Innovations, Number 73 June 2023

Innovations

Work-related musculoskeletal disorders and ergonomic hazards

among Cameroonian metallurgists

Ndoh M.I1* and Ebango E.A.A1

1Energy, Materials, Modelling & Methods Laboratory (E3M); National Higher Polytechnic School of Douala
(NHPSD) BP 2701, Douala-Cameroon

*Corresponding author: Ndoh M.I

Abstract
The aim of this cross-sectional study was to determine the prevalence of musculoskeletal disorders (MSDs),
ergonomic hazards, and their relationship among Cameroonian metallurgists, taking the city of Douala as an
example. A structured questionnaire was self- administered to 80 metallurgists in three of the five urban
municipalities that constitute the city of Douala. Both descriptive and inferential statistics were performed to
summarize and organize the data, and to explore the relationship between MSDs and potential risk factors,
respectively. We found that the prevalence rate of MSDs was 85.4% in the previous 12 months and 53.8% in
the previous 7 days. Majority, 76 (95%), of the metallurgists were youths between 20 and 42 years (mean =
32.7, SD = 8.8) old. Disorders in the upper back (52.2%), lower back (50.2%), and shoulders (46.45%) were
the most commonly reported symptoms. Those who reported symptoms of MSDs did differ by sex, X 2(1, N=80)
= 9.21, P=.000), age category, X2(1, N=80) = 8.74, P=.000), and educational level, X2(1, N=80) =7.71, P =.000).
Multivariate logistic regression analysis predicted that Metallurgists who regularly lifted, pushed, and pulled
loads greater than 20 kg without assistance from colleagues or assistive tools were 4.85-fold more exposed to
the risk of MSD than those who did not (AOR: 4.85, 95% CI: 2.65-8.87). Similarly, workers whose activities
frequently involved repetitive motions were 4.29 times more likely to develop WMSDs than those whose tasks
did not involve repetitive motions (AOR: 4.29, 95% CI (1.78–10.2). Our study shows that though similar
studies have been carried out in relation to the epidemiology of musculoskeletal disorders worldwide, there is
yet a dearth of studies on how this syndrome affects people of different occupational background. Further
studies on the epidemiology of musculoskeletal disorders, especially the impact on the psychosocial safety
climate of workplaces are recommended.
Keywords: Risk factors, musculoskeletal disorders, Nordic Musculoskeletal Questionnaire

1. Introduction
All over the world, workers from different occupational backgrounds are exposed to varying types of
physical conditions that may pose a risk of injury to the musculoskeletal system due to poor ergonomics.
These hazards include awkward or static postures, high forces, repetitive motion, or short intervals
between activities. This syndrome accounts for more than 48% of all work-related disorders (Backhans et
al. 2015), making them a significant occupational health problem in all professions. The prevalence varies
by activity (Westergren, Ludvigsen, and Lindberg 2019), and it affects both adolescents (Guessogo et al.
2020) and adults (Wintergreen et al. 2019). Continuous exposure to the risk of injury causes an
inflammatory response, followed by pains and loss of motor functions (Barbe and Barr 2006). The

