Prevalence and Associated Factors of Work-Related Spinal Pain Among Bank Workers in Harar, Eastern Ethiopia: A Cross-Sectional Study

Abstract

Background

Spinal pain is a prevalent occupational health issue, particularly among bank workers who often experience prolonged sitting and poor ergonomic conditions. Despite the increasing occupational-related burden of spinal pain, data specific to bank workers in study setting, remains limited.

Objective

This study aimed to determine the prevalence of spinal pain and its associated factors among bank workers in Harar, Eastern Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 322 bank workers from July 20 to August 20, 2023. Participants were selected using a simple random sampling technique to ensure unbiased representation. The standardized Nordic Musculoskeletal survey was interviewer-administered for data collection. Data were entered in EpiData version 3.1 and exported to STATA version 17.0 for analysis. Descriptive statistics, including frequencies and percentages, were applied to calculate the proportion. Bivariate and multivariable binary logistic regression was conducted to identify factors associated with spinal pain, with an alpha level of 0.05 defining statistical significance. Adjusted odds ratios with their 95% confidence intervals were used to assess the strength and direction of associations.

Results

The study found that lower back pain (45.4%), neck pain (37.14%), and upper back pain (34.92%) were the most frequently reported spinal complaints among bank employees in the past 12 months. Neck pain was associated with female gender, job stress, and high workload. Lower back pain showed association with alcohol consumption, longer duration of service, managerial roles, and workload intensity. Upper back pain was associated with being in a managerial position.

Conclusion

The study highlights a high burden of spinal pain among bank workers, with distinct associations across neck, upper back, and lower back regions. Ergonomic strain, occupational stress, behaviors, and job roles significantly contributed to pain. These findings underscore the need for targeted workplace interventions that address both physical and psychosocial risk factors to enhance employee wellbeing in banking environments.

Introduction

Spinal pain is one of the most commonly reported musculoskeletal conditions that encompasses both neck pain (cervical region) and back pain (upper: thoracic and lower: lumbar region) (Izzo et al., 2015). Both back and neck pain can be classified as acute, lasting less than 6 weeks; subacute, when persisting 6 to 12 weeks; or chronic, when persisting more than 12 weeks (Blanpied et al., 2017; Casiano et al., 2023; NIAMS, 2017). The causes of this pain are multifactorial, including mechanical strain, poor posture, sedentary behavior, traumatic injuries, or underlying medical conditions such as herniated discs, arthritis, or osteoporosis (Blanpied et al., 2017; Casiano et al., 2023; Meleger & Krivickas, 2007).

The mechanism of pain development often involves strain or damage to muscles, ligaments, intervertebral discs, or nerve compression, leading to inflammation, pain, and restricted movement (Adams et al., 2012; Blanpied et al., 2017; Meleger & Krivickas, 2007).

Globally, the prevalence of spinal pain in lower and upper regions was 691,398.3 in 2005 and increased by 18.7% over the past 10 years (Hurwitz et al., 2018). Bank workers are employees who perform financial activities that include supervision, customer service, public relations, accounting clerks, loan officers, and managers (Dagne et al., 2020). Due to the sedentary nature of their jobs, they experience extended periods of sitting or standing, which increases their risk of developing musculoskeletal, particularly back pain (Kanyenyeri et al., 2017). Poor workplace ergonomics, including misleading chairs, desks, and computer screens, further exacerbate discomfort. Additionally, occupations that involve long hours of standing, lifting heavy objects, or maintaining static postures are particularly at risk (JONES, 2023). The combination of repetitive movements, limited physical activity, and work-related stress contributes to back pain prevalence among bank employees, making their working environment a significant factor in musculoskeletal health concerns (Singh & Gebrekidan, 2019).

