Work-related musculoskeletal disorders (WRMSDs) are:

They may be associated with daily working hours, work experience, workstation postures or personal factors such as age, gender, and medical history (Koiri 2020; Muhamad Ramdan, Candra & Rahma Fitri 2020; Nag, Vyas & Nag 2010; SPF-EMPLOI 2013). A report by the International Labour Organisation (ILO) ranked WRMSDs as the leading cause of absenteeism in the workplace among work-related illnesses with over 160 million people affected per year (ILO 2013). The prevalence of WRMSDs varies among countries and sectors; workers of the informal sector appear to be more exposed than those of the formal sector (Durlov et al. 2014; Siddiqui et al. 2021). In low-income countries, musculoskeletal disorders are a major health issue, because of their high prevalence among workers and on account of the scarcity or absence of ergonomic prevention measures in the workplace (Durlov et al. 2014).

Weaving is a widespread occupation in several low-income countries, such as India, Bangladesh, Indonesia, and Burkina Faso (BRMN 2018; Muhamad Ramdan et al. 2020; Rahman et al. 2017; Siddiqui et al. 2021). Burkina Faso is a leading cotton producer in Africa and this sector is one of the country’s primary resources (FAO/EST 2022). Hand looming is an independent activity, part of the informal sector, and more than 20 500 Burkinabe women were involved in cotton processing through weaving in 2004 (BRMN 2018).

Weaving activity is divided into three phases: preparation of the yarn or warping, dyeing, and weaving. The preparation of the yarn can be done either by walking and unwinding the yarn around pegs planted in the ground or by staying on the spot and unwinding the yarn around a wooden spinning top. For dyeing, the threads are first soaked in basins containing hot water mixed with toxic chemical dyes. Thereafter, the threads are removed from the mixture, rinsed, and spread out to dry. Weaving is the longest lasting activity; it is carried out in a seated position with alternating and rhythmic movements of the limbs: the lower limbs operate the two pedals of the loom and the upper limbs pass the shuttle through a space created by the heddles as a result of the action of the pedals.

In Asia, weaving is considered as one of the most strenuous and demanding occupations and a high-risk for the development of musculoskeletal disorders. Artisan weavers demonstrate a high prevalence of WRMSDs in all parts of the body and the lower back is among the areas most affected (Durlov et al. 2014; Muhamad Ramdan et al. 2020; Rahman et al. 2017).

In Burkina Faso, the consequences of weaving on the musculoskeletal health of weavers are still poorly understood because of the lack of research on the issue and that weaving is undertaken in the informal work sector. A recent study carried out among weavers in Burkina Faso showed a high prevalence of WRMSDs; however, the issues of the consequences of WRMSDs and the physical and environmental risk factors involved were not investigated (Sawadogo et al. 2020).

Firstly, our study aimed to assess the prevalence of WRMSDs among weavers and their consequences on work, and secondly, to highlight physical risk factors and environmental constraints.

Our descriptive cross-sectional study was conducted from June 2020 to October 2020, following the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines (Von Elm et al. 2008). Purposive sampling was used to select the participants based on geographical distribution.

Our study was carried out among 247 handloom weavers at their workplace in the Ouagadougou area (Burkina Faso) (Figure 1). Participants were female, using horizontal pedal looms, and having at least 1 year of practice in the profession.

The objectives of our study were to assess the prevalence of WRMSDs and their consequences and to analyse in parallel the associated occupational risk factors.

Eighty-five percent of the weavers declared WRMSDs during the last 12 months, particularly in the low back region (71%). These results are comparable to the ones evidenced by a recent study carried out among Burkina Faso weavers showing an annual prevalence of 98% with a prevalence of 77% for the low back region (Sawadogo et al. 2020). Similar prevalences are also reported for carpet weavers in India 68% (Durlov et al. 2014), 79% (Pavana & Mica 2021), 67% (Naz, Kwatra & Ojha 2015), in Bangladesh 66% (Rahman et al. 2017) and in Iran 68% (Nazari et al. 2012). The prevalence of low back WRMSDs among weavers is higher than that observed in other occupations in Burkina Faso, such as nursing (57%) and physical education teachers (59%) (Nana et al. 2022; Ouédraogo et al. 2010).

Although there are differences among anatomical areas, all areas of the body are affected: the low back region firstly, the shoulder secondly, then the knee, hips and thighs and upper back (Table 2). There seems to be a consensus all around the world regarding these main affected regions (Durlov et al. 2014; Nazari et al. 2012; Sawadogo et al. 2020). This high prevalence of WRMSDs in all body areas in several countries and continents highlights that weaving is a demanding occupation exposing workers to health risk factors (Nag et al. 2010).

However, despite the high prevalence of WRMSDs, few weavers consult a health professional (Table 2). Burkina Faso is a low-income country where most workers of the informal sector are poor and cannot read or write. Indeed, the gross domestic product (GDP) per capita in Burkina Faso is less than 900 € (Euro) and 58% of women have no educational level (EDS 2021). A lack of information and/or difficulties in accessing healthcare system could explain this low attendance.

The sale of Faso Dan Fani is a source of income for the Burkinabé women, enabling them to look after their families and schooling of their children; however, more than a quarter of the weavers reduced their activities and/or interrupted their occupation because of their back pain in the year preceding the survey. As the weaving belongs mainly to the informal sector, it is difficult to precisely identify the economic consequences of work absence, but individual consequences are not negligible in terms of income and family status in a country where the status of women and poverty are challenging. Moreover, the consequences of LBP observed here could be underestimated because the answers to the questions depend on the weaver’s ability to recall what happened exactly over the past year. Indeed, the impact of LBP on the reduction of activities and work interruptions was assessed directly by answering the questions in the NQ: (1) Has low back trouble caused you to reduce your activity during the last 12 months? and (2) What is the total length of time (in days) that low back trouble has prevented you from doing your normal work (at home or away from home) during the last 12 months?