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economically active population's exposure could have both economic and social consequences, such as
early retirement (Palmer et al. 1999; Inoue et al. 2008), worker disability (Kahraman et al. 2016),
productivity loss (Moraru and Băbuţ , 2016). The syndrome is likely to increase as industrialization
accelerates, particularly in developing countries like Cameroon, as they strive to meet a slew of
development targets. For these reasons, this study was designed to systematically characterize and model
the prevalence of MSDs among metallurgical workers and to investigate the risk factors that influence this
prevalence.
A review of literature on MSDs shows that a variety of ergonomic tools have been developed to aid in
the identification of MSD risk factors and the assessment of risk on workstations. Of common use are
observational techniques such as the Ovako Working Posture Analysis System, OWAS (Karhu et al. 1977),
and the associated software WinOWAS (Tiilikainen 1996), the Rapid Upper Limb Assessment (RULA)
(McAnarney, and (Corlett 1993), and the Rapid Entire Body Assessment (REBA)(Hignett 2000). Though
these techniques are inexpensive, easy to use, flexible, and do not interfere with workers’ tasks or the jobs
being performed (Gómez-Galán 2017), they do not consider the effects of recovery, duration, vibration,
environmental conditions, and psychosocial and individual factors, which have been known to affect the
occurrences of MSDs (Kee et al. 2013; and Chiassonet al. 2012).
Away from the above direct methods are indirect methods such as Michigan (Lifshitz and Armstrong
1986), the Standardised Nordic Questionnaires, NMQ (Kuorinka et al. 1987), Keyserling (1993), and the
Quick Exposure Check Method (David et al.2008), etc. However, the complexity, the statistical treatment of
data, and the need to administer questionnaires to a representative portion of workers under study are
the main disadvantages.
The drawbacks of all the foregoing approaches suggest that, while it may generally be true that several
methods could be available for going about a given phenomenon, these approaches differ, inter alia, in the
accuracy of the recording and assessment (Punnet and Wegman 2004). However, because of its
repeatability, sensitivity, and usefulness as a screening and surveillance tool, and its multiple applications
in the assessment of musculoskeletal problems in a variety of occupational groups such as car drivers
(Porter and Gyi 2002), whisky industry workers (Macdonald and Waclawski 2006), nurses (Smith 2004),
and forestry workers (Briggs et al. 2016), the standardised Nordic musculoskeletaf questionnaire (NMD)
was found to be a useful supplement for this study, aimed at, assessing the prevalence of MSDs among
metallurgists in small-scale manufacturing enterprises, and to investigate their relationships with
sociodemographic, ergonomic and psychosocial related characteristics of the workers.

2. Materials and Methods

2.1 Survey Design and Sampling
The sample points for this cross-sectional study were small-scale metal workers' garages in the city of
Douala. We decided to limit the survey to three of the five urban municipalities because the majority of
these businesses are located there. In the absence of statistics on the total number of employees working
in this sector, the sample size was determined using the Cochran (1963) model (Equation 1) with a
margin of error of +/- 10% based on the 30% expected global prevalence rate of MSD (Briggs et al. 2015).
(1)
Where:
S = sample size for infinite population
Z = Z- score
P = population proportion (assumed as 30% or 0.3)
M = Margin of error
In this study, we used Z = 1.960, P = 0.3, and M = 10% to have S ⁓ 81. Assuming a non-response rate of
10% (8.87 ⁓ 9), the minimum sample size is, therefore, rounded up to 90 respondents. Respondents had
to have worked in the metallurgical industry within the previous 12 months. Cutting and bending metal
tubes, assembling, welding, calibrating, and packaging for the production of doors and windows were all
part of the job.

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2.2 Survey Design and Sampling

A structured questionnaire complimented by the standard Nordic musculoskeletal questionnaire was
used. The questionnaire was divided into three sections:
In the first part, sociodemographic variables such as the respondent's age (years), marital status, weight
(kg), height (meters), sex, educational level, self-reported hand dominance, smoking habits, and practice
of regular physical activities (whether the participant regularly practices aerobic activity or resistance
training) were recorded. Self-reported body mass (kg) and height (m) were used to calculate the body
mass index (kg/m2), which was then used to categorize respondents into three groups using the World
Health Organization (WHO) classification system (WHO, 2000 ). For physical activity classification, the
updated WHO guidelines * Fiona, 2020 ) were used.
The questionnaire's work-related characteristics section included questions about company experience
(in months), workload (push and/or lift loads above 10 kg), repetitive work (perform repetitive and
stereotyped motions at work), work pause (perform short rest breaks at work), and vibration exposure
(use of vibrating tools). A four-point Likert-type scale with ratings of 'never,' 'rarely,' 'often,' and 'always'
was used to classify physical workload, repetitiveness, and vibration exposure perceived by the workers.
Answers such as 'never' or 'rarely' were classified as 'no,' while answers such as 'often' and 'always' were
classified as 'yes.'
In the third section of the questionnaire, the Standardized Nordic Questionnaire was used to collect
data on musculoskeletal symptoms. NMQ includes questions about overall body problems as well as
questions about specific body parts (wrist, upper and lower arms, neck, trunk, and legs). A body "map"
was also used to make it easier for workers to pinpoint their problems in each body area. The
questionnaires' reliability had been demonstrated to be acceptable in different studies since 1987, for
example (Kuorinka 1987; Wicaksono 2019).

