up more than 50 % of the total
time period for that particular job is considered to be a
repetitive one [
Discomfort level scale
Discomfort level scale is a 10-point scale for discomfort
and pain sensation, where 1 represents just noticeable pain,
5 represents moderate pain and 10 represents intolerable
pain (Fig. 1). This scale was used for identifying the
discomfort level of the female brick field workers in their
different postures. The intensity of pain or discomfort was
measured by utilizing the Body Part Discomfort (BPD)
The working postures were analyzed by the Rapid Entire
Body Assessment (REBA) tool [
]. The working postures
were recorded with the help of a digital video camera
(Sony handycam). Later stick diagrams were drawn from
frozen frame video recordings and eventually they were
analyzed. The most frequently repeated postures or the
postures that were held for the longest amount of time of
the work cycles were chosen for assessment.
Fig. 1 Different brick field
activities among female brick
Data were examined using the statistical package PRIMER
OF BIOSTATISTICS version 5.0 (Primer of Biostatistics
5.0.msi, Msi Version = 1.20.1827.0, Primer for Windows,
Mc-Graw-Hill). Descriptive statistics (frequency and
percentage) were used to summarize the data.
Cross-tabulations were done to get the frequency and percentages of the
Statistical analysis included calculation of mean and
standard deviation of the various physical parameters. The
association of LBP between two groups of female brick
field workers with and without having LBP was examined
by v2 test and the associations were described by the odds
ratio with 95 % confidence interval.
Demographic factors relating to the study population,
including age, years in experience in worker, duration of
employment, marital status, education status and types of
work are given in Table 1. The mean age of the workers
was 30.3 (SD = 10.7) years: age ranged from 21 to
49 years, the mean duration of work was 6.4 h/day.
Whereas the years employment was 5.6 years (SD = 8.2)
and majority of them were uneducated (56.1 %).
The result of the study shows that the LBP is more
prevalent (OR 1.59 and 95 % CI 0.411–6.207) followed by
shoulder (OR 0.29 and 95 % CI 0.135–0.650), neck (OR
0.62 and 95 % CI 0.318–1.234), hands (OR 1.95 and 95 %
CI 1.011–3.786), knee (OR 7.27 and 95 % CI
3.506–15.083), and leg pain (OR 4.86 and 95 % CI
1.970–11.998) among the both group of female brick field
workers (brick moulders and brick carriers).
Table 2 of this study shows the responses to physical
and psychosocial attributed factors or causes of LBP at
work among female brick field workers. In this study it was
observed that 70 % of the female workers reported LBP
due to awkward working posture for prolonged period of
time; whereas, 61 % of the female stated that LBP due to
repetitiveness of work and 55 % reported LBP due to
constant sitting static work posture. This was mainly
reported by brick moulders. 45 % reported LBP due to
manual material handling (MMH) and 40 % due to
awkward lifting of heavy objects (brick).
The analysis of questionnaire (Table 2) also showed that
52 % of the female workers performed skilful activity.
Most of them (84 %) did not make frequent mistakes at
work. As large as 76 % of the female brick field workers
stated that they frequently changed their place while at
work. 63 % of the workers reported rigidity in work
methods and procedure. 84 % of the workers want to work
in a group. 93 % of the workers want to accept new jobs/
responsibilities and 78 % of the female workers want the
job rotation to relieve from their job monotony. About
89.0 % of the workers reported that their job requires
repetitive motion of body segments, particularly the
movement of the hands. 39 % of the workers reported to
take new responsibility that enhanced stress at work. 45 %
of the female brick field workers main brick carriers lifting
or loading 30–40 kg of bricks at a time with a constant
forward bending posture with twisted back and arms. The
complaints of LBP can be attributed to the strenuous
From Table 3, it is evident that the female brick field
workers performed various tasks during brick field
activities that were highly repetitive, including carrying mud
(61.44 %), moulding (65.16 %), loading raw bricks
(68.01 %), carrying raw bricks to kiln (58.64 %),
unloading raw bricks to kiln (78.22 %), picking burn bricks from
kiln (66.23 %), Carrying burn bricks from kiln to storage
(71.89 %). All these activities involved are performed in an
awkward posture and in high repetitive manner which is
responsible for acute LBP among female brick field
Figure 2 indicates that 27 % of the brick moulders had
complaints of LBP throughout the year which could be
suggestive of development of musculoskeletal disorder in
their low back region and this pain persists for 24 h among
67 % of the female brick moulders which is responsible
from absenteeism from work and 72 % of the workers
reported acute pain during work. Whereas in case of brick
carriers 25 % had complaints of LBP throughout the year,
Time taken: this means the time required to perform the main activity which is part of a single work cycle
Total time taken in one work cycle: this means the time spent on the completion of a single work
73 % brick carriers had complaints of LBP persists for 24 h
and 75 % brick carriers had complaints of LBP suffering
during their work.