Years lived with disability due to low back and neck pain were 80,051.9 in 2005 and rose by 18.6% over the past 10 years (Hurwitz et al., 2018). Back and neck pain has become the leading cause of disability worldwide (GBD, 2024; Hurwitz et al., 2018; WHO, 2022). An estimated $200 billion is spent annually on managing back pain (Casiano et al., 2023). In industrialized nations, over medicalization of back pain drives unnecessary surgeries and opioid prescriptions, straining insurance systems, while low-income countries face treatment gaps that push manual workers into poverty (Organization, 2023; Traeger et al., 2019). It reduces individual productivity, leading to losses linked to absenteeism. Such productivity declines stem from reduced workforce output and costs incurred from replacing workers impacted by illness, disability, or premature death (Krol & Brouwer, 2014). Furthermore, early retirement caused by such health challenges imposes a heavy societal burden, combining direct healthcare expenses with indirect economic costs like prolonged absenteeism and diminished workforce efficiency (WHO, 2019). Ethiopia has recently experienced significant economic growth, which requires a substantial workforce and is a sector of the financial industry that is currently expanding its branches and working extensively (Alemu, 2021). However, occupational health and safety services are not yet robust enough to prevent work-related health problems, including back pain (Kumie et al., 2016).

Review of Literature

The review revealed a significant burden of spinal pain among bank workers, with lower back pain being the most prevalent at 49.19%, followed closely by neck pain at 46.11%, and upper back pain at 42.08% (Marzban et al., 2024). More than half of bank workers in Kuwait have reported experiencing musculoskeletal disorders, with neck pain being the most prevalent at 53.5%, followed by lower back pain at 51.1%, and upper back pain at 38.4% (Akrouf et al., 2010). A study conducted in Malaysia and Bangladesh revealed that the prevalence of low back pain among bank workers was 79.2% and 36.6%, respectively (Ali et al., 2020; Subramaniam et al., 2023). Studies conducted in Rwanda reported 46% of bank workers had back pain (Kanyenyeri et al., 2017). Similarly, research in Ghana reported high prevalence rates, with lower back pain being the most common (64.8%), followed by upper back pain (61.7%) and neck pain (47.4%) (Abledu & Abledu, 2012). In Ethiopia, studies reported a significant prevalence of spinal pain among bank workers, that lower back pain affecting 54.3%, neck pain 38.0%, and upper back pain 35.4% (Dagne et al., 2020).

While previous studies have investigated low back pain among bank workers in other regions (Jonga et al., 2024; Singh & Gebrekidan, 2019; Workneh & Mekonen, 2021), there is a critical gap in localized evidence from Eastern Ethiopia, where unique cultural practices and occupational stressors may influence back pain risk. Furthermore, existing research predominantly focuses on low back pain, overlooking the broader pattern of musculoskeletal back pain (mid or upper back pain) and spinal pain that may arise from prolonged sitting, repetitive tasks, or inadequate workstations setup common in banking. This study addresses these gaps by evaluating the prevalence of overall work-related spinal pain and associated factors among bank workers in Harar town, Eastern Ethiopia.

Methods

Study Design and Setting

An institution-based cross-sectional study was conducted among bank workers in Harar, Eastern Ethiopia, from July 20 to August 20, 2023. Harar is the capital of the Harari regional state and serves as the administrative center of the East Hararghe Zone, which is located 525 km away from Addis Ababa, the capital of Ethiopia. According to the Central Statistical Agency population projection in 2022, the region has an estimated population of 276,000, consisting of 139,000 males and 137,000 females. In Harar town, there are 17 banks; one is government-owned, and the rest (16) are private banks with a total of 64 branches comprising 1258 bank workers (female 513 and male 745) (Bekele & Lakew, 2014; Geleta, 2023). According to the Harari Regional Health Bureau, there are four hospitals (two public, one police, and one private), 40 private clinics, and eight health centers. All hospitals have chronic follow-up clinics where patients with chronic diseases follow their treatment.

Population

The study included all bank workers who had been actively employed for at least 6 months prior to data collection, ensuring a representative sample of the workforce. However, individuals with pre-existing illnesses or prior injuries that could contribute to back pain, those with congenital anomalies affecting the lumbar or spine, pregnant employees, and those absent during the data collection period were excluded to maintain the integrity of the findings and minimize confounding factors.

Sample Size and Sampling Procedure

The sample size was calculated using Open Epi 3.1, using a single population proportion formula, assuming 50% prevalence, as there was no previous study in the study area, a 95% confidence level (CL), and a required precision of 5% on either side of the proportion. The final sample size, with a 10% nonresponse rate after the correction formula, was 323.

$$n={\displaystyle \frac{{(Z_{\frac{\alpha }{2}})}^2*P_{}(1-P_{})}{d^2}}$$

where: n = the minimum required sample size, Z = the cut off value of normal distribution at 95% confidence level (CL), α = the significance level = 0.05, P = prevalence of spinal pain, and d = precision required on either side of the proportion (5%).

