THE CORRELATION AGE, BODY MASS INDEX, WORK PERIOD AND WORK POSITION WITH MUSCULOSKELETAL DISORDERS IN WORKERS PACKING PART

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School of Health Sciences Jenderal Achmad Yani Page 330 Jenderal Sudirman Canal Road – Cimahi 40533 Phone: +62-22-6631622 - 6631624

THE CORRELATION AGE, BODY MASS INDEX, WORK PERIOD AND WORK POSITION WITH MUSCULOSKELETAL DISORDERS IN WORKERS PACKING PART

OF PT. SANBE FARMA UNIT II IN 2019

R. Setijo Widodo*, Winda Nurarinda, Novie Elvinawaty Mauliku [email protected]

Department of Public Health, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia

ABSTRACT

Background: Musculoskeletal disorders (MSDS) are the second largest contributor in the world to cause disability with a prevalence of 33%. In 2017 the prevalence of musculoskeletal disorders in Indonesia reached 37% of workers into one of the high-risk jobs. The main causes of MSDs are excessive muscle stretching, repetitive activity and unnatural work attitude, plus secondary and combination factors. Entering a chronic condition affects an individual's health, impedes work, results in disability or even death.

Objectives: The purpose of this study was to determine the correlation between age, body mass index, length of work and work position with musculoskeletal disorders in packing workers at PT. Sanbe Farma Unit II.

Methods: The research method was an analytical observational with cross sectional approach. The sample uses a total sampling of 50 workers. Data obtained through observation, interviews and measurements, using the Nordic body map (NBM) questionnaire, Rapid Upper Limb Assessment (RULA), scales, microtoice and camera. The data analysis was by univariate and bivariate analysis with Chi Square test.

Results: The results showed that age (p = 0.002), duration of work (p = 0.045) had a significant correlation with musculoskeletal disorders. While body mass index (BMI) (p = 1,000) and work position (p = 1,000) do not have a significant correlation with musculoskeletal disorders.

Conclusion: Based on the results of the study, workers are advised to maintain physical strength, with regular physical activity, maintaining an adequate diet and rest, the existence of work rotation so as to prevent the occurrence of musculoskeletal disorders

Keywords: Musculoskeletal disorders, Cross Sectional, duration of work, BMI, Work position.

INTRODUCTION

Musculoskeletal disorder is a disorder that affects the motor system due to damage to muscles, nerves, tendons, ligaments, joints, cartilages, and invertebral discs. Complaints felt from mild complaints to very fatal. Ranging from those that appear suddenly and are short- lived, such as broken bones, sprains, and strains, for chronic conditions associated with ongoing pain and disability. Disorders of damage to muscles can be in the form of tension, inflammation, and degeneration. Meanwhile, damage to the bone in the form of bruises, microfractures, broken, or twisted. In doing activities, the use of muscles that are not controlled, complaints in the form of joint damage, ligaments and tendons will be felt (Soedirman & Suma’mur, 2014).Pain in the neck, upper back, shoulders, arms or hands is a symptom that is often felt by workers. Usually starting from certain body parts that can spread to all parts of the upper body, sometimes followed by sensibility disorders. Complaints of

this disease is prolonged so that it can result in reduced skills to carry out work, decreased work productivity, waste and high absenteeism (Harrianto, 2013).

In 2016 the Global Burden of Disease study stated that musculoskeletal disorders are the second highest contributor to global disability. The prevalence of musculoskeletal conditions varies by age and diagnosis, between 20% -33% of people worldwide live with painful musculoskeletal conditions (World Health Organization, 2018). According to the Indonesian Ministry of Health (2005) 40.5% of workers in Indonesia have occupational health disorders including musculoskeletal disorders of 16% (Kementrian Kesehatan RI, 2015). In 2013, the prevalence of musculoskeletal disorders was 24.7%. In 2017 the estimated prevalence rate is 37%. The highest based on employment is fishermen, farmers, and laborers at 31.2% (Mayasari & Saftarina, 2016; Puspita, Suroto, & Kurniawan, 2017).

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Third International Seminar on Global Health (3^rd ISGH) Page 331 Vol 3 | No. 1 | October 2019 |

The causes of musculoskeletal complaints are many factors due to excessive stretching, repetitive activities, work attitudes, then secondary factors due to pressure, vibrations, and microclimates as well as combination factors such as age, sex, smoking habits, physical health, physical strength, work period and body size (Bernard, 1997; National Research Council and the Institute of Medicine, 2001).

According to the results of research conducted by Sari, et al (2017) that age is significantly related to musculoskeletal disorders in laundry workers in Yogyakarta with a p value of 0.005. In line with research Fathoni, et.al. (2009) there is a relationship between age and length of work with Low Back Pain (LBP) for nurses in Purbalingga District Hospital with a p value <0.05 (Fathoni, Handoyo, & Swasti, 2009). Based on Jalajuwita and Paskarini's (2015) research, there is a significant relationship between work positions and musculoskeletal complaints in welding workers in Bekasi (p value 0,005) (Jalajuwita &

Paskarini, 2015).

PT Sanbe Farma Unit II is a company that is engaged in providing medicine. The Worker was work 8 hours a day and doing repeatedly such as transports, arranging medicine bottles, installing drug labels, installing stickers, weighing drugs and putting ready-made drugs in the packaging into the master box. The position of the workers is different, there are those who just sit and stand. Based on observation, found that 6 workers experienced stiff complaints after work. Complaints are felt in the neck, shoulders, waist and legs.The purpose of this study was to determine the correlation between age, body mass index, length of work, and work position with musculoskeletal disorders in packing workers at PT. Sanbe Farma Unit II.

METHODS

Study design: The design of this research used analytical survey with cross sectional study (Sastroasmoro, 2014).

Samples: The populations of this study were a worker in PT Sanbe Farma Unit II with a total 50 employees. The samples were total sampling.

Instrument: The instrument was used in this research is a questionaire of Nordis Body Maps (NBM) and Rapd Upper Limb Assessment (RULA) for the position of work, while body mass index was measured using microtoice.

Data collection procedures: Data was collected by interview, observation and measuring.

Statistical analysis

All data were analysis using the person Chi- square test to know the relationship categorical characteristic variables between the exposed and the non-exposed groups. The risks of having different respiratory symptoms lung among workers were measured as relative risks (RR) with 95%

confidence intervals (p≤0. 05).

RESULTS

This research was conducted on workers in PT.

Sanbe Farma Unit II by 50 participants. The result of data analysis shows that more than 70%

participants has low symptoms of MSDs, more than 60% was aged <35 years old, most of body mass index not normal, and has 80% work more than 8 hours with 80% has risk position while work (Table 1).

Table 1 Distribution of risk factors of the musculoskeletal disorder

Variable Frequency Persentage (%) Musculoskeletal

disorder High Low

14 36

28 72

Age years

Risk (>35 years old) No Risk (<35 years old)

31 19

62 38 Nutrition status

Malnutrition/Obesities Normal

28 22

56 44 Length of work

Long (> 5 years) New (< 5 years)

40 10

80 20 Position of work

Risk No risk

39 11

78 22

* n = 50

Based on the bivariate analysis statistical test with person chi square between the risk factor and MSDs showed that age was significant correlated with the MSDs (p Value 0.002), same as a length of work (p Value 0.045). While the nutrition status and position of work showed do not have relation of the MSDs (p Value > 0.05).

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Table 2 Correlation between the risk factor with the musculusceletal disorder on the worker in PT Sanbe Farma Unit II

Variabel Musculusceletal disorder SUM pValue

Risk No Risk

Age years

Risk (>35 years old) No Risk (<35 years old)

14 (45.2%) 0 (0%)

17 (54.8%) 19 (100%)

31 (100%) 19 (100%)

0.002 Nutrition status

Malnutrition/Obesities Normal

8 (28.6%) 6 (27.3%)

20 (71.4%) 16 (72.7%)

28 (100%) 22 (100%)

1.000 Length of work

Long (> 5 years) New (< 5 years)

14 (35%) 0 (0%)

26 (65%) 10 (100%)

40 (100%) 10 (100%)

0.045 Position of work

Risk No risk

11 (28.2%) 3 (27.3%)

28 (71.8%) 8 (2.7%)

39 (100%) 11 (100%)

1.000

DISCUSSION

The results of this study identified Work positions based on RULA scores between 3-7 (moderate to very high) are at risk for experiencing MSDs, although complaints that arise are relatively low. Almost all participant stated complaints on all parts of the body, with the most complaints being on the waist, back, neck, buttocks, and batches. Age range of participants mostly at risk and is related to their years of service. The average age of the worker is 36 years old and has worked since the age of 20 years. Based on body mass index, almost 30 participant have abnormal body mass index, which is in the range of 16.4-36.4 with an average of 25.7 (light fat level), and most of the workers are women who have more body fat than men (Supariasa, Bakri,

& Fajar, 2014). The body mass is a factor that can cause it to occur musculoskeletal complaints.

Where obese women have a higher risk than thin women (Tarwaka, 2015). The working period of workers has an average of 14 years. Workers with long years of