Background: Prostate cancer (PCa) accounts for 21.6% of all cancers among men in Botswana, ranking as the fourth most common cancer (9%) across all age groups. This study aimed to assess the knowledge, attitudes and practices related to PCa screening among men aged 40 years and older in Ramotswa, Botswana. Design and methods: A cross-sectional survey was conducted involving a random sample of 362 males aged 40 years and older in Ramotswa. Logistics regression models were utilised to examine associations between socio-demographics, knowledge, attitudes, practices and PCa screening. Results: Of the 362 respondents, 105 (29%) men reported having undergone prostate screening tests either prostate-specific antigen (PSA) or digital rectal examination (DRE). Additionally, 221 (61%) had prior knowledge of PCa, with 114 (32%) receiving information from the radio while fewer than 20% learnt about it from health care providers. Single men were found to be 63% less likely to go for screening compared to married men (AOR = 0.37; [95% CI 0.22–0.61]). Men who were not afraid of the screening test results were twice as likely to go for screening compared to those who were afraid of a positive result for prostate test (AOR = 2.14; [95% CI 1.12–4.09]). Conclusions: While respondents demonstrated above-average knowledge of PCa, fewer than half had undergone a PSA test. Urgent and targeted interventions are needed to address predisposing factors such as fear of prostate screening. Furthermore, the low rates of PCa information dissemination by healthcare workers underscore the need for enhanced engagement of medical practitioners in educating men about PCa.

Background: Air pollution is a serious public health concern, killing an estimated 800,000 people annually in developing and developed nations. In urban areas, traffic is one of the most significant sources of hazardous exhaust pollutants. Street vendors are often exposed to air pollutants as a result of their proximity to busy roads and intersections where vehicle emissions are high. Street vendors form an integral part of urban life globally as they provide convenience, affordable goods, and services to the general public. Aim: This study aimed to assess the prevalence and factors associated with respiratory and other health symptoms among street vendors in Gaborone, Botswana. Materials and Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire distributed to randomly selected street vendors. The questionnaire gathered information on demographic characteristics and respiratory and other health symptoms among street vendors. Data was analysed using logistic regression. Results: About 392 street vendors participated in the study, with 71% females. The mean age (M±SD) of the respondents was 46±13 years, with an age range of 25–66 years. About 46%) and 38% attained senior and junior secondary school certificates, respectively and 78%) worked for >8 hours/day. Coughing, headache and dizziness were reported by 89%, 62% and 58% of respondents respectively. Female vendors were at increased risk of wheezes (Odds Ratio (OR): 3.12, 95% Confidence Intervals (CI):1.24-7.85) and headaches (OR: 4.61, 95% CI: 2.02-10.54) when compared to males. Increasing age and working for >5 days/week were significantly associated with respiratory and other health symptoms such as sore throat, nasal congestion and wheezes. Tobacco smoking and alcohol consumption predisposed street vendors to nasal congestion (OR: 4.34, 95% CI: 1.28-14.72) and shortness of breath (OR: 3.70, 95% CI: 1.29-10.65), respectively. Physical exercise provided a protective effect against chest tightness (OR: 0.133, 95% CI: 0.03-0.06) and dizziness (OR: 0.73, 95% CI: 0.15-0.35). Conclusion: Street vendors reported a high prevalence of respiratory and related health symptoms. Factors such as increasing age, tobacco smoking and alcohol consumption have been associated with respiratory and related health symptoms among street vendors. Large scale research that quantifies TRAP pollutants and health symptoms is needed to inform policy development.

Objective. This study aimed to investigate the prevalence, risk factors and impacts of neck and back pain among supermarket cashiers in Botswana. Results. A total of 174 supermarket cashiers participated in this study, the majority of whom were females (72%). The prevalence of lower back pain was 69%, upper back pain 53% and neck pain 37%. Increasing age was associated with neck (95% confidence interval [CI] [1.43, 5.15]) and upper back (95% CI [1.43, 3.60]) pain. Cashiers working at a low work surface and overreaching for items were 19 and 11 times more likely to report neck (95% CI [1.7, 255.9]) and lower back (95% CI [1.84, 62.1]) pain, respectively. Almost 6% of cashiers who reported lower back pain reported considering changing jobs due to pain. Conclusions. More than two-thirds, one-half and about two-fifths of supermarket cashiers reported lower back, upper back and neck pain, respectively. Individual and work-related factors were associated with neck and/or back pain. To reduce their prevalence and progression, supermarkets should introduce occupational health and safety talks.