Whatever the risk of underestimating the consequences, the results show that it is necessary to implement a strategy to reduce these work interruptions and ensure good living and working conditions.

A correlation analysis was carried out to identify if there are associations between the WRMSDs prevalence and occupational risk factors such as the number of hours worked per day, working experience, and age. The 8-h working day limit imposed by the labour code in Burkina Faso is obviously not respected. Long working hours has already been acknowledged as a source of WRMSDs in the weaving occupation (Durlov et al. 2014; Rahman et al. 2017; Sawadogo et al. 2020). To help weavers avoid working long hours, they should be informed of their negative effects on health and testimonials from people who have suffered from long working hours could, for example, be included in such an approach.

An association between the WRMSD prevalence and working experience is reported (Table 3); similarly other studies show that work-related illness occurs and increases after long exposure to risks (ILO 2013; Rahman et al. 2017; Siddiqui et al. 2021; SPF-EMPLOI 2013). Hence, the interest in taking preventive measures for entry-level workers to anticipate WRMSDs.

The prevalence of low back and knees WRMSDs are associated with the age of the weavers, those who are older than 40 years are more likely to develop WRMSDs (Table 3). Age is a natural phenomenon that reduces physical capacity, muscle strength, endurance, and flexibility, but the demands of the occupation remain the same. This leads to an increased risk of WRMSDs as the demands of the occupation may exceed the physical capabilities of the worker (Chiron et al. 2008; SPF-EMPLOI 2013).

The differences in prevalence within anatomical areas (Table 2) may be explained by a difference in the exposure of these body parts to risk factors in the weaving occupation as the origin of WRMSDs is multifactorial and can come from several sources such as organisation, work techniques, and tools (Dianat & Karimi 2016; Sawadogo et al. 2020). In our study, the assessment of the prevalence of WRMSDs is accompanied by the analysis of the weaving occupation. The results of KIM indicate that the weavers are exposed to several physical and environmental risk factors (Table 4), as shown in the high prevalence of WRMSDs in Table 2. Several risk factors identified here are similar to those of Indian weavers; namely, bent back posture, limited working space, muscular strain, and repetitive limb movements (Nag et al. 2010). Such risk factors have also been identified by other authors who have used biomechanical models to demonstrate associations between low back WRMSDs and biomechanical risk factors, including back bending and twisting, load carrying, muscle fatigue, awkward postures, and frequency of movements (Afshari et al. 2014; Coenen et al. 2013, 2014). These risk factors can lead to potential health consequences such as functional disorders and/or structural damage.

Carrying of heavy loads in the dyeing activity is identified by the KIM as a risk factor (Table 4). These findings are similar to the results of the study conducted by Kadota et al. (2020) on the consequences of heavy load carrying among women in Tanzania (East Africa) showing a substantial burden of MSDs and disability in this population who carry heavy loads daily (Kadota et al. 2020). According to the National Institute for Occupational Safety and Health, there is an acceptable limit of low back compression force and this compression force depends on several factors such as the distance between load and body, the duration of the handling, the frequency of handling, and the weight of the load (NIOSH 1981). Here the weavers use a unimanual technique to carry the buckets filled with yarn and water, so splitting the load could be proposed to decrease the low back compression force (Figure 1).

The risk factor of working in a sitting position should also be considered, as a prolonged sitting position is known to increase pain in cases of LBP (De Carvalho et al. 2020). One can suggest a more comfortable working position or that weavers alternate the sitting position with stretching and/or walking breaks, as the weaving activity is performed while sitting for long hours (Table 1). Finally, the weaving activity is carried out under unfavourable environmental conditions such as heat, glare from daylight, wind, narrow space for movement, and noise (Table 4). Similar results on unfavourable working conditions have been observed in weaving workshops in Asia with an association between the thermal condition of the workshops and low back symptoms (Nazari et al. 2012). Exposure to environmental factors can aggravate, maintain or be a source of WRMSDs for workers (SPF-EMPLOI 2013).

In conclusion, preventive solutions should be implemented in the weaving sector to reduce the high prevalence of WRMSDs (Siddiqui et al. 2021) and limit the occupational risk factors, especially because the resources to manage musculoskeletal conditions are limited in Africa (Ahenkorah et al. 2019; Kaboré, Zanga & Schepens 2022). In addition, particular attention should be given to the informal sector, which is outside the systems that provide prevention, registration and compensation for occupational diseases (ILO 2013).

Work-related musculoskeletal disorders are common among weavers and LBP is the most frequently cited disorder and the primary reason for work interruptions and reduction of activities. The prevalence of WRMSDs is associated with factors such as the number of hours worked per day, the years of experience and age, but these results need to be confirmed by other studies considering possible confounding factors. Actions based on ergonomic rules are necessary to prevent WRMSDs as the weavers are exposed to several physical and environmental risk factors such as back bending or twisting, load carrying (> 20 kg – 25 kg), awkward shoulder and hand postures, repetitive movements, sitting in forced postures, long working hours, and unfavourable environmental working conditions.

It is hoped that our study will help to implement new strategies to prevent WRMSDs and improve the health status and the quality of life of weavers in Burkina Faso.