Low back pain and some correlates among taxi drivers in Khartoum State, Sudan: a cross-sectional study

Abstract

Background

One of the most common causes of disability and inability to work is low back pain (LBP). Owing to a number of physical and occupational factors, taxi drivers are particularly susceptible to low back pain or discomfort. There is a lack of knowledge on the problems of the LBP among taxi drivers in Sudan. The aim of this work was to study the frequency of LBP among taxi drivers in Khartoum State and to determine the risk factors associated with this problem.

Methods

An analytical cross-sectional study was conducted among 242 taxi drivers in Khartoum State via a pretested and validated questionnaire. The data were analyzed via SPSS Version 24, and multivariate logistic regression analysis was performed to identify factors associated with LBP.

Results

The prevalence of LBP among the studied drivers was 62.8%. The use of lumbar support, taking breaks while driving and job satisfaction were significantly linked to a lower occurrence of LBP. On the other hand, driving hours ≥ 8 h, job-related stress and having other jobs requiring prolonged sitting were significantly associated with LBP.

Conclusions

A high prevalence of LBP among the studied taxi drivers was reported. Modification of ergonomic and occupational risk factors among taxi drivers is recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-25110-z.

Background

LBP is considered a vital cause of disability and work absenteeism [1]. LBP is characterized by pain and discomfort above the inferior gluteal folds (lumbar spine) and below the costal border; it may be linked to leg pain [2].

It is the most commonly reported musculoskeletal problem among those between 30 and 50 years of age [3]. Previous studies conducted in Canada and the USA revealed that low back pain is approximately two times more common among professional drivers than among the general population [4].

Prolonged sitting, exposure to vibration, and psychosocial factors are among the occupational risk factors for LBP among drivers, in addition to some nonoccupational factors, such as smoking, obesity, and a family history of musculoskeletal disorders, whereas the use of lumbar support and a backrest has been found to decrease the risk of LBP [5]. Taxi drivers are at greater risk for developing low back pain than other professional drivers are because they spend more time driving [4]. The frequency of LBP among drivers varies between 34.3% and 78% across different regions of the world [6]. In addition to placing a heavy financial burden on people, families, and communities, LBP has a major financial impact on healthcare systems in many nations. It is estimated that the annual expense of this condition in the United States is $100 billion [7, 8].

A study conducted in Gondar, Ethiopia, reported an 86% annual prevalence rate of LBP among taxi drivers [9]. In Yaoundé (Cameroon), musculoskeletal disorders involving the lower back affected 86.8% of drivers [10]. These findings highlight the global and regional burdens of LBP among commercial drivers and underscore the need for more context-specific research in underrepresented regions such as Sudan.

As part of development and urbanization, taxis have become a main and important method of transportation [11]. Taxi driven by organized companies have been introduced in Sudan in the last few years and have found acceptance in different sectors of the community as a source of increasing income or even as a main source of income. Poor economic status and poor traffic conditions in Sudan may increase the risk among drivers.

Many studies have been conducted to assess the LBP among taxi drivers worldwide, but fewer studies have been conducted in Africa [6]. However, no published studies have been conducted on this problem in Sudan. Thus, the aim of this work was to study the frequency of low back pain among taxi drivers in Khartoum, Sudan, and to determine the risk factors associated with this problem.

Methods

Study design and study area

This was an analytical cross-sectional facility-based study conducted from the 1 st of January 2022 to the 31 st of December 2022 in Khartoum State; it is the capital of Sudan, with an estimated total population of 7,351,331 in 2022.

Throughout the study period, each participant was interviewed just once. Owing to logistical limitations and the mobile nature of taxi drivers, which prevented simultaneous access, the data gathering window was extended to one year. Sudan’s political climate was unstable during that time, which had an impact on the research period as well.

Study population

All taxi drivers registered at Tirhal Taxi Company in Khartoum who had no history of back trauma composed the study population. However, those with prior episodes of nonspecific low back pain (LBP) were eligible to participate.