Musculoskeletal disorders (MSDs) are among the most common and important occupational health problems in working populations with significant impact on quality of life and a major economic burden from compensation costs and lost income. MSDs decrease productivity at work due to absenteeism, presenteeism and sick leave. During the course of their work, teachers can be subjected to conditions that cause physical and psychosocial illness. Common MSDs among teachers include those affecting the lower back, neck and upper extremities. Research suggests that the aetiology of MSDs is complex and multifactorial in nature. Occupational factors including location of school, carrying heavy loads, prolonged computer use, awkward posture and psychosocial factors such as poor social work environment, high anxiety and low job satisfaction have been found to contribute to development of MSDs. Factors such as high supervisor support and regular physical exercise on the other hand have been found to have a protective effect against MSDs among teachers. The interventions for these conditions need to be contextualized for them to be effective and to take into consideration, the risk factors for these conditions and how they interact with each other.

Introduction Tobacco smoking and secondhand smoke (SHS) are recognised risk factors for acute and chronic respiratory illness. Studies have reported an increasing smoking prevalence among university students across all levels of study. This study assessed SHS and self-reported respiratory symptoms among students in three academic institutions in Gaborone, Botswana. Methods A cross-sectional survey was carried out among students aged ≥18 years in three randomly selected universities in March 2019. Smoking status, exposure to SHS in the past 30 days and respiratory symptoms were assessed. Logistic regression was used to analyse respiratory symptoms among non-smoking students. Results Out of 450 students, current tobacco smoking was reported by 142 (32%) participants, with males 97 (68%) smoking the most. Exposure to SHS was highest at school (93%) followed by public places (89%) and home (48%). Exposed non-smokers exposed to SHS were 1.6 times (OR: 1.64, 95% CI: 1.35 –1.99) more likely to experience respiratory symptoms and 1.9 times (AOR: 1.91, 95% CI: 1.55 – 2.35) more likely to have headaches compared to non-exposed non smokers. Exposed non-smokers were also 3.6 times (AOR: 3.58, 95% CI: 2.50 – 5.11) more likely to feel irritated by tobacco particles in a place or car someone previously smoked in than non-smokers not exposed. Conclusions Exposure to SHS and self-reported respiratory symptoms are high. Non-smokers exposed to SHS were more likely to report respiratory symptoms and irritation compared to non-smokers not exposed. Further research is recommended to inform strengthening policies and strategies to reduce exposure to SHS in academic institutions.

BACKGROUND:Welding tasks involve the use of awkward working postures and repetitive movements and therefore pose a risk for developing work-related musculoskeletal disorders (WRMDs).OBJECTIVES:This study aimed to assess the prevalence, severity and risk factors for WRMDs among welders in the informal sector.MATERIALS AND METHODS:A total of 128 welders (33±10.5 years) were purposively selected from three urban centers in Zimbabwe. WRMDs were assessed using a Modified Cornell Musculoskeletal Questionnaire (MCMQ). The Quick Exposure Check (QEC) and the Rapid Entire Body Assessment (REBA) were used for postural risk analysis. P < 0.05 was considered significant.RESULTS:Analyses showed a high prevalence of pain in the lower back (78%), right shoulder (66%), left hand wrist (62%) and right hand wrist (61%). With regards to the severity of lower back pain, 4% reported low pain, 24% mild pain and 48% were severe cases of pain. Elevated grand REBA scores were significantly associated with self-reported in various body regions. Multinomial regression analyses showed that smoking, prolonged working hours and not engaging in physical activities were significant predictors for pain. High job satisfaction and taking adequate work-rest breaks were protective factors for WRMDs (p < 0.05).CONCLUSION:There is a high prevalence of WRMDs among welders due to individual and work-related risk factors. Ergonomics education is required to address the risk factors for and progression of WRMDs among welders.