The selection of study participants followed a stratified sampling approach, ensuring adequate representation of both governmental and private bank workers in Harar. Initially, banks in the study area were categorized into two strata: governmental banks and private banks. After defining the strata, the required sample size was proportionally allocated to each group based on the total number of employees in governmental and private banks. Following the proportional allocation, simple random sampling was employed to select the study participants within each stratum.

Study Variables

Dependent Variable

Spinal pain (neck pain, lower back pain, and upper back pain)

Independent Variables

Sociodemographic and behavioral factors: age, sex, years of experiences, marital status, educational status, type of banks, physical activity, body mass index (BMI), chewing khat, smoking, and alcohol consumption.

Psychosocial and medical factors: Workload, job stress, job satisfaction, back trauma chronic illness like Diabetes Mellitus and hypertension.

Occupational factors: Using fixed chair, chair without armrest, sedentary behavior, lifting heavy objects, working overtime, work in hours, working without break, working in the same position, job experience, ergonomic, and awkward posture.

Data Collection and Measurements

The questionnaire was based on the previously published literature and adapted from the Standard Nordic Questionnaire to assess pain in three specific body regions: neck, upper back, and lower back. This modified version would consist of three forced-choice questions for each region (Chaiklieng et al., 2014; Crawford, 2007). Additionally, the questionnaire includes sociodemographic information, behavioral, medical, occupational, and psychosocial characteristics that could potentially influence back pain. The data were collected using a face-to-face interviewer-guided self-administered questionnaire. An English version of the questionnaire was prepared and translated into the local language (Amharic) to make it suitable for participants and then retranslated back into English to maintain consistency with the original version.

Data were collected with the help of six trained BSc nurse data collectors and one MSc nurse supervisor. A written guideline was given to the data collectors to ensure that every participant received the same directions and information. The participant's anonymity was kept by informing them not to write their name. The instruments were distributed among the study population, after ensuring their willingness to take part in the study, and then it was collected by the data collectors after completion.

Spinal pain is defined as self-reported discomfort in the cervical (neck), thoracic (upper back), or lumbar (lower back) regions within the past 12 months. The Nordic Musculoskeletal Questionnaire categorizes back pain as “Yes” if a participant scores between 4 and 6 or reports pain in at least one of the three body regions. If a participant reports no pain in all three regions, they are categorized as “No” (Shah et al., 2016). Bank workers, who perform various financial activities such as supervision, customer service, public relations, clerical tasks, loan processing, and management, may experience occupational risks contributing to spinal pain (Dagne et al., 2020).

Awkward posture, defined as any unnatural bending or twisting of the body, further exacerbates spinal discomfort (Moore et al., 2011). Ergonomic training programs help mitigate these risks by educating employees on optimizing work environments to reduce strain and prevent injuries (Adiga, 2023). Other behavioral risk factors include smoking and alcohol consumption. Smoking refers to ever-practiced smoking habits by bank workers. Alcohol drinking is the consumption of any kind of alcohol by a bank worker ever. A sedentary lifestyle is defined as a lifestyle characterized by little physical activity, sitting or lying while reading, socializing, or using a mobile phone or computer for ≥ 8 h per day (Motuma et al., 2020).

BMI plays a role in spinal health, calculated as weight in kilograms divided by height in meters squared (kg/m²). BMI classifications include underweight (<18.5 kg/m²), normal range (18.5–24.99 kg/m²), overweight (25.00–29.99 kg/m²), and obese (≥30.00 kg/m²) (WHO, 2015).

The job satisfaction score is measured using the generic job satisfaction scale, very low (10–26), low (27–30), average (31–38), high (39–41), and very high (42–50) (Macdonald & Maclntyre, 1997). A job stress is measured using a standardized questionnaire consisting of eight items, developed by The Marlin Company in collaboration with the American Institute of Stress. The scoring system between 16 and 40 indicates the presence of job stress, and a score of 15 or lower indicates the absence of job stress (Barsade & Wiesenfeld, 1997). A sedentary lifestyle is defined as a lifestyle characterized by little physical activity, sitting or lying while reading, socializing, or using a mobile phone or computer for ≥ 8 h per day physical activity refers to any habit of doing physical activities, including activities at the workplace, by calculating metabolic equivalent per week. Physical activity was categorized as high (3,000 MET-minutes or above), moderate (between 2,999 and 600 MET-minutes), and low (< 600 MET-minutes) (Bull et al., 2020).