Tirhal Taxi Company was selected because it is the largest, most organized, and most accessible provider of taxi services in Khartoum State. Furthermore, it was the only company with whom we were able to contact the management committee and obtain approval to proceed in this study.

Sample size

The sample size was calculated via the Epi-Info7 program on the basis of the prevalence of LBP among taxi drivers in a study carried out in Egypt (73.9%), with a 95% confidence interval and assuming a target population of 1,000 active and reachable Tirhal drivers in Khartoum State [12]. The minimal estimated sample size was 229; it was increased to 242 to take into consideration the nonresponse rate.

Sampling technique

The participants in this study were taxi drivers who came to Tirhal Company’s offices during the sample collection period. All three offices of the company in the state were covered. According to the office load, samples were taken as follows: 142 participants from the Khartoum locality office, 50 participants from the Bahri locality office and 50 participants from the Um Durman locality office. In this study, a convenience sampling technique was used.

Data collection tool

After the relevant literature was examined, a questionnaire that interviewers used was constructed and expertly translated into Arabic. To assess the acceptability and clarity of the questions as well as the time required to complete them, the questionnaire was piloted with 20 drivers from the target group who were not included in the study sample. It was then adjusted accordingly. Cronbach’s alpha was used for the reliability test. The internal consistency questionnaire reliability was 0.82. The questionnaire was divided into 3 sections.

The first section included demographic characteristics of the study sample (age, weight, height, educational level, etc.) and lifestyle information (smoking, exercise and sleeping hours). The second section included the occupational and ergonomic factors of the research subjects (years of involvement in driving, driving hours per day, previous driving experience other than taxis, lumbar support usage, luggage carrying and lifting at work, job satisfaction, job-related stress, etc.). The third section included questions concerning the presence of LBP, its severity, the influence of driving on LBP, health care utilization and the absence of work due to LBP (see supplementary data).

Operational definitions

• Low back pain (LBP): Pain or discomfort that lasted one day or more during the previous 12 months in the low back region between the twelfth rib and the gluteal folds, with or without radiating pain in one or both legs [2].

• Physical exercise was defined as follows: at least two days of physical activity, including walking, running, bicycling, and stretching, for thirty minutes [13].

• Rest breaks between driving: after driving for an hour or longer, if a driver takes a break but does not include a meal rest [14].

• Luggage carrying and lifting at work: Carrying or lifting objects weighing 25 kg or more every day or every other day [15].

• Job-related stress is a self-reported feeling of physical or emotional strain resulting from prolonged working hours, traffic congestion, financial pressure, or difficult interactions with passengers [16, 17].

Data analysis

The Package for Social Sciences (IBM-SPSS), version 24 (May 2016); IBM- Chicago, USA, was used for statistical data analysis. Numbers, percentages, means, and standard deviations (SDs) were used to express the data. The descriptive values for quantitative data were the means and standard deviations. Group proportions were compared via the chi-square test, and the Mann‒Whitney U test was used for continuous variables that were not normally distributed.

Multivariate logistic regression analysis was performed to identify factors associated with LBP. The associations were described via odds ratios with 95% confidence intervals. The reported odds ratios (ORs) are adjusted odds ratios (AORs), as the model included multiple relevant covariates to control for potential confounding. Although convenience sampling was used, logistic regression was applied to examine associations within the study population. A P value was considered significant if it was ≤ 0.05.

Ethical considerations

The study was approved by the ethical committee at Khartoum University, Faculty of Medicine (ID number: COMMED 2022-93-14), in compliance with the Helsinki Declaration. Following an explanation of the study’s purpose and nature, all the participants provided signed informed consent. The participants were recognized by codes, names were not written on the questionnaire, and confidentiality was assured.

Results

Table 1 shows the personal and behavioral characteristics of the taxi drivers who participated in this study. The ages ranged from 18 to 73 years, with a mean of 37.76 ± 11.68 years. Half of them (50%) were in the age category (26–40). The percentage of those who had a university degree was 81.8%. More than half of them (56.2%) were nonsmokers. With respect to their sleeping hours, more than two-thirds of them (70.7%) reported that they slept between 6 and 8 h, and a minority of them (6.6%) slept more than 8 h.