Background: Although neck and back pain represent a common occupational problem, few epidemiological studies have investigated the prevalence and risk factors for these disorders among supermarkets cashiers in Botswana. Cashiers represent an occupational group whose work tasks put them at an increased risk of development of neck and back pain. Aim: The objective of this study was to determine factors associated with neck and back pain and their prevalence among supermarkets cashiers in Botswana. Methods: A cross-sectional study was conducted among supermarkets cashiers using self-administered questionnaires distributed to randomly selected supermarkets. The questionnaire gathered information on participants’ demographic characteristics, neck and back pain information, lifestyle and work-related factors. Data were analysed using Chi-squared and logistic regression models. Results: A total of 174 supermarkets cashiers participated in this study. The prevalence of lower back pain was 68.3%, upper back pain 51.1% and neck pain only 35%. The results of logistic regression analysis revealed that female gender and previous injury were associated with neck and upper back pain. Length of employment was associated with lower and upper back pain. Having children less than 6 years was associated with lower back pain [Odds Ratio (OR): 1.66, 95% CI: 1.15-2.87]. Poor workstation layout [OR: 1.71, 95%CI: 1.43-3.22] and serving more than 100/day customers [OR: 2.85, 95% CI: 1.57-10.22] were associated with neck and back pain, respectively. Young cashiers aged between 21- 25 years and those who exercised regularly were less likely to report lower pack [OR: 0.29, 95% CI: 0.27-0.80] and upper back [OR: 0.83, 95% CI: 0.75-0.95] pain, respectively. Conclusion(s): Back pain was more prevalent among supermarket cashiers when compared to neck pain. Individual factors and work-related factors were associated with neck and/or back pain. Younger cashiers and regular exercise were protective factors for lower back and upper back pain, respectively. This study has found that neck and back pain are multifactorial. Thus, to reduce their prevalence and progression, supermarkets should introduce occupational health and safety talks. Presenter e-mail: erickp@ub.ac.bw

This study reviewed literature on ergonomic risks for work-related musculoskeletal symptoms (WRMS) among welding and metal fabrication workers. The preferred reporting item for systematic reviews and meta-analyses (PRISMA) guidelines were used to screen the articles. A pre-designed criterion was used for evidence synthesis. Twenty articles met the inclusion criteria. Most studies were cross-sectional, used small sample sizes, and lacked statistical rigour. Prolonged working hours using awkward posture were consistently reported to contribute to the development of WRMS. The prevalence rate of WRMS among workers in the reviewed studies ranged between 60% and 85%. Only 6 out of 20 studies assessed the severity of the reported WRMS. Studies did not implement interventions to reduce the risk, prevalence rate and severity of WRMS. There is need for improved study designs that implement and evaluate interventions to reduce the risk, prevalence and severity of WRMS among welding and metal fabrication workers.

ABSTRACT Background Intentional poisoning is becoming an important public health concern particularly among young women globally. Consequently, there is a need to analyze this further within countries to establish pertinent policies to reduce current incidence rates. This includes sub-Saharan African countries where there has been a scarcity of information. Consequently, we sought to establish the nature and sources of poisoning in patients admitted to a leading hospital in Botswana to help develop pertinent future policies for Botswana and surrounding countries. Methods Retrospectively reviewing the medical records of all patients admitted to Princess Marina Hospital (PMH), which is a leading tertiary hospital in the capital city of Botswana, due to acute poisoning over a six-year period. Results The records for 408 patients were reviewed. The majority of admissions (58%) were females, and the mean age of patients was 21(±14) years. Most poisoning cases (53%) were intentional. The 15–45 years age group was most likely to intentionally poison themselves compared to other age groups, with females four and half times more likely to intentionally poison themselves compared to males (AOR 4.53, 95% CI: 2.68–7.89, p < 0.001). Half of the patients were poisoned by medicines followed by household chemicals (22%), with females overall four times more likely to be poisoned by medicines compared to males. The medicine mostly ingested was paracetamol (30%). Failing relationships (57%) were the principal reason for intentional poisoning. Six patients died from poisoning representing a 1.5% mortality rate. Conclusions The findings suggest in-depth and urgent investigations on intentional poisoning are needed among young women across countries including sub-Saharan African countries to inform future policies on prevention strategies. Further, strategies for poisoning prevention should target social and family relationship problems. We will be following this up in the future.