Data Quality Control

The Standard Nordic Questionnaire was used, and it was translated into the local language to ensure quality. Before the actual data collection started, a pretest was carried out among 17 bank workers in Haramaya town, representing 5% of the participants, to refine the questionnaire based on feedback. Additionally, data collectors were trained for 2 days before actual data collection, focusing on the study's objective, data collection techniques, data quality, and ethical issues. Each data collector checked the questionnaires for completeness before leaving each participant. Data completeness, accuracy, and clarity were checked daily by the supervisor. The principal investigator managed and supervised the data collection daily to maintain data quality.

Data Analysis

After data collection, the questionnaire was checked for completeness, coded, entered into Epi Data Version 3.1, and then exported to STATA version 17.0. Before analysis, missing values for each variable were managed. Descriptive statistics were used to determine the distribution of sociodemographic characteristics of the study participants. For categorical data, commonly used descriptive statistics include frequencies, percentages, and the mode, which identifies the most frequently occurring category. Meanwhile, continuous data is described using measures of central tendency, including the mean, and median, and mode, alongside measures of dispersion such as standard deviation. Visual representations such as bar charts and frequency tables help to illustrate the distribution of categories.

Binary logistic regression was conducted for both bivariable and multivariable analysis to determine the associations of the independent variables with the outcome variable. All variables with a p value < .25 in the bivariable logistic regression analysis were entered into the final multivariable analysis model to control for confounders and identify the independent association of variables with back pain, with an alpha level of 0.05 defining statistical significance. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to assess the direction and strength of the association. The model's fitness was checked using the Hosmer–Lemeshow goodness-of-fit test, and it was found to be insignificant at p = .3203, indicating good model fitness. Multicollinearity is assessed to determine the linear correlation among independent variables using the variance inflation factor (VIF) and standard error. A VIF >10, a standard error > 2 or a tolerance test < 0.1 were considered suggestive of multicollinearity. No multicollinearity was detected during the analysis in this study.

Results

Sociodemographic Characteristics of Participants

Of the 322 study participants, 315 participated, yielding a 97.82% response rate. The mean age and standard deviation (SD) of the study participants were 29.4 ± 5.08 years. The majority of the participants, 272 (86.35%) a Bachelor of Science (BSc) degree, 223(70.79%) worked in customer service, and more than half, 182(57.78%), were married. Moreover, the majority of the study participants, 191 (60.63%) were male, and more than half, 178(56.5%), had less than 5 years of work experience. Additionally, more than half (54.92%) of the study participants were from privately owned banks (Table 1).

Table 1.

Sociodemographic Characteristics of Bank Workers in Harar, Eastern Ethiopia, 2023 (n = 315).

Variable	Category	Frequency	Percent
Age	20–29 years	170	53.97
30–39 years	128	40.63
≥ 40 years	17	5.4
Sex	Male	191	60. 63
Female	124	39.37
Marital status	Married	182	57.78
Single	114	36.19
Divorced	10	3.17
Widowed/separated	9	2.86
Educational status	Bachelor degree	272	86.35
Masters and above	43	13.65
Average monthly salary, ETB	8000–16,000	47	14.93
16,000–32,000	220	69.84
≥ 32,000	48	15.24
Job designation	Manager	30	9.52
Customer service	223	70.79
Cashier	25	7.94
Other	37	11.75
Service year	< 5	178	56.5
≥ 5	137	43.49
Bank ownership	Government	142	45.08
Private	173	54.92

ETB: ethiopian birr; Other: loan officer and public relations.

Behavioural, Medical, and Psychosocial Characteristics

Based on self-reported data, 243 (77.14%) of the study participants were in the normal BMI category, and the majority of the participants, 206 (65.4%), had low physical activity. The majority of the study participants, 279 (88.57%), had no history of chronic illness. Satisfaction levels varied, with 17.78% of respondents experiencing very low satisfaction, 13.97% reporting low satisfaction, and 38.10% falling into the average category. Additionally, 207 (65.71%) demonstrated poor knowledge about back pain (Table 2).

Table 2.

Behavioral, Medical, and Psychosocial Characteristics of Bank Worker in Harar, Eastern Ethiopia (n = 315).