2.3 Data Collection

Data were collected between March and May of 2022. We gathered both primary and secondary data.
Secondary data was gathered through document analysis to comprehend the current state-of-the-art
literature regarding MSDs and the most effective approaches in place. The specially designed
questionnaire was used to collect primary data. We used a face-to-face interview strategy with the
employees to ensure that we observed and triangulated every response. First, we conducted a pretest on
10 enterprises in the city to uncover any misinterpretation of the questions. Following this was the
questionnaire administration proper. For each enterprise, a worker was selected (mostly the head of the
enterprise), and a questionnaire was administered. Only small-scale metallurgical enterprises were
chosen because they account for more than 90% of the market share and are easily accessible.
Participants in the study had to have worked in the metallurgical industry within the previous 12 months.
Participants on sick leave due to musculoskeletal issues were excluded from the study. There were 80
qualified workers in the study sample. Cutting and bending metal tubes, assembling, welding, calibrating,
and packaging for the production of doors and windows were all part of the job.

2.4 Data analysis

To summarize the characteristics of the sample population, descriptive statistics were used. Chi-square
tests of independence were performed to detect the relationship between MSD symptoms and selected
demographic and work-related factors. Lastly, a supervised learning algorithm, the binary logistic
regression model (Cox, 1958), was used to estimate or predict the impact of sociodemographic and work-
related factors on the occurrence of musculoskeletal complaints. The dependent variable, MSD is designed
as a dichotomous dummy (whether the respondent contracted MSD or not). The model is (Equation 2).
(2)

= the regression coefficients;

= the independent variables

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P = the probability that the event occurs (MSD =1)

= odd ratio; ; (p = p(x))

= log of the odd ratio;

As p(x)  0, - , and as p(x) 1, -+

The transformation from odds to log of odds is the log transformation, and this is a monotonic
transformation. That is, the greater the odds, the greater the log of odds and vice versa. Logit (p) can be
back-transformed to p by the following formula:
(3)
The transformation from probability to odds is a monotonic transformation as well, meaning the odds
increase as the probability increases or vice versa.
The transformation from probability to odds is a monotonic transformation as well, meaning the odds
increase as the probability increases or vice versa. The independent variable was double-checked for
multicollinearity. To evaluate the model fitness, the Hosmer-Lemeshow goodness of fit test was used. The
"Enter" method was then used to run the adjusted logistic regression model. In the multivariate analysis,
only significant potential risk factors (p<0.03) in the univariate analysis were included.
Odds ratios (ORs, Equation 3) were used to compare the relative odds of the outcome of interest, MSDs
(Dependent variable) occurring given exposure to the variable of interest. The dependent variable is
whether the worker had been exposed to MSDs within the last 12 months or the last 7 days (Yes=1). As
independent variables in the final adjusted model for musculoskeletal symptoms, company experience,
sleep disorders, general health state, and work pause were included. These analyses were performed
separately for each of the following locations: neck, upper limb, upper/lower back, and lower limb (Yes =
1) (Table 1):

Table 1: Sample crosstab used in ORs modelling

Exposed to MSDs? Sociodemographic/work-related variables Total
Yes (1) No (0)
Yes (1) (a) (b) (a+b)
No (0) (c) (d) (c+d)
Total (a+c) (b+d) (a+b+c+d)

The odds ratio is calculated to compare the odds across groups (Equation 4)
(4)

Data were computerized and analyzed using the SPSS 20 software (SSPS Inc., Chicago, Illinois,
USA) and Microsoft Excel for windows 10.

3. Results and Discussion

3.1 General characteristics of metallurgists in the city of Douala
Eighty filled questionnaires were analyzed. There were 72 (90%) males and 08 (10%) [Link] age range was 20 to 42
years (Mean = 32.7, SD=8.8), with the majority, 76 (95%), being young. With regard to qualifications, it was revealed that,
29(36%) were primary school graduates; 53(66.3%) had 2 to 4 years of work experience; and 28(35%) were married (Table
1).