According to the World Health Organization (WHO), 5.9 million children under age 5 died in 2015, and globally, the main causes of child deaths are pneumonia, prematurity, intrapartum-related complications, neonatal sepsis, congenital anomalies, diarrhoea, injuries and malaria. In 2012, it was reported that one quarter of childhood deaths and disease burden could have been prevented by reducing environmental risks. Children are vulnerable to environmental risks such as air pollution, inadequate water, sanitation and hygiene, hazardous chemicals and waste, radiation, climate change, as well as emerging threats like e-waste. They are particularly vulnerable to these threats due to their developing organs and immune systems, smaller bodies and airways. In 2010, there were 132,989 in-patient morbidities. This number represents a 5.2% increase from the 126,381 registered in 2009. The major causes of infant morbidity and morbidity in children under 5 years old were diarrhoea and pneumonia. Although morbidity cases increased in 2010, there was a 6% decline in in-patient mortality from 6952 registered deaths in 2009 to 6535 deaths in 2010. Pneumonia and diarrhoea were the major causes of both infant and child mortalities. In Botswana, various environmental risk factors such as contaminated water, air and soil pollution and poor waste management have been associated with children's environmental health (CEH). The outbreaks of diarrhoea in the country have always been associated with contaminated water. In the recent outbreak of diarrhoea in August 2018, laboratory investigations attributed the outbreak of diarrhoea to rotavirus. Children (1-6 years) living in areas with high levels of traffic congestion (living near a busy road) had higher levels of lead in their blood than those who lived in areas with less traffic. Poor waste management may lead to contamination of air, soil and water. CEH has not been given the attention it deserves in Botswana. It is, therefore, time to raise awareness on the subject. Health care workers, for example, need to be trained on diseases affecting children that are due to environmental exposures. Communities as well need to be trained on environmental factors that are prevalent in their areas and the effects of those on children's health. It is important that research should be conducted on CEH in Botswana. At the time of compiling this report, the author was not aware of any CEH network in the country or networks in the region. To raise awareness and advocacy of CEH, there is a need for the establishment of a CEH network in the country or to participate in networks in the regions.

Objectives: Hairstylists form an occupational group whose tasks involve repetitive and forced movements of hands and wrists, thus posing a risk of developing carpal tunnel syndrome (CTS). This study assessed the prevalence of and factors associated with CTS symptoms among hairstylists in Gaborone, Botswana. Material and Methods: A cross-sectional study was conducted using a self-administered questionnaire distributed among randomly selected hairstylists. The questionnaire gathered information on demographic characteristics, lifestyle, work-related characteristics and psychosocial factors. The Boston Carpal Tunnel Syndrome Questionnaire was used to determine the severity of CTS symptoms and its functional effects. Data were then analyzed using chi(2) and logistic regression models. The level of significance was determined at p < 0.05. Results: A total of 165 hairstylists took part in the study, with 92 (56%) of the respondents being females. The mean age (M +/- SD) of the respondents was 35.05 +/- 7.54 years with an age range of 22-63 years. Seventy-three (42.2%) hairstylists reported CTS symptoms, with the majority (73%) being females. Out of all the CTS cases, 53 (72.6%) and 16 (21.9%) had mild and moderate symptoms, respectively. Over 80% of the hairstylists did not know about CTS. Among individual factors, CTS symptoms were associated with being female (the odds ratio [OR] of 9.99, and the 95% confidence interval [CI]: 3.64-27.44), increasing age (OR 9.84, 95% CI: 2.74-35.36), the length of employment (OR 3.73, 95% CI: 1.39-9.95), hair washing (OR 2.88, 95% CI: 1.41-5.85), an awkward posture (OR 2.52, 95% CI: 1.03-6.19), and the use of a great muscular effort when performing a task (OR 2.39, 95% CI: 1.01-5.72). Perceived heavy workload and stressful work were also risk factors. Conclusions: The results suggest a high prevalence of CTS among female hairstylists in Gaborone, and also point out that individual, work-related and psychosocial factors are associated with this syndrome. Future large-scale research is needed to establish the extent of CTS countrywide to influence policy-making. Currently, CTS is not listed amongst occupational health diseases in Botswana.