Table 1.

Demographic and behavioral characteristics of the studied taxi drivers in Khartoum

	No. (n = 242)	%
Age categories
≤ 25	38	15.7
26–40	121	50.0
> 40	83	34.3
Mean ± SD (range): 37.76 ± 11.68 (18–73)
Educational level
Secondary	44	18.2
University and higher	198	81.8
Doing physical exercise	52.0	21.5
Smoking
Yes	61	25.2
Ex smoker	45	18.6
No	136	56.2
Sleeping hours
Less than 6 h	55	22.7
6–8 h	171	70.7
More than 8 h	16	6.6

Table 2 shows that more than two-thirds of the study participants (68.2%) had been working as taxi drivers for ≥ 5 years, with a mean of 9.64 years, and approximately one-third of them (34.7%) drove between 8 and 12 h per day. With respect to the use of lumber support while driving, a minority (8%) used it, and nearly one-fifth of them (20.7%) reported wearing seat belts while driving. The frequent sitting posture adopted while driving was straight for 130 (53.7%) and slouched for 112 (46.3%). Lifting and carrying luggage while working was mentioned by 25.6% of the respondents. Nearly half of the participants (43.8%) had previous driving experience other than taxi driving, and 79.8% of them were taking breaks while driving. Half of them (51.2%) were satisfied with their job, one third (33.5%) had other jobs that required prolonged sitting, and more than one half (63.2%) expressed job-related stress.

Table 2.

Job characteristics of taxi drivers in Khartoum

	No. (n = 242)	%
Years of driving
< 5	77	31.8
≥ 5	165	68.2
Mean ± SD (range): 9.64 ± 8.174(1–48)
Daily driving hours
less than 8 h	144	59.5
8–12 h	84	34.7
more than 12 h	14	5.8
Using of lumbar support	19	8
Wearing seat belt during driving	50	20.7
Frequent sitting posture adopted while driving
Straight	130	53.7
Slouched	112	46.3
Luggage carrying and lifting
Luggage carrying and lifting at work	62	25.6
Previous driving experience other than taxi	106	43.8
Break during driving hours	193	79.8
Taxi owner ship	211	87.2
Job satisfaction	124	51.2
Job related stress	153	63.2
Other jobs require prolong sitting	81	33.5

Table 3 shows that more than half of the study participants (62.8%) complained of low back pain or discomfort, and more than two-thirds (69.7%) stated that their pain was aggravated by driving. Health care utilization and absence from work due to low back pain were reported in 15.8% and 21.7% of the participants, respectively.

Table 3.

Prevalence and characteristics of low back pain among taxi drivers in Khartoum

	No. (n = 242)	%
Presence of low back pain or discomfort	152	62.8
Influence of driving on LBP
No change	46	30.3
Aggravate	106	69.7
Health care utilization due to low back pain	24	15.8
Absent from work due to low back pain	33	21.7

Table 4 shows that LBP was significantly more common among those who drove more than 12 h per day, carried and lifted luggage at work, and suffered from job-related stress and among those who had other jobs that required prolonged sitting, with percentages of 7.2%, 29.6%, 75% and 37.5%, respectively. On the other hand, using lumbar support, taking breaks while driving and job satisfaction were significantly associated with a lower occurrence of LBP.

Table 4.