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Table 1. Demography of the study population

Variable Description N (%)
Sex Female 8(10)
Male 72(90)
Age (years) 20–30 60(75)
30–40 16(20)
40+ 4(5)
Marital status Single 32(48)
Married 28(35)
Others 20(25)
Education level Primary 36 (45)
Secondary 29(36.25)
Post-secondary 15(18.75)
Education is one of the most important factors influencing overall enterprise performance. The link between educational
level and management techniques is understandable given that metallurgical activity management is a long-term
phenomenon that can only be grasped and understood with time and practical experience. Furthermore, literacy allows access
to modern/strategic management information that non-literates do not normally have. Individuals may be less exposed to
MSDs if they can complete their education before beginning work, have enough experience before performing certain tasks,
and have less potential stress in their working lives resulting from their marital environment, among other factors.
Gender is used to determine the contribution of males and females in manufacturing industries as such. This data could help
decision-makers consider the significance of gender participation in safety and ergonomics plans. It also assists decision-
makers in determining the type of motivation to be assigned per gender. Because the results show that male participation is
higher than female participation, management could focus more on female employee motivation and engagement. With an age
range of 20–30 years, the majority of workers in this sector are in their prime working years. Overall, males appear to
dominate human resources in this sector across all age groups in this region.
The purpose of using marital status in our research is to know how much respondents are supporting their families and
how much they are not. Therefore, most people first try to get a good job, secure it, and then get married. The results show
that 28 (35%) of the participants were married, and 32 (48%) were single. These figures indicate that a reasonable fraction of
the employees support their families, which is a moral right. Therefore, management should provide opportunities to all those
employees to retain them for a long time through motivation and engagement.

3.2 Social characteristics of the Respondents

Twenty-eight (35%) of the workers smoke, and 48 (60%) drink alcohol. In terms of physical activities, 42 (52.5%) exercised
regularly. Only 8% of those polled admitted to having a history of systemic illness (Fig. 1).

Fig 1: Personal characteristics of metallurgical workers in the city of Douala, Cameroon

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Methods such as providing good professional training to young employees, regular physical exercises, a medical history of
systematic illnesses, maintaining a healthy work-life balance, and supporting employees in their efforts to give up various bad
habits such as smoking through rehabilitation could all play important roles in reducing workplace accidents.

3.3 Work environment-related characteristics of respondents.

Respondents were assessed on the number of hours they spent at the work site per week. A total of 69 (86.25%) reported
working more than 40 hours per week while the remainder worked less than 40 hours. Regarding their work experience, it
was found that most of them, 53 (66.3%) were between 2 – 4 years of experience. On the other hand, most of them, 60(75%)
stood for more than 6 hours per day at the work site (Table 3).

Table 3: Work environment-related characteristics of the respondents

Variable Description N (%)
Work Experience ≤1 year 17(21.3)
2 – 4 years 53(66.3)
≥ 5 years 10(12.5)
Work Hours per week 20 - 40 11(13.7)
40 - 60 64(80)
60 + 5(6.3)
Work pause Yes 64(80)
No 16(20)
Hours spent standing at work/day 1–3 hours 6 (7.5)
4–6 hours 14(17.5)
>6 hours 60(75)

3.4 Ergonomic and Psychosocial Characteristics of Respondents

In terms of working posture, 47 (58.75%) of the respondents sometimes worked in the same position for more than 2 hours
per day, and 68 (85%) of respondents' jobs awkwardly required constant bending/twisting However, in their daily work, 63
(78.75%) of the participants routinely pushed, pulled, lifted, and moved loads weighing more than 5 kg without assistance or
assistive equipment. The majority of the workers, 72 (90%), had never received any training in ergonomic postures or safe
equipment handling. They hardly used assistive equipment 13(16.25) during work and used a lot of force 72(90%) when
using tools and equipment. In terms of the most commonly used work posture, only 8(10%) adopted a sitting position, while
the rest preferred either standing, 23(28.75%), kneeling, 21(26.25%), bending, 15(18.75%), or squatting, 13 (16.25%). In
terms of psychosocial characteristics, 23 (28.75%) of respondents reported job stress, while 62 (77.5%) reported
dissatisfaction with their current occupation (Table 4).

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Table 4: Ergonomic and psychosocial characteristics of the workers

Variable Description N (%)
Yes 13(16.25)
Use of assistive tools
No 67(83.75)
Yes 72(90)
Exert force while using tools
No 8(10)
Sitting 8(10)
Standing 23(28.75)
The most commonly adopted work posture Kneeling 21(26.25)
Bending 15(18.75)
Squatting 13(16.25)
1–3 hours 6 (7.5)
Hours spent standing at work/day 4–6 hours 14(17.5)
>6 hours 60(75)
Never 0(0)
Bending/twisting in an awkward way Sometimes 12(15)
Always 68(85)
Never 0(0)
Working in the same position for>2 hrs Sometimes 47(58.75)
Always 33(41.25)
Never 24(30)
Repetitive motions Sometimes 17(21.25)
Always 39(48.75)
Yes 23(28.75)
Job stress
No 57(71.25)
Yes 62(77.5)
Job satisfaction
No 18(22.5)
Yes 63(78.75)
Lift, push, pull, carry, move >5 kg
No 17(21.25)
Yes 8(10)
Training on ergonomics-related issues
No 72(90)