Background: Sexually Transmitted Infections (STIs) remain a major public health problem in subsaharan African countries, particularly Botswana. In Gaborone, STIs increased from 24 272 in 2015 to 28 106 in 2016 (16%), despite intense advocacy for behavior change by stakeholders to reduce HIV and AIDS prevalence. This study aimed to establish therisk factors associated with STIs. Materials and Methods: A case-control design was used to study 90 cases and 153 controls (Mean age=28; SD= ± 6.48; age range= 18 – 60 years) enrolled from two health facilities. Data were collected through interviewer-administered questionnaires and participants were selected using simple random sampling. Data were captured and analyzed using SPSS statistical software (version 25). Results: Traveling long distances to access condoms from clinics or pharmacies was a risk factor for contracting STIs among males [Adjusted Odds Ratio (AOR) = 3.46; 95% CI 1.37-8.73]. Negative attitudes, for instance, reduction of quality of sex (pleasure) caused by condom use, was found to be a risk factor among females (AOR= 4.15; 95% CI 1.71-10.08). Additionally, belonging to a particular religion, that is, Pentecostal, was a deterrent to contracting STIs for both genders (AOR=0.27; 95% CI 0.11-0.68). Conclusions: Knowledge of the deleterious effects of STIs was not sufficient to curb contracting any of the infections. Barriers to easy access of condoms such as traveling long distances and negative attitudes towards condom use are obstacles to maintaining healthy behaviors. Stakeholders should increase condom collection points and changenegative attitudes through the use of cost-benefit analysis in the AIDS era.

Background Several studies have associated smoking with oral conditions such as tooth staining and bad breath, periodontal diseases, impaired healing of wounds, precancer and oral cancer. These effects are often visible and potentially reversible after cessation of smoking. Dentists are frequently in contact with the general population and therefore provide an opportunity for early intervention in smoking cessation counseling compared to other health professionals. This study profiled patients with oral conditions, to assess their knowledge on oral conditions and tobacco use. Methods A cross-sectional survey was carried out at Princess Marina Dental Clinic in Gaborone. The study population included all dental patients visiting the clinic. Only dental patients from the age of 18 years old and above participated in the study. Patients were interviewed using a structured questionnaire and investigated clinically for the presence of oral conditions by a qualified dentist. Results The prevalence of Tobacco use was 21% among the patients. The prevalence was significantly higher among patients aged 25 and 36 (p< 0.05). Dental carries was the most common condition affecting 45% of patients followed by periodontal disease affecting 21% of patients. The age group 25-36 years was the most affected by oral conditions (p< 0.05). Current smokers had a higher prevalence of tooth staining (26%) compared with never smokers (11%). Periodontal disease was prevalent in 32% of tobacco users and 20% of past tobacco users. Overall, 25%(n=68) of patients were not aware of the relationship between smoking and oral health. Conclusions Tobacco use prevalence is high among dental patients in this study. The lack of awareness on tobacco use and effects on oral health is also concerning. On account of their frequent contact with the general population, dentists could provide a window of opportunity for early detection of oral conditions associated with smoking, provide patient education, counseling and smoking cessation advice.

Background: Cervical cancer is the leading cause of cancer deaths in Botswana. More than two-thirds of cases occur in HIV-infected women, in a nation with a high HIV prevalence of 17%. Even though cancer screening is free in health facilities, cervical cancer screening is low. The objective of this study was to assess the knowledge and attitudes of University of Botswana female students on cervical cancer screening. Methods: A cross-sectional study was conducted among University of Botswana female students to elicit information about their knowledge and attitudes on cervical cancer screening. Results: A total of 335 students completed the questionnaire and all reported that they were aware of cervical cancer. The awareness was mostly through brochures, posters and other printed material. Regarding cervical cancer risk 315 (94%) attributed cervical cancer to smoking and 301 (89.9%) to early sexual debut. The majority of students 329 (98.2 %) were aware of cervical cancer screening. Papanicolaou (Pap) smear was the most popular screening test reported by 160 (47.8%) of the respondents as compared to Human Papilloma Virus testing (HPV) reported by 106 (31.6 %) of the respondents. The overall Pap smear screening rate was 92 of 335 students (27.5%). Those who perceived themselves to be at risk of contracting cervical cancer 203 (60.6%) where 1.8 times more likely to go for Pap smear than those who perceived to be safe, (Adjusted Odds Ratio [AOR] 1.834; 95% Confidence Interval [CI]; 1.094-3.067), (P = 0.02). Conclusions: Pap smear screening uptake is low amongst University of Botswana female students. The likely reason for this could be because students do not perceive themselves to be susceptible to cancer so the lesser the likelihood of engaging in preventive behaviours. There is urgent need for university based cancer education campaign on cervical cancer screening benefits and incorporating these campaigns into the existing university medical services to increase uptake of screening programs offered.