Demographic and job factors related to low back pain among taxi drivers in Khartoum

	Presence of LBP N = 152	Absence of LBP N = 90	P- value
Age categories
≤ 25	27(17.8%)	11(12.2%)	0.364
26–40	77(50.7%)	44(48.9%)
> 40	48(31.6%)	35(38.9%)
Educational level
Secondary	28(18.4%)	16(17.8%)	0.522
University and higher	124(81.6%)	74(82.2%)
Physical exercise	29(19.1%)	23(25.6%)	0.153
Smoking
Yes	38(25.0%)	23(25.6%)	0.836
Ex smoker	30(19.7%)	15(16.7%)
No	84(55.3%)	52(57.8%)
Sleeping hours
Less than 6 h	36(23.7%)	19(21.1%)	0.759
6–8 h	105(69.1%)	66(73.3%)
More than 8 h	11(7.2%)	5(5.6%)
Years of driving
< 5	45(29.6%)	32(35.6%)	0.206
≥ 5	107(70.4%)	58(64.4%)
Median (IQR)	7(9)	7(12)	0.978≠
Daily driving hours
less than 8 h	81(53.3%)	62(68.9%)
8–12 h	60(39.5%)	24(26.7%)	0.05*
more than 12 h	11(7.2%)	4(4.4%)
Using of lumbar support
Yes	8(5.3%)	11(12.2%)	0.04*
No	144(94.7%)	79(87.8%)
Wearing seat belt	31(20.4%)	19(21.1%)	0.509
Frequent sitting posture adopted while driving
Straight	80(52.6%)	50(55.6%)	0.380
Slouched	72(47.4%)	40(44.4%)
Luggage carrying and lifting at work	45(29.6%)	17(18.9%)	0.04*
Previous driving experience	64(42.1%)	42(46.7%)	0.288
Break during driving hours	116(76.3%)	77(85.6%)	0.05*
Taxi owner ship	129(84.9%)	82(91.1%)	0.113
Job satisfaction	70(46.1%)	54(60.0%)	0.02*
Job related stress	114(75.0%)	39(43.3%)	0.0001*
Other jobs require prolong sitting	57(37.5%)	24(26.7%)	0.05*

* Statistically significant difference #Mann-Whitney U test was used, and in other variables, the chi squared test was used

Table 5 shows the results of the multivariable logistic regression for predictors of LBP. The following factors were significantly linked to the occurrence of LBP among the studied participants: driving hours from 8 to 12 h had an approximately 1.9 times greater risk of developing LBP than did driving hours less than 8 h (AOR = 1.9) (C.I.= 1.023–3.597), job-related stress had 3.7 times greater odds of developing LBP (AOR = 3.7) (C.I.= 2.002–6.883), and drivers who had other jobs that required prolonged sitting were 2 times at greater risk of developing this pain (AOR = 2.016) (C.I.= 1.077–3.775).

Table 5.

Multivariable logistic regression showing aors for predictors of low back pain

	B	S.E.	Wald	df	Sig.	AOR	95.0% C.I.for EXP(B)
							Lower	Upper
Luggage carrying and lifting at work (reference group; No)	0.462	0.349	1.757	1	0.185	1.587	0.802	3.144
Take a rest between driving (reference group; Yes)	− 0.490-	0.384	1.633	1	0.201	1.633	0.770	3.464
Average daily driving hours (reference group; < 8 h)  • 8–12 h  • more than 12 h	0.652 0.397	0.321 0.660	4.193 4.127 0.361	2 1 1	0.123 0.042* 0.548	1.918 1.487	1.023 0.407	3.597 5.426
Job satisfaction (reference group; Yes)	− 0.087-	0.312	0.077	1	0.782	1.090	0.591	2.011
Job related stress (reference group; No)	1.312	0.315	17.325	1	0.0001*	3.712	2.002	6.883
Other jobs require prolong sitting(reference group; No)	0.701	0.320	4.806	1	0.028*	2.016	1.077	3.775
Constant	− 0.965-	0.303	10.124	1	0.001	0.381

AOR Adjusted Odds Ratio, CI Confidence Interval

*Statistically significant at p < 0.05

Discussion

The purpose of this research was to determine the prevalence of LBP and its contributing factors among taxi drivers in Khartoum State, Sudan. The results revealed a high 12-month prevalence of low back pain or discomfort (62.8%) among the 242 studied taxi drivers.