3.5 Prevalence of Self-Reported Work-Related Musculoskeletal Disorders

Twelve (12) - months and seven (7) - day prevalence of MSDs in different body parts showed differing prevalence
for the different body parts (Fig 3).

Fig. 3: Prevalence of WMSDs in different body segments

We infer from figure 3 that the upper back was the area with the highest prevalence rate 52(65%), followed by the lower
back 50(62.5%), the shoulders 46(57.5%), and the knees 44(55%) were the areas of the body that required the most medical
attention in the previous year, while the low back 68(85%), upper back 61(76.25%), and knees 44(55%) were body parts

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most commonly affected in the recent 7 [Link] there is significant literature on the prevalence of MSDs, most studies
only look at MSDs reported in the previous 12 months (Sirajudeen et al. 2018 ) or the previous 7 days (Solis-Soto et al. 2017)..
Our study included both previous 7-day and previous 12-month MSDs. This provides more reliable data on the ongoing
process as well as the population's history of MSDs. Moving loads of more than 5 kg, repetitive tasks, force exertion, and job
stress were all significantly associated with the prevalence of MSDs.

3.6 Multiple Body Parts (Right and Left Side) WMSDs

The majority of the workers reported pains in both the right and left parts of the body, including the shoulder, elbow,
hand/wrist, knee, hip/thigh, and feet/ankle. Of those with shoulder complaints, 21(26.25%) of the total participants reported
pains, aches, or discomforts in both shoulders, while none reported elbow pains, aches, or discomforts on both sides of the
body (Fig. 2).

Fig. 3: Multiple body parts (right and left side) WMSDs among the workers

The presence of multiple disorders is most likely exacerbated by the fact that most workers in the developing world
maintain, install, dismantle, or even repair heavy materials using crude appliances that necessitate manual handling. All of
these activities put workers at risk of MSDs [38]. The low back, neck, and shoulders were the hardest hit. Back pain could be a
result of several interconnected factors, including insufficient equipment, incorrect static postures, psychosocial and
organizational factors, stress, job satisfaction, and work pressure.
Harcombe et al. (2010) found similar results among nursing personnel in New Zealand, with 96.3% experiencing
musculoskeletal discomfort in the previous 12 months and 73.1% experiencing it in the previous 7 days. Workers frequently
maintaining twisted, bent, and/or other non-neutral trunk postures while working could explain the similarity of the findings.

3.7. Relationship between MSDs symptoms, demographic/Ergonomic, and psychosocial related factors
According to the chi-square independence test results in Table 2, some significant relationships were found between
individuals experiencing MSDs and socio-demographics.

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Table 2: Relationship between MSDs symptoms and demographic related characteristics

Experienced MDSs?
Variable Description Yes(%) No(%) N (%) P-value
Demography of the study population
Sex Female 5(7.94) 3(17.65) 8(10) .000*
Male 58(92.06) 14(82.35) 72(90)
Age (years) 20–30 20(33.33) 8(40) 28(35) .000*
30–40 36(60) 10(25) 46(57.5)
40+ 4(6.67) 2(10) 6(07.5)
Marital status Single 32(49.23) 6(40) 34(42.5) .245
Married 27(41.54) 7(46.67) 38(47.5)
Others 6(9.23) 2(13.33) 8(10)
Education level Primary 38(62.29) 9(47.37) 47(58.75) .000*
Secondary 14(22.95) 6(31.58) 20(25)
Post-secondary 9(14.75) 4(21.05) 13(16.25)
*p < .01

All working environment-related characteristics showed significant associations with MSDs (Table 3).