Variable	Category	Frequency	Percent
BMI in kg/m2	Under weight	12	3.81
Normal	243	77.14
Overweight and obese	60	19.05
Physical activity in MET-minutes	Low	206	65.40
Moderate	89	28.25
High	20	6.35
Sedentary behavior	Yes	182	57.78
No	133	42.2
Cigarette smoking	Yes	33	10.47
No	282	89.52
Alcohol use	Yes	112	35.56
No	203	64.44
Khat chewing	Yes	162	51.43
No	153	48.57
Ever diagnosed for NCDs	No	279	88.57
Yes	36	11.43
Job stress	Yes	174	55.24
No	141	44.76
Job satisfaction	Very low	56	17.78
Low	44	13.97
Average	120	38.10
High	41	13.02
Very high	54	17.14
Back pain knowledge	Poor	207	65.71
Good	108	34.29

MET=metabolic equivalent of task; NCD=noncommunicable diseases.

Occupational and Ergonomic Characteristics

More than three-fourths, 264 (83.81%) of the bank workers had no break time except for lunch, and 246 (78.10%) reported that their working hours per week were ≥48 h. The majority of the participants, 246 (78.10%), used an adjustable chair. Regarding ergonomic risk factors, 270 (85.71%) of bank workers had never received any ergonomic training (Table 3).

Table 3.

Occupational and Ergonomic Characteristics of Spinal Workers in Harar, Eastern Ethiopia (n = 315).

Variable	Category	Frequency	Percent
Total working hours per week	≥48 h	246	78.10
< 48 h	69	21.90
Awkward posture	Yes	201	63.81
No	114	36.19
Working in the same position	Yes	217	68.89
No	98	31.11
Types of chairs	Adjustable	246	78.10
Fixed	69	21.90
Chair with Armrest	Yes	235	74.60
No	80	25.40
Break except lunch time	No	264	83.81
Yes	51	16.19
Among those who have break	≤ 15 min	37	11.75
> 15 min	14	4.44
High loaded work	Never	64	20.32
Sometimes	192	60.95
Frequently	59	18.73
Ergonomic characteristics
Repetitive motion	Yes	173	54.92
No	142	45.08
Experience pain while on work	Frequently	68	21.59
Occasionally	159	50.48
Never	88
Feel unsafe while performing job	Yes	168	53.33
No	147	46.67
Ergonomic training	Yes	45	14.29
No	270	85.71

Prevalence of Spinal Pain Among Bank Workers

This study revealed that 72.38% (95% CI: 67.08–77.24%) of the bank workers had reported spinal pain in three of their body regions over the past 12 months. Out of these, 45.4% (n = 173) reported lower back pain, 34.92% (n = 110) had upper back pain, and 37.14% (n = 117) had neck pain.

Factors Associated With Work-Related Neck Pain Among Bank Workers

In the bivariable analysis, neck pain was significantly associated with being female, alcohol consumption, job satisfaction, job stress, type of chair used, and frequency of highly loaded work. These variables were included in the multiple binary logistic regression analysis. The odds of experiencing neck pain were 1.75 times greater among female participants compared to their male counterparts (AOR = 1.75; 95% CI: 1.06–2.86). Employees who reported job-related stress had 1.69 times greater odds of having neck pain than those who did not experience stress (AOR = 1.69; 95% CI: 1.02–2.78). Additionally, participants with frequent high workload were 2.19 times more likely to report neck pain compared to those with less frequent workload exposure (AOR = 2.19; 95% CI: 1.17–4.10; Table 4).

Table 4.

Factors Associated With Neck Pain Among Bank Workers in Harar, Eastern Ethiopia (n = 315).

Variable category	Neck pain	COR (95% CI)	AOR (95% CI)	p Value
No (%)	Yes (%)
Sex
Male	128	63	1	1
Female	70	54	1.56 (0.98–2.49)	1.75 (1.06–2.86)	.026*
Alcohol consumption
Yes	62	50	1.63 (1.02–2.62)	1.54 (0.93–2.55)	.087
No	136	67	1	1
Job satisfaction
Satisfied	61	49	1	1
Unsatisfied	137	68	1.61 (1.01–2.60)	1.53 (0.93–2.51)	.090
Job stress
Yes	100	74	1.68 (1.05–2.69)	1.69 (1.02–2.78)	.038*
No	98	43	1	1
Type of chair
Adjustable	163	83	1	1
Fixed	35	34	1.91 (1.11–3.27)	1.43 (0.80–2.56)	.090
High loaded work
Never	37	27	1.64 (0.91–2.94)	1.60 (0.87–2.93)	.126
Sometimes	133	59	1	1
Frequently	28	31	2.49 (1.37–4.53)	2.19 (1.17–4.10)	.014*

1=Reference; AOR=adjusted odds ratio; CI=confidence interval; COR=crude odds ratio. * p Value < .05 considered statistically significant.