Recently, overweight and obesity were found to be an increasing public health crisis in Botswana. Despite these findings, there is scant epidemiological studies carried out to investigate the prevalence and risk factors of obesity among tertiary students in Botswana. The aim of this study was to determine the prevalence and factors associated with overweight/obesity among University of Botswana (UB) students. A descriptive cross sectional study was conducted at University of Botswana between February and April 2016 using convenient sampling to recruit participants. A total of 202 students in the age range of 18–30 with mean age 21.59 ± 1.81 completed the study procedures. Self-administered questionnaires were used for data collection, body mass and height were measured from participants in order to calculate Body Mass Index (BMI) to determine whether they fall under the category of being overweight/obese. The prevalence of overweight and obesity was 36.8%. Overweight and obesity among students was significantly associated with age (Odds Ratio [OR]: 1.72, 95% Confidence Interval [CI]: 1.06–4.46), year of study (OR: 1.60, 95%CI: 1.09–3.99), physical activity and ones opinion about him/her being overweight/obese (p < 0.05). The findings also revealed that gender, faculty of study, family history of obesity and alcohol are not significantly associated with obesity. The prevalence of obesity is relatively high (36.8%) among UB students. Obesity and overweight are associated with age and level of studies. Students practiced unhealthy dietary practices and lifestyle behaviors that should be targeted and modified. Promoting healthy dietary and weight management practices might be of great importance when developing health education programs.