Table 3: Relationship between MSDs symptoms and work environment-related characteristics

Experienced MDSs?
Variable Description Yes(%) No(%) N (%) P-value
Work Experience ≤1 year 7(12.5) 5(20.83) 12(15.00) .000*
2 – 4 years 18(32.14) 9(37.5) 27(33.75)
≥ 5 years 31(55.36) 10(41.67) 41(51.25)
Work Hours per week 20 - 40 7(11.67) 4(20) 11(13.75)
40 - 60 51(85) 13(65) 64(80)
60 + 2(3.33) 3(15) 5(6.25) .000*
Work pause Yes 58(87.88) 4(28.57) 62(77.5) .000*
No 8(12.12) 10(71.43) 18(22.5)
Hours spent standing at work/day 1–3 hours 3 (5.17) 3 (13.64) 6(7.5)
4–6 hours 9(15.52) 5(22.73) 14(17.5)
>6 hours 46(79.31) 14(63.64) 60(75) .000*
*p < .01

All ergonomic and psychosocial characteristics of workers also showed significant association with MSD symptoms (Table 4)

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Table 4: Relationship between MSD symptoms, Ergonomic, and psychosocial characteristics of workers
Experienced MSDs?
Variable Description Yes(%) No(%) N (%) P-value
Yes 16(27.59) 7(31.82) 23(27.5) .000*
Job stress
No 42(72.41) 15(68.18) 57(71.25)
1–3 hours 4 (6.78) 2 (9.52) 6(7.5) .000*
Hours spent standing at work/day 4–6 hours 9(15.25) 5(23.81) 14(17.5)
>6 hours 46(77.96) 14(66.67) 60(75)
Never 0(0) 0(0) 0(0.0)
Bending/twisting in an awkward way Sometimes 7(14.29) 5(16.13) 12(15) .000*
Always 42(85.71) 26(83.87) 68(85)
Never 0(0) 0(0) 0(0.00)
Working in the same position for>2 hrs Sometimes 37(64.91) 10(43.48) 47(58.75) .000*
Always 20(35.09) 13(56.52) 33(41.25)
Never 16(29.09) 8(32) 24(30)
Repetitive motions Sometimes 11(20) 6(24) 17(21.25) .000*
Always 28(50.91) 11(44) 39(48.75)
Yes 48(82.76) 14(63.64) 62(77.5) .000*
Job satisfaction
No 10(17.24) 8(36.36) 18(22.5)
Yes 48(82.76) 15(68.82) 63(78.75) .000*
Lift, push, pull, carry, move >5 kg
No 10(13.79) 7(31.82) 17(21.25)
Yes 6(8.45) 2(22.22) 8(10) .000*
Training on ergonomics-related issues
No 65(91.55) 7(77.77) 72(90)
Yes 8(13.33) 5(25) 13(16.25)
Use of assistive tools
No 52(86.67) 15(75) 67(83.75) .000*
Yes 58(93.55) 14(77.77) 72(90) .000*
Exert force while using tools
No 4(6.45) 4(22.22) 8(10)
Sitting 5(8.62) 3(13.34) 8(10)
Standing 15(25.86) 5(22.73) 20(25)
The most commonly adopted work posture Kneeling 7(12.07) 4(18.18) 11(13.75)
Bending 15(25.86) 6(27.27) 21(26.25) .000*
Squatting 16(27.58) 4(18.18) 20(25)
*p < .01

3.7 Factors Associated with WMSDs among metallurgical workers

Moving loads weighing more than 20 kg, professional training, repetitive motions, force exertion, and job stress were found
to be significant predictors of MSDs (Table 7).

Table 7: Multivariate logistic regression of factors associated with MSDs among the workers.
Work-related MSD
Variable Yes, N(%) No, N(%) COR (95% CI) AOR (95% CI) P value
Educational status
Primary 23(63.89) 13(36.11) 2.27 (0.75–9.87) 1.07 (0.20–5.51) .023
Secondary 19(65.52) 10(34.48) 2.04 (1.18–3.52) 1.64 (0.74–3.62) .013
Post-secondary 9(60) 6(40) 1.33 (0.79–2.26) 0.83 (0.38–1.79) .018
Professional training
Yes 27(42.86) 36(57.14) 1 1
No 8(47.06) 9(52.94) 2.08 (1.34–3.20) 2.04 (1.09–3.81) 0.02

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Most commonly adopted posture :