The prevalence of LBP in our study (62.8%) is consistent with findings reported in other African and Asian settings. Studies conducted in Saudi Arabia [18], Nigeria [19] and Addis Ababa, Ethiopia [6], reported prevalence rates of 60.7%, 70.4% and 64.2%, respectively, and identified similar risk factors, such as long working hours, inadequate lumbar support, and occupational stress. These similarities suggest that despite differences in geography, socioeconomic context, and health systems, occupational exposure and ergonomic risk remain key contributors to LBP among drivers in developing countries.

However, the prevalence in the present study was higher than that reported in studies conducted in Iran (24.3%) [20], Malaysia (48.5%) [3], Turkey (49.7%) [21], Taiwan (51%) [4], Ghana (34.3%) [22], and China (54%) [11]. Conversely, recent research revealed a lower prevalence of LBP than that reported in studies conducted in Gondar city, Ethiopia (85.7%) [9], Nigeria (73.5%) [23] and Egypt (73.9%) [12]. Differences in the research population, sample size, inclusion criteria, and study area could all contribute to this discrepancy in prevalence. Since persons with a history of back trauma are at risk of developing LBP, the high prevalence among Egyptian taxi drivers may be explained by their inclusion.

This study revealed that the use of seats without lumbar support while driving, daily driving hours, and employment in other occupations involving extended sitting were significant predictors of LBP in taxi drivers. However, among the studied sample, there was no significant correlation between the number of years spent working while driving and the incidence of LBP. Unlike the current study, a systematic review conducted by Pickard et al. (2022) [24] revealed that longevity in a driving occupation is a contributing factor to LBP, and the risk increases as the number of working years increases.

The present findings are in accordance with those of Wang et al. (2017) [9, 11], Abledu et al. (2014) [22] and Chen et al. (2005) [4], who reported that the odds of developing LBP were 3.3 times, 1.7 times, and 1.78 times greater, respectively, for taxi drivers who worked longer hours each day. Additionally, the results of this study are also in line with those of Wanamo et al. (2017) [6] and Alperovitch-Najenson et al. (2010), who reported that prolonged sitting while driving was significantly associated with a greater occurrence of LBP [25].

Sitting alone did not increase the risk of LBP. However, a long duration of sitting during workdays, especially when combined with other risk factors such as whole-body vibration and/or uncomfortable postures, increases the risk of developing LBP [26].

Long periods of time spent behind the wheel are linked to aberrant load on the neuromuscular system and muscle exhaustion, both of which contribute to LBP [24, 27].

The present study revealed that the use of lumbar support was significantly associated with a lower occurrence of LBP, which is in agreement with the findings of a cross-sectional study conducted among male taxi drivers in Mekelle city, Tigray, Ethiopia, which reported that average daily driving hours and lumbar support usage were significant predictors of LBP among taxi drivers [2]. This result is also consistent with Abere et al.’s (2023) community-based study of taxi drivers in Gondar city, which revealed that low back pain was more common among those who worked longer hours per day (AOR = 2.64; 95% CI (1.02–6.08)) and did not use adjustable seats with back support (AOR = 6.38, 95% CI (2.39–17.01)) [9]. This is because stress caused by uncomfortable sitting behind the wheel for extended periods of time without lumber or back support results in musculoskeletal problems [25, 28].

The importance of adjusting the car seat is emphasized by maintaining the “S” shape of the spine while sitting and being careful not to sit too high or too low from the steering wheel with the shoulders back and the back of the head resting on the headrest with the chin level [29].

Stress at work was a significant predictor of LBP in this study, whereas job satisfaction was significantly linked to a decreased incidence of LBP. Among taxi drivers who reported feeling stressed during workdays, the risk of having low back pain (LBP) was 3.7 times greater than that of taxi drivers who did not. Research from Taiwan [4], Turkey [21], and Ghana [22] confirmed this conclusion.