Factors Associated With Work-Related Lower Back Pain Among Bank Workers

In the bivariable analysis, lower back pain was significantly associated with alcohol consumption, service duration of 5 or more years, managerial and customer service roles, and frequent high workload. These variables were included in the multiple binary logistic regression analysis. The odds of experiencing lower back pain were 2.58 times greater among participants who reported alcohol consumption compared to those who did not (AOR = 2.58; 95% CI: 1.56–4.28). Employees with 5 or more years of service had 1.94 times higher odds of reporting lower back pain than those with less than 5 years (AOR = 1.94; 95% CI: 1.18–3.19). Managers were found to have 4.14 times greater odds of experiencing lower back pain compared to employees in other job categories (AOR = 4.14; 95% CI: 1.38–12.36). Likewise, customer service workers had elevated odds, with a 3.52 increase in likelihood of lower back pain relative to other roles (AOR = 3.64; 95% CI: 1.54–8.06). Additionally, participants with frequent high workload were 1.93 times more likely to experience lower back pain compared to those with less frequent workload (AOR = 1.93; 95% CI: 1.01–3.71; Table 5).

Table 5.

Factors Associated With Lower Pain Among Bank Workers in Harar, Eastern Ethiopia (n = 315).

Variable category	Lower back pain	COR (95% CI)	AOR (95% CI)	p Value
No (%)	Yes (%)
Alcohol consumption
Yes	44	68	2.63 (1.64–4.23)	2.58 (1.56–4.28)	.000*
No	128	75	1	1
Service in year
<5	108	70	1	1
≥ 5	64	73	1.75(1.12–2.76)	1.94(1.18–3.19)	.008*
Job designation
Manager	14	16	3.08 (1.11–8.55)	4.14 (1.38–12.36)	.011*
Customer service	110	113	2.77 (1.28–5.99)	3.52 (1.54–8.06)	.003*
Cashier	21	4	0.51 (0.41–1.87)	0.73 (0.18–2.85)	.654
Other	27	10	1	1
Break except lunchtime
Yes	34	17	1	1
No	138	126	1.82 (0.97–3.42)	1.65 (0.84–3.26)	.144
High loaded work
Never	33	31	1.34 (0.76–2.37)	1.12 (0.61–2.07)	.710
Sometimes	113	79	1	1
Frequently	26	33	1.82 (1.01–3.27)	1.93(1.01–3.71)	.047*

1=Reference; AOR: adjusted odds ratio; CI=confidence interval; COR=crude odds ratio; . *p Value < .05 considered statistically significant. Other: loan officer and public relations.

Factors Associated With Work-Related Upper Back Pain Among Bank Workers

Results from bivariate logistic regression showed that alcohol consumption, service duration, job designation, type of chair, khat chewing, and high workload frequency had p values of less than 0.25 for upper back pain. These variables were considered for inclusion in the multivariate analysis. Multivariate analysis showed that factors independently associated with upper back pain included managerial job designation (AOR = 3.33, 95% CI: 1.12–9.87; Table 6).

Table 6.

Factors Associated With Upper Pain Among Bank Workers in Harar, Eastern Ethiopia (n = 315).

Variable category	Upper back pain	COR (95% CI)	AOR (95% CI)	p Value
No (%)	Yes (%)
Alcohol consumption
Yes	64	48	1.71(1.05–2.75)	1.60(0.97–2.63)	.062
No	141	62	1	1
Job designation
Manager	17	13	2.77(0.95–8.04)	3.33(1.12–9.87)	.030*
Customer service	140	83	2.14(0.93–4.92)	2.24(0.96–5.21)	.059
Cashier	19	6	1.14(0.34–3.82)	1.44(0.42–4.94)	.555
Other	29	8	1	1
Type of chair
Adjustable	167	79	1	1
Fixed	38	31	1.72(1.03–2.97)	1.61(0.92–2.83)	.097
Khat chewing
Yes	98	64	1.51(0.95–2.42)	1.45(0.90–2.35)	.125
No	107	46	1	1

1=Reference; AOR: adjusted odds ratio; CI=confidence interval; COR=crude odds ratio; . *p value < .05 considered as statistically significant. Other: loan officer and public relations.