Sitting 5(62.5) 3(37.5) 1 1 0.344
Standing 12(52.17) 11(47.83) 1.44 (0.45–4.55) 0.50 (0.12–2.02) 0.273
Kneeling 8(38.09) 13(61.90) 1.59 (0.46–5.44) 0.973 (0.20–4.66) 0.309
Bending 7(46.67) 8(54.33) 1.53 (0.48–4.90) 0.921(0.226–3.75) 0.062
Squatting 6(46.15) 7(53.85) 1.80 (0.44–7.30) 1.17 (0.19–6.89) 0.121

Lift, push, and pull loads of >5 kg

Yes 26(41.27) 37(58.73)
6.19 (3.86–9.94) 4.85 (2.65–8.87)∗∗∗
No 9(52.94) 8(47.06) 0.000
1 1
Repetitive motions
Never 11(57.89) 8(42.11) 1 1
Sometimes 8(47.06) 9(52.94) .76 (0.97–3.16) 4.49 (1.94–10.4)∗∗∗ .000
Always 24(54.54) 20(45.45) 2.50 (1.36–4.59) 4.29 (1.78–10.2)∗∗∗ .001

Exert force while using tools

Yes 54(75) 18(25)
2.97 (1.88–4.68) 2.40 (1.24–4.62) ∗∗ 0.000
No 6(75) 2(25)
1 1
Job stress
Yes 58(85.29) 10(14.71) 0.001
No 8(66.67) 4 (33.33)
∗Significant association; significant at ∗P≤0.05, ∗∗P≤0.01, and ∗∗∗P≤0.001 (OR: odds ratio; CI: confidence interval
We infer from the table that workers with no professional training were 2.04 times more likely to develop WMSDs than
those with professional training (AOR: 2.04, 95% CI (1.09-3.81)). This could be explained by the fact that Workers who have
received professional training are more likely to follow recommended safety rules and to be more knowledgeable about the
prevention of work-related injuries and disorders [40].
Heavy manual handling was another important determinant of MSDs in this study. Workers who usually pushed, and pulled
loads greater than 20 kg without assistance from colleagues or assistive tools had a 4.85-fold greater exposure to the risk of
MSD than those who did not (AOR: 4.85, 95% CI: (2.65-8.87). This was however expected since, in many developing nations,
most workers resort to manual material handling, as there is limited access to weight-lifting equipment. Our findings concur
with those of other authors such as [41],
Another important explanatory variable of MSD was repetitive motions. Workers whose activities frequently involved
repetitive motions were 4.29 times more likely to develop WMSDs than those whose tasks did not involve repetitive motions
(AOR: 4.29, 95% CI (1.78–10.2)). According to studies, workers who perform highly repetitive tasks are at the greatest risk of
developing MSDs [42].
In a globalizing world, enterprises must improve their ergonomic and psychosociological performances to compete on a
global scale. Work-related MSDs lead to long-term impacts, resulting in workers being unable to work for a long time, creating
huge costs for enterprises. In addition, the workers being unable to work because of their injuries, and their inability to
continue their work for a long time, psychologically depress individuals, apart from economic problems. Investing in
techniques and equipment that can minimize or prevent work-related MSDs and educating individuals in this area are
important in terms of reducing costs. The development of an ergonomic and safety culture throughout the workplace is
important in this context.

4. Conclusion
The study aimed specifically to assess the prevalence of musculoskeletal injuries among metallurgical workers as well as the
relationship between these injuries and workers' sociodemographic characteristics and work-related risk factors has been
studied in the above discussion. A simple machine learning algorithm that predicts the risk of the problem has been used. A
comparison shows that the results are similar to those of other researchers in the field. The collection of data from a selected
number of workers in the sector, as well as the use of internationally accepted or validated measurement tools to assess
workers' musculoskeletal complaints, job stress, and job satisfaction, were key strengths of this study. Nonetheless, this study
has some limitations. There is a risk of over-, under-, or misreporting of musculoskeletal complaints in self-reported studies.
Furthermore, participant responses may be skewed due to social desirability to provide sociably preferred answers over

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answers that reflect their true experiences. The main causes of the existing health problems were found to be force exertion
when using tools; repetitive tasks; manual handling of loads greater than 5 kg; job-related stress; and a lack of professional
training.

Competing Interests

The authors declare that they have no competing interests

Acknowledgment
The authors wish to thank the authorities and personnel of the metallurgical sector in the chosen municipalities for their
valuable cooperation. We would also like to express our gratitude to Cameroon’s head of State for his wonderful support through
the modernization allowance.

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