Musculoskeletal disorders (MSD) represent one of the most common and important occupational health problems in the teaching profession, which although long neglected, has attracted increasing concern in recent years1, 2). By definition, MSD include a wide range of inflammatory and degenerative conditions affecting the muscles, joints, tendons, ligaments, nerves, bones and the localised blood circulation system, that may be caused by or aggravated by work tasks and by the effects of the immediate environment in which work is carried out3). School teachers in general, have been demonstrated relative to other occupational groups, to report high rates of MSD4) of between 40% and 95%5). The work of a teacher involves not only teaching students, but also preparing lessons, assessing students’ work and extracurricular activities, such as sports. These activities may cause teachers to suffer adverse mental and physical health issues due to their unique and wide variety of job functions6). By body site, school teachers appear to be more prone to suffer MSD of the back, neck and upper limbs4, 6, 7). While a number of studies have been carried out to specifically investigate back and neck related MSD, few studies have looked at whole body MSD, and even fewer have been carried out to specifically investigate MSD of the lower extremities. The literature suggests that the cause of MSD is multifactorial5, 8, 9), with individual factors such as female gender1, 10, 11), smoking, sleep disturbance, previous injury and number of children having been found to contribute12). While MSD has been positively associated with length of employment, research findings are somewhat inconsistent in this regard, with some studies reporting longer length of employment as being positively associated with MSD; while others have found that new teachers are more likely to report MSD. Similar, albeit conflicting, findings have also been observed for age5). Work-related factors such as school level, prolonged standing, sitting and awkward posture are known to be positively associated with MSD1, 12, 13). Research suggests that psychosocial factors such as high workload/demands, high perceived stress levels, low social support, low job control, low job satisfaction and monotonous work are most likely associated with MSD among school teachers5, 11). On the other hand, factors such as regular exercise and satisfaction with one’s work environment may have a protective effect against MSD within this occupational group11). In the teaching profession, MSD has been shown to lead to ill health retirement of school teachers in, for example, developed countries such as Ireland14) and Scotland15). In developing countries, however, the true burden of MSD and its impact on workplace productivity is not well known. One can hypothesise that the burden is probably high. In a recent study of school teachers in Botswana, for example, it was found that MSD prevented some teachers from carrying out their normal activities, and caused some to change jobs or duties, reduce their activity at home and seek medical attention. Some teachers in this study also reported that MSD resulted in them being unable to work for several days1). This clearly suggests that if preventative control measures are not put in place to curb the burden of MSD and the progression of symptoms; governments of all countries will likely find themselves battling with more widespread disabilities and increased health costs in future. The complex nature of MSD risk factors in developed and developing countries suggests that any single intervention strategy would probably be suboptimal in reducing MSD among school teachers. In fact, if little or nothing is done to reduce the prevalence rate of this crucial workplace problem, MSD may potentially lead to reduced teachers’ performance which may contribute to poor students’ performance, increased sick leave, ill-health, early retirement or increased health care costs. Cost-effective intervention strategies are particularly important for developing countries. Therefore, to help alleviate the burden among teachers in these regions, as elsewhere, a greater emphasis needs to be placed on raising MSD awareness. Awareness and knowledge of the relationship between school teaching and MSD are important for preventing MSD and minimising their progression. In addressing the serious issue of MSD in the teaching profession, ergonomics training specific to MSD risk factors and prevention should now be introduced into teachers’ training institutions, while refresher courses relating to the work tasks and workstations of teachers should also be introduced for in-service teachers. As the majority of MSD studies conducted among teachers have focused on recall information and self-reported MSD, future research may involve clinical diagnosis of MSD and its severity, ideally undertaken with longitudinal studies. Future research should employ a mixed-methods approach, to include a more rigorous quantitative approach such as observational studies which include the physical observation of teachers when carrying out their work tasks and inspection of their workstations for further identification of risk factors. Future research should also consider the epidemiological profile and medical causes of ill-health or early retirement of teachers in both developed and developing countries. The implementation of these measures will go a long way in helping to alleviate the significant burden of workplace injury amongst this important occupational group.

Background Although low back pain (LBP) represents a common occupational problem, few epidemiological studies have investigated the prevalence and risk factors for LBP among school teachers, particularly in Africa. School teachers are known to represent an occupational group among which there appears to be a high prevalence of LBP. The objective of this study was, therefore, to conduct one of the first epidemiological investigations of LBP among teachers in Botswana. Methods A cross-sectional study was conducted among teachers in Botswana using self-administered questionnaires which were distributed to 3100 randomly selected school teachers and collected over a five-month period between July and November 2012. The questionnaire included low back pain information, demographic data, lifestyle, work-related characteristics and psychosocial factors. Data were analysed using Chi-squared and logistic regression models. The 12 month prevalence and LBP disability and associated risk factors were also analysed. Results A total of 1747 teachers returned completed questionnaires, yielding a response rate of 56.3%. The 12-month prevalence of LBP was 55.7%, with 67.1% of them reporting minimal disability. The results of logistic regression analysis revealed that female gender [OR: 1.51, 95% CI: 1.14-2.00] and previous back injury [OR: 9.67, 95% CI: 4.94-18.93] were positively correlated to LBP. Awkward arm position [OR: 1.81, 95% CI: 1.24-2.62] and high psychological job demands [OR: 1.40, 95% CI: 1.02-1.93] were also significantly associated with LBP. Regular physical exercise was negatively associated with LBP [OR: 0.63, 95% CI: 0.43-0.93]. Female gender [OR: 2.67, 95% CI: 1.52-3.99] and previous back injury [OR: 3.01, 95% CI: 1.92-4.74] were also positively associated with LBP disability. Conclusion The prevalence of LBP appears to be high among school teachers in Botswana. A wide variety of LBP risk factors were identified in this study. Female gender and previous injury were both associated with LBP presence and disability. The complex nature of LBP risk factors found in this study suggests than no single specific preventative or intervention strategy will help in reducing these conditions. As such, to help reduce the prevalence, progression and burden of LBP among Botswana teachers, a greater emphasis should now be placed on ergonomics education, regular physical exercise and occupational stress.