Discussion

The findings of this study revealed that the overall prevalence of spinal pain (back pain and neck pain) among bank workers in the past 12 months was 72.38% (95% CI: 67.08–77.24%). Of these, 45.4% reported lower back pain, 34.92% had upper back pain, and 37.14% had neck pain. Sex, service years, sedentary behavior, types of chairs, working hours per week, and alcohol were significantly associated with spinal pain.

The present study revealed that the lower back, 45.4% (95% CI: 39.8%–51.1%), was the most affected body part in the previous 12 months. These study findings were consistent with the studies conducted in Gonder and Addis Ababa, Ethiopia (Dagne et al., 2020; Workneh & Mekonen, 2021). However, it is higher than the findings of other studies conducted in Dhaka city, in Bangladesh, 36.6% (Ali et al., 2020), and Pakistan, 36.6% (Umar et al., 2019), and lower than the results of studies performed in Saudi Arabia, 73% (Gupta et al., 2015). The present study revealed that 37.14% of participants experienced neck pain. These findings are consistent with previous studies conducted in Lahore, Pakistan (Boota et al., 2018) and are higher than the study conducted in India, which reported that about 10% of bank employees suffered from neck pain (Bhandari & Gadhavi, 2024). This discrepancy might be due to differences in tools used, workload, time, and area of study variation between the previous and the present study.

In this study, the odds of experiencing neck pain were higher among females than among their male counterparts. This finding is consistent with the studies conducted in the United Kingdom (Malińska et al., 2021) and in Iran (Ehsani et al., 2017). Other studies suggest that female employees are more susceptible to neck pain than males (Nimbarte, 2014; Ostergren et al., 2005). This significant gender disparity aligns with existing literature showing women's greater susceptibility to musculoskeletal disorders may be attributed to heightened pain sensitivity, hormonal fluctuations throughout the menstrual cycle, and biological adaptations related to pregnancy and childbirth (Bizzoca et al., 2023; Zhang et al., 2023). These findings underscore the need for gender-sensitive occupational health interventions and ergonomic strategies tailored to the unique physiological needs of female employees, particularly in environments that demand prolonged static postures or repetitive tasks.

Employees who reported job-related stress had greater odds of experiencing neck pain compared to those who did not report stress. This finding was consistent with studies done among bank workers in Addis Ababa, Ethiopia (Dagne et al., 2020). Bank employees often face high work demands, sedentary tasks, and limited autonomy, all of which contribute to elevated stress levels (Giorgi et al., 2017). Chronic stress may provoke muscle tension, reduce pain tolerance, and impair recovery, thereby increasing vulnerability to neck pain (Timmers et al., 2019). Since banking involves high cognitive demands and sedentary postures, employers should consider ergonomic improvements (e.g., adjustable chairs and monitor height) and stress-reduction initiatives (e.g., mindfulness sessions and workload management).

Additionally, participants with frequent high workload were associated with neck pain and lower back pain. This aligns with findings from multiple occupational health studies, high workload is a consistent risk factor across (da Costa & Vieira, 2010; Heneweer et al., 2011; Malińska et al., 2021). Prolonged sitting, repetitive tasks, and sustained poor posture during periods of high workload likely exacerbate muscle tension and spinal strain (Christensen et al., 2023). Additionally, the mental stress from heavy workloads may reduce employees’ awareness of their posture and discourage them from taking necessary breaks (Vieten et al., 2023). These findings suggest that workplace interventions should not only address ergonomic factors but also implement workload management strategies, such as task rotation and mandatory microbreaks, to mitigate neck pain risks.

