Subas Neupane

Multi‐site pain and working conditions as predictors of work ability in a 4‐year follow‐up among food industry employees

We investigated the separate and joint effects of multi‐site musculoskeletal pain and physical and psychosocial exposures at work on future work ability.

Factors associated with reproductive health care utilization among Ghanaian women

BackgroundThis study investigates factors determining the timing of antenatal care (ANC) visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women.MethodData for the study was drawn from the women questionnaire (N=4,916) of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey.ResultsMajority of Ghanaian women attended ANC visit (96.5%) but many (42.7%) did so late (after the first trimester), while 36.5% had delivery without the assistance of a trained personnel (30.6%) or anyone (5.9%). Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds), religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers) wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest) were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0) and Moslems (OR=1.9, CI=1.1-3.3) were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest).ConclusionsDespite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the year 2015.

A four-year follow-up study of physical working conditions and perceived mental and physical strain among food industry workers

This study hypothesized that in a longitudinal setting deteriorating physical working conditions increases the perceived physical and mental strain among food processing employees. The study was conducted in 2003 and 2007. It examined 248 blue-collar workers, all of whom were in the same occupation throughout the entire follow-up period. The data were obtained through a structural questionnaire distributed to the employees at the workplace. Mental strain had increased (7%) significantly among younger employees during the follow-up. The changes in mental strain for the younger employees were positively associated with the changes in physical strain. The changes in physical strain were also significantly associated with the changes in physical working conditions among both younger and the older workers. The results of this study partly support the study hypothesis, namely that deteriorating physical working condition increases physical strain and also increases mental strain, especially among younger employees.

An effort to assess the relation between productivity loss costs and presenteeism at work

Purpose. This study assesses potential presenteeism costs and the association of these with a company’s business figures. Materials and methods. We conducted the questionnaire surveys in alternate years between 2003 and 2007 and linked them to sickness absence register data. Perceived work ability levels were assessed and converted into presenteeism days using the Presenteeism Scale tool. Sickness absence and presenteeism days were converted into monetary figures using median monthly salary information. Results. The share of presenteeism costs was constant at about 1% of annual turnover and about 3.7% of personnel costs. The lowest annual presenteeism cost per employee was EUR 986 and the highest was EUR 1302. The lowest number of presenteeism days per employee in a year was 8.7 days and the highest number was 10.4 days. Estimated losses to a company due to sickness absences and presenteeism ranged from EUR 4.6 million to EUR 5.6 million annually. The potential presenteeism costs to the company and to Finnish society were vast. Conclusions. Presenteeism is a costly problem but more research is needed to reveal the connections between presenteeism and a company’s turnover, personnel costs and profit.

Work-related determinants of multi-site musculoskeletal pain among employees in the health care sector

BACKGROUND Work-related musculoskeletal pain is a major occupational problem. Those with pain in multiple sites usually report worse health outcomes than those with pain in one site. OBJECTIVE This study explored prevalence and associated predictors of multi-site pain in health care sector employees. METHOD Survey responses from 1348 health care sector employees across three organisations (37% response rate) collected data on job satisfaction, work life balance, psychosocial and physical hazards, general health and work ability. Musculoskeletal discomfort was measured across 5 body regions with pain in ≥ 2 sites defined as multi-site pain. Generalized linear models were used to identify relationships between work-related factors and multi-site pain. RESULTS Over 52% of the employees reported pain in multiple body sites and 19% reported pain in one site. Poor work life balance (PRR = 2.33, 95% CI = 1.06-5.14). physical (PRR = 7.58, 95% CI = 4.89-11.77) and psychosocial (PRR = 1.59, 95% CI = 1.00-2.57) hazard variables were related to multi-site pain (after controlling for age, gender, health and work ability. Older employees and females were more likely to report multi-site pain. CONCLUSION Effective risk management of work related multi-site pain must include identification and control of psychosocial and physical hazards.

Good work ability despite multisite musculoskeletal pain? A study among occupationally active Finns.

Aim: Although multisite pain (MSP) often threatens work ability (WA), some of those with MSP retain good WA. Our aim was to identify factors associated with good WA among subjects with MSP. Methods: A nationally representative sample (the Health 2000-Study, response rate 87%) comprising 3884 occupationally active Finns aged 30–64 years. Data on WA, musculoskeletal pain, physical and psychosocial working conditions, chronic diseases, lifestyle and domestic situation were gathered by questionnaire, interview and clinical examination. Good current WA compared with the lifetime best was defined as ⩾9 on a 0–10 scale. Musculoskeletal pain in 18 body locations was combined into four sites, and thereafter pain in two or more sites was defined as MSP (N=1351). Poisson regression analysis was used to obtain prevalence rate ratios (PRR). Results: Good WA was reported by 48% of the women and 37% of the men with MSP. In a multivariable model good WA was associated with younger age, female gender, physically non-strenuous work (PRR 1.3, 95% CI 1.1–1.5), low job strain (1.2, 1.0–1.4), high supervisor support (1.2, 1.0–1.4), and not having musculoskeletal diseases (1.3, 1.1–1.5), mental disorders (1.4, 1.1–1.9), daytime tiredness (1.4, 1.2–1.7) or economic troubles (1.5, 1.1–1.9). Age-stratified analyses revealed also associations with high coworker support (1.2, 1.0–1.4) and strenuous leisure-time physical exercise (1.2, 1.0–1.4) in those aged 30–44 and low alcohol consumption (1.8, 1.2–2.6) in the age-group 45–64. Conclusions: Several potentially modifiable factors related to health, work, and lifestyle were associated with good WA among occupationally active subjects with MSP.