One possible explanation is that mental strain or stress is linked to a decrease in blood flow to the body’s soft tissues in the back. This leads to the buildup of waste products in the muscles because there is not enough oxygen reaching all of the tissues. High levels of stress are also linked to sympathetic nervous system stimulation, which causes the release of stress mediators that can put strain on the musculoskeletal system and cause LBP [30]. Dissatisfied employees are also more likely to experience stress, which leads to increased muscle tension and, in turn, is positively connected with lumbar spine complaints. However, satisfied drivers are better able to control imbalance and manage job demands, which lowers the risk of LBPs [31].

The significant association found between job stress and LBP in our study is also supported by findings from Bangladesh and Cameroon, where psychosocial factors such as dissatisfaction and work-related fatigue were linked to musculoskeletal complaints [10, 32].

This result was also in agreement with Abere et al.’s (2023) study, which revealed that dissatisfied taxi drivers had greater odds of having LBP than did those who were happy with their jobs did (AOR = 4.58, 95% CI (1.39–15.2)) [9], and Chen et al. (2005) reported that a high frequency of LBP among taxi drivers was linked to both job dissatisfaction and self-perceived job stress [4].

Additionally, Yosef et al. (2019) reported a significant relationship between perceived job stress and LBP occurrence among studied truck drivers [14]. In contrast, Hakim and Mohsen (2017) reported an insignificant association between work satisfaction and the occurrence of LBP [12].

The present study revealed that taking breaks during driving hours was associated with a low occurrence of LBP among the studied taxi drivers, which is consistent with the findings of a similar study conducted in Jeddah, Saudi Arabia [18]. This result is also consistent with the findings of Miyamoto et al. (2008) and another Ethiopian cross-sectional study conducted in Addis Ababa (2017), which reported that the occurrence of LBP among taxi drivers was related to poor lifestyles, such as a lack of time to relax and a lack of exercise [1, 6].

In this study, a higher frequency of lower back pain (LBP) was observed in workers who lifted luggage or other items during working hours. The fact that taxi drivers are confined to the driver’s seat for the majority of the day may be one factor, as this limits muscle relaxation. Muscle injuries in the lower back can occur when heavy lifting is performed without muscle relaxation [6]. This finding matches those of previous studies conducted in Turkey [21] and Ethiopia [14].

Conclusions and recommendations

In this study, the frequency of LBP among taxi drivers was 62.8%. Driving ≥ 8 h daily, sitting on chairs without lumbar support, stress during work and having other jobs requiring prolonged sitting were significantly associated with LBP. Appropriate organizational strategies and health programs can alter ergonomic and occupational risk factors linked to LBP.

Strengths and limitations

This is the first study on this problem in Khartoum State, Sudan. There are several limitations to this study. First, the convenience-based nonprobability method used to collect the sample may prevent representation of all classes and limit its generalizability. Second, although multivariable logistic regression was applied to adjust for confounding among measured variables, we acknowledge the possibility of residual confounding from unmeasured factors such as physical fitness, associated comorbidities, or ergonomic knowledge. Finally, comparisons with local studies among taxi drivers are lacking due to the absence of published papers regarding this problem in Sudan, which was mitigated by referencing studies from similar socioeconomic contexts in other low- and middle-income countries.

Abbreviations

LBP

Low back pain

IBM-SPSS

Statistical Package for Social Sciences

SDs

Standard deviations

ORs

Odds ratios

AOR

Adjusted odds ratio

IQR

Interquartile range

Authors’ contributions

ES was involved in conceptualization, study design, data gathering, and manuscript drafting. HE participated in the interpretation of the data and manuscript drafting.SAE contributed to the data analysis and interpretation, manuscript writing and critical revision. The final manuscript was read and approved by all of the authors.

Funding

There was no funding for this study from any source.

Data availability

Upon reasonable request, the corresponding author can provide the datasets used and/or analyzed in the current study.

Declarations

Ethics approval and consent to participate

The study was approved by the ethical committee at Khartoum University, Faculty of Medicine (ID number: COMMED 2022-93-14), in compliance with the Helsinki Declaration. Following an explanation of the study’s purpose and nature, informed written consent was obtained from all the participants in the study. The questionnaire did not include names, participants were recognized only by codes, and confidentiality was assured.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.