Figure 2 also represents the assessment of LBP in
different body parts according to the BPD scale. The figure
shows that most predominant LBP felt among the 71 % of
the brick moulders and 72 % brick carriers in BPD scale
range of 8-10, which is described as intolerable pain;
whereas, 18 % brick moulders and 21 % brick carriers felt
LBP in BPD scale range of 6–7, which is described as
moderate pain. Figure 3 of the study shows the linear
regression between LBP occurred and working days lost
among female brick field workers.
From the analysis of working postures (Table 4), it was
found that most of the working postures are of risk and
high risk and require immediate corrective measures, as
indicated by the REBA analysis (by comparing the REBA
score with REBA risk level). The stick diagrams, obtained
from the still photographs of working postures of the
female brick field workers in different brick making
activities. These types of working postures are frequently
adopted by the brick field workers, and often, they suffer
from musculoskeletal complaints in the lower back pain
and upper extremities. The posture codes of the REBA
indicate that, all the postures in different brick making
activities is a high-risk level and it demands immediate
attention (i.e., the posture change necessary soon).
The main findings of the study showed that LBP was more
prevalent among the females especially brick field sectors
where most of the female workers perform heavy and
hazardous work for long time in duration. Work-related
musculoskeletal disorders (WMSDs) especially LBP
continues to present a major challenge to workers and their
employers in virtually every industry and every working
sector. The relationship between task demands, ergonomics
and LBP can become significant as a result of many
activities of daily life both at work and elsewhere.
This study showed the prevalence of LBP among the
female brick field workers. The results showed that the
majority (63 %) of the female workers are in the age
group of 21–30 years. This study also showed that most of
the female workers are casual workers, because the casual
brick field workers are mainly involved in brick making
process from October to May in the year. Besides this,
they are mainly involved in other activities (construction
labor, masonry, etc.) during off season. This study
(Table 1) shows that most of the female brick field
workers are illiterate (49.3 %) and (31.1 %) have a
The brick field industry is filled with tasks that require
high physical demands. Furthermore, manual lifting and
handling of heavy supplies and other material are still
commonplace in brick field. A number of risk physical
factors for LBP have been identified such as MMH (51 %),
awkward lifting (53 %), constant sitting static posture
(55 %), awkward working posture (70 %) and repetitive
work (61 %) and frequent bending and twisting (51 %).
These study was corroborates with the work of Bernard
]. He stated that few number of risk factors for LBP.
These risk factors include manual materials handling,
frequent bending and twisting and heavy physical load. These
results also echo the findings of a comprehensive review by
the National Institute for Occupational Safety and Health
(NIOSH), which found strong evidence for a causal
relationship between LBP and lifting/forceful movements and
evidence for a causal relationship between awkward
postures and heavy physical work and LBP. Devereux et al.