In this study, alcohol consumption was significantly associated with lower back pain. This finding was supported by studies conducted in Ethiopia, Kuwait, Ghana, and India (Abledu & Abledu, 2012; Akrouf et al., 2010; Etana et al., 2021; Moom et al., 2015). Observational studies have also reported that alcohol consumption appears to be associated with complex and chronic lower back pain (Ferreira et al., 2013). Alcohol consumption may lead to nutritional deficiencies, such as reduced calcium and vitamin D absorption, which are essential for bone strength and spinal integrity (Yeum et al., 2025). Furthermore, alcohol is known to disrupt sleep quality, which plays a crucial role in muscle recovery and spinal health. Poor sleep patterns due to alcohol use can lead to increased tension and stiffness, worsening spinal discomfort (Park et al., 2015). While this association does not necessarily imply causation, the findings suggest that reducing alcohol consumption may play a role in preventing or managing spinal pain. Further investigation into the frequency, quantity, and type of alcohol consumed could provide deeper insights into the extent of its impact on spinal health.

Bankers who had ≥ 5 years of working experience more likely to have lower pain than those who had <5 years of working experience. This finding was consistent with the study done in Jimma, Ethiopia (Etana et al., 2021). This association suggests that prolonged engagement in banking work environments exposes employees to risk factors that contribute to musculoskeletal disorders, particularly affecting the spine and posture (Demissie et al., 2024; Motamedzadeh et al., 2021). Bank employees with extensive work experience may suffer from spinal pain as a result of poor posture, improper chair ergonomics, and repetitive tasks, with age also being a factor in back pain. This might be because cashiers have less responsibility than other staff, which in turn puts them under stress (Tosunoz & Oztunc, 2020). Implementing adjustable furniture, posture training, and movement breaks can help mitigate these issues, promoting spinal health and overall wellbeing for long-term employees.

Additionally, participants with frequent high workload were more likely to experience lower back pain compared to those with less frequent workload. This aligns with findings from multiple occupational health studies, which underscore the biomechanical stress and repetitive strain linked to physically demanding tasks (Heneweer et al., 2011). Moreover, other studies emphasized that high workload is a consistent risk factor across diverse occupational settings (da Costa & Vieira, 2010). These findings underline the importance of ergonomic interventions and workload balancing strategies in preventing lower back pain, especially in resource-constrained environments where preventive infrastructure may be limited.

This study found that managers were found to have greater odds of experiencing lower and upper back pain compared to employees in other job categories. This finding is consistent with study conducted in Hawassa, Ethiopia (Jonga et al., 2024). This finding may reflect demands associated with managerial responsibilities, such as prolonged desk work, increased decision-making pressure, and reduced opportunities for physical movement during work hours (Bontrup et al., 2019). Further investigation is warranted to explore workplace dynamics and preventive strategies tailored to higher-risk occupational groups.

Strengths and Limitations

This study offers valuable insights into public health by examining spinal pain among bank workers in a consistent work environment. Its strength lies in sampling from both private and government banks, enhancing relevance and comparability. However, the reliance on self-reported data may introduce bias, and the lack of standardized pain intensity measures limits depth. Future research should use longitudinal designs to explore causality and broaden applicability across occupations.

Implications for the Practice

The findings of this study carry important implications for nursing practice and occupational health policy within the banking sector of Eastern Ethiopia. By identifying the prevalence and associated factors of spinal pain among bank employees, this research underscores the urgent need for targeted interventions that promote musculoskeletal wellbeing and prevent productivity loss. Organizational policies should support ergonomic workstation modifications, gender-sensitive stress management, workload regulation, and integration of health education on behavioral factors. Nurses in occupational health roles need to deliver health education, develop wellness programs, and implement regular screening programs to enhance preventive care, early detection, and improve long-term workforce resilience. Additionally, this finding emphasizes the role of nurses in conducting ergonomic assessments and contributing to policy development that prioritizes employee wellbeing.

Conclusion

This study revealed a high prevalence of spinal pain among bank workers, with over 72% reporting pain in at least one spinal region within the past 12 months. The most commonly affected areas were the lower back, followed by the neck and upper back. Neck pain was significantly linked to female gender, job-related stress, and frequent high workload. Lower back pain is associated with alcohol consumption, longer service duration, managerial roles, customer service positions, and high workload frequency. Upper back pain was independently predicted by managerial job designation, reinforcing the elevated risk among leadership roles. These findings highlight the urgent need for tailored workplace interventions, including ergonomic improvements, workload management, stress reduction programs, and health promotion strategies, including lifestyle modifications and mental health support, to effectively mitigate risks and enhance occupational wellbeing in financial institutions.