Developmental pathways of multisite musculoskeletal pain: what is the influence of physical and psychosocial working conditions?

Objective To investigate the developmental pathways of multisite musculoskeletal pain (MSP) and the effect of physical and psychosocial working conditions on the development of MSP trajectories. Methods The study was conducted among food industry workers (N=868) using a longitudinal design. Surveys were conducted every 2 years from 2003 to 2009. The questionnaire covered MSP, physical and psychosocial working conditions (physical strain, environmental factors, repetitive movements, awkward postures; mental strain, team support, leadership, possibility to influence) and work ability. MSP as an outcome was defined as the number of painful areas of the body on a scale of 0–4. Latent class growth modelling and multinomial logistic regression were used to analyse the impact of working conditions on MSP pathways. Results Five MSP trajectories (no MSP 35.6%, persistent MSP 28.8%, developing MSP 8.8%, increasing MSP 15.3% and decreasing MSP 11.5%) were identified. In a multivariable model, the no MSP pathway was set as the reference group. High physical strain (OR 3.26, 95% CI 2.10 to 5.04), poor environmental factors (3.84, 2.48 to 5.94), high repetitive movements (3.68, 2.31 to 5.88) and high mental strain (3.87, 2.53 to 5.92) at baseline predicted the persistent MSP pathway, allowing for poor work ability (2.81, 1.84 to 4.28) and female gender (1.80, 1.14 to 2.83). High physical strain and female gender predicted the developing MSP pathway. High physical strain, poor environmental factors and high repetitive movements predicted the increasing and decreasing MSP pathways. Conclusions A substantial proportion of individuals reported having persistent MSP, and one-third reported changing patterns of pain. Adverse physical working conditions and mental strain were strongly associated with having high but stable levels of MSP.

Newborn Health Interventions and Challenges for Implementation in Nepal

Neonatal mortality is a major challenge in reducing child mortality rates in Nepal. Despite efforts by the Government of Nepal, data from the last three demographic and health surveys show a rise in the contribution of neonatal deaths to infant and child mortality. The Government of Nepal has implemented community-based programs that were piloted and then scaled up based on lessons learned. These programs include, but are not limited to ensuring safe motherhood, birth preparedness package, community-based newborn care package, and integrated management of childhood illnesses. Despite the implementation of such programs on a larger scale, their effective coverage is yet to be achieved. Health system challenges included an inadequate policy environment, funding gaps, inadequate procurement, and insufficient supplies of commodities, while human resource management has been found to be impeding service delivery. Such bottlenecks at policy, institutional and service delivery level need to be addressed incorporating health information in decision-making as well as working in partnership with communities to facilitate the utilization of available services.

Neonatal mortality in Nepal: A multilevel analysis of a nationally representative

Objectives: This study investigated individual, community and district level factors associated with neonatal mortality among a national sample of Nepalese women. Methods: Data were drawn from the 2006 Nepalese Demographic and Health Survey on women aged 15–49 who delivered within three years prior to the survey (N = 4136). Multilevel logistic regression models with three levels were fitted to assess the influences of measured individual, community and district level variables on neonatal mortality. Results: The total neonatal mortality in three years preceding the survey was 4.5 deaths per 100 live births (N = 190), with neonatal mortality rate (NMR) = 46 per 1000 live births. Having a partner with no formal education, being in the middle on the wealth index and residing in less developed district were associated with neonatal death in bivariate analysis. Women who were assisted by skilled personnel during delivery were less likely to have neonatal death (adjusted OR for no assistance = 2.26, 95% CI = 1.19–4.26). Having prenatal care with skilled attendant was associated with less likelihood of neonatal death (adjusted OR for no care = 1.75, 95% CI = 1.17–2.62). Older women, mother’s education, parity and wealth index were associated with neonatal mortality. Considerable variations in neonatal mortality at community and district levels were found. Conclusions: These findings emphasize the need for interventions at the individual level with regard to access and utilization of healthcare in order to reduce the neonatal mortality in Nepal.

Work behaviour during pregnancy in rural China in 2009

OBJECTIVES To describe the pattern and determinants of working during pregnancy in rural China. METHODS A cross-sectional survey was carried out in 2009 in three provinces (Anhui, Chongqing and Shaanxi) in rural China among 3966 mothers who had recently given birth. Multilevel logistic regression was used to examine the determinants of work behaviour during pregnancy. RESULTS Overall, 39% of the women stopped working during early pregnancy, 32% worked the same throughout pregnancy and the rest decreased their work or stopped later in pregnancy. Women from Anhui (53%) and Chongqing (54%) provinces were more likely to stop work in early pregnancy than women from Shaanxi province (20%). Older women [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.56-0.99], those having two or more children (OR 0.55, 95% CI 0.43-0.69) and non-farmers (OR 0.50, 95% CI 0.65-0.99) were less likely to stop working on the first trimester, but those with higher education (high school OR 1.43, 95% CI 1.05-1.94) were more likely to stop working. Stopping work early was not related to household income and adequacy of prenatal care. Women with two or more children, non-farmers and those from Shaanxi province were more likely to continue to work to the same extent during pregnancy. But those with higher household income and middle and high school were less likely to work the same. CONCLUSIONS Womens working patterns during pregnancy in rural China were polarized: many women stopped working already in early pregnancy, but others continued to work as before. The key determinant of the working patterns was the province of residence.