] and Waters et al. [
] stated that the combination of
workplace stress and physical work demands increase rates
Low Back Pain
This study showed that the some psychosocial factors
like job dissatisfaction (52 %), monotony at work (62 %),
poor relationship with the managers of the brick field
(34 %), perceived inadequacy of income (92 %) and
unpleasant work environments (18 %) have a relationship
between LBP. These studies have same findings of a study
of Snook et al. [
]. They also described that psychosocial
factors, such as job dissatisfaction, poor relationship with
immediate supervisors, perceived inadequacy of income,
lack of control over one’s job, and unpleasant work
environments seem to have an impact on LBP. Hoogendoorn
et al. [
] stated that, one of the consistent findings related
to workplace psychosocial stressors is that low job
satisfaction is associated with LBP. Monotony at work is also
usually associated with higher levels of LBP. Svensson and
] stated that monotony was found to have a
direct relationship to LBP. Davis and Heaney [
that job dissatisfaction and stress are more consistently and
more strongly associated with the development of MSD
mainly in lower back. Dissatisfaction with a work situation,
a supervisor, or a dead-end job and boredom contribute
greatly to the onset and persistence of musculoskeletal
Carrying heavy loads are the most common human
activities in several occupations involving MMH. During
brick making, female brick field workers perform several
types of MMH that may be causative factors for the
development of LBP among them. The present study deals
with MMH in which female brick field workers carry,
loading and unloading heavy loads (mud, raw bricks and
burn bricks) in a repetitive manner is also a causative factor
of LBP among them. This study was supported with the
result or study of Cole and Grimshaw [
]; they also stated
that carrying heavy loads in a repetitive manner is a
causative factor of LBP.
Postural analysis can be a powerful technique for
assessing work activities. In this posture analysis study
(REBA method) it was found that most of the posture
adopted by the female workers are high-risk level and
change the posture necessary soon. Prolonged working in
squatting and kneeling postures is also common in many
activities related to brick manufacturing especially
moulding, where the female brick field workers mould the
bricks with clay in a squatting posture for prolonged period
of time. This study shows that the lower back is the most
affected body part among the female brick field workers.
Static loading occurs when fixed postures are adopted,
often in awkward positions and the muscles remain
contracted for extended periods. During moulding activities
female brick field workers are engaged in a prolonged
forward bent posture without providing any back support, a
constant load was maintained in the lumbar region
throughout the work. This makes the neck extensor and
spinal extensor muscles to get fatigued soon, which in turn
leads to neck pain and low back ache among them. In this
study, brick carriers mainly carried heavy loads while
carrying mud and bricks in their head. Lower back pain has
been associated with lifting of heavy objects while in an
awkward posture [
]. Posture and the location and weight
of a load affect the moment of the force applied in the
lumbar region, which in turn affects muscle loading and
compressive forces on the internal vertebral disc [
Thus, lower back problems appear to be associated with
those types of postures that require back flexion, carrying
and lifting of heavy loads, and exposure to whole-body
vibration . Even nowadays, many physically heavy
work phases and a combination of several stress factors,
including poor work postures and activities requiring the
use of force are common among brick field workers.
The most significant potential risk factors for MSDs in
female brick field workers are heavy lifting and carrying
and working in stooped or awkward postures [
Prolonged extreme trunk flexion is commonly found in farm
tasks such as pruning, weeding, labeling and harvesting
crops. Female potato cultivators have to carry heavy loads
when carrying seeds for planting in grooves in the soil and
during harvesting, which may be the causative factor for
musculoskeletal disorders [
This study showed that female brick field workers
suffered from chronic LBP due to carrying heavy loads as
well as working in an awkward posture in the brick field
which may be the causative factor of musculoskeletal
disorder especially LBP. Although it has been widely
acknowledged that constrained working postures are one of
the important factors of musculoskeletal disorders
This study found that, female brick field workers
suffered from acute LBP due to working in an awkward
(stooping and kneeling) and static posture in a brick field.
One of the main causative factors of LBP is MMH of
bricks and loading and unloading of bricks from the kiln.
Repetition of work is the main causative factors of LBP
and also pain in the upper extremities of the body. REBA
posture analysis suggested that, working in an awkward
posture for prolonged period of time is one of the leading
causative factor for WMSDs among female brick field
Recommendations: The following recommendations are
made for reducing the occupational stress of the brickfield
Interim rest pauses should be enhanced to avoid
excessive physical stress among the female brick field
One day break in a week which helps to reduce
physical and mainly psychological stress.
Careful about posture, try to avoid static work posture.
Avoiding long distance travelling that reduces working
hour and thus physical stress.
Acknowledgments The authors would like to thank all the brick
field workers and brick field owners for their immense cooperation
during this study.
Funding This work was partially supported by the University Grant
Commission (UGC). UGC Reference No. F. PSW-147/11-12 (ERO).
Conflict of interest None declared.
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