Development of a multifaceted ergonomic educational program to prevent work-related musculoskeletal disorders among nurses in intermediate public hospitals in Namibia
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Date
2025
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University of Namibia
Abstract
Work-related Musculoskeletal Disorders (WRMSDs) are impairments, discomfort,
disability, and persistent pain in joints, muscles, bones, ligaments, and tendons. Globally,
WRMSDs are common problems and prevalent in the nursing profession. The WRMSDs
among nurses have been observed and documented in the Namibian context at some
Intermediate Hospitals (IHs), despite the efforts made by the Ministry of Health and Social
Services (MoHSS) to develop an Occupational Health and Safety (OHS) policy aimed at
preventing WRMSDs in health care workers. The individual OHS policies or single
ergonomic interventions have failed to reduce WRMSDs because these disorders are
multifactorial in nature and require multiple interventions to address them. This study aimed
develop a multifaceted ergonomic educational program to prevent WRMSDs among nurses
in IHs in Namibia. The study utilized an explanatory sequential study design with a mixed
method approach, comprising quantitative (cross-sectional) and qualitative (exploitativedescriptive) components. The self-administered Standardized Nordic Musculoskeletal
Questionnaire was used to collect data from 808 randomly selected nurses at IHs Katutura,
Onandjokwe, Oshakati, and Rundu. An interview guide was used to collect data from
purposively sampled OHS key informants from MoHSS and nurses at IHs. SPSS Statistics
26 was used for descriptive statistical analysis. The relationship between the independent
and dependent variables was analysed using multiple logistic regression analysis, while the
interviews were analysed using inductive thematic analysis. The 12-month prevalence rate
of WRMSDs among nurses was highest at Katutura Intermediate Hospital (76%), followed
by Oshakati (73%), Rundu (69%), and Onandjokwe (65%). Over the 12-month period, the
lower back was the most affected body part by WRMSDs, with prevalence rates at Katutura
(74%), Onandjokwe (72%), Rundu (71%), and Oshakati (69%) Intermediate Hospitals,
respectively. Age, years of experience, high workloads, repetitive manual tasks, awkward
postures, manual handling, extensive standing, and sitting were strongly associated with the
development of WRMSDs among nurses (p≤0.005) across all IHs. The study developed a
multifaceted ergonomic educational program with five key elements: adequate staffing;
training; promotion of physical activity, healthy lifestyles, and hazard analysis; preemployment screening; and work and equipment modification. The program was evaluated
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using the Centres for Disease Control and Prevention (CDC) framework for program
evaluation. It was concluded that WRMSDs are a prevalent health problem among nurses at
all IHs in Namibia. It is recommended that MoHSS implement the program as it could
prevent WRMSDs among nurses and ensure a healthy working team. Further studies are
recommended to assess the long-term impact and sustainability of the program in diverse
healthcare settings
Description
A dissertation submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health
Keywords
Educational program, Ergonomics, Musculoskeletal disorders, Namibia, Nurses, Occupational health, Prevention strategies, Program development, Public hospitals, Work-related injuries, University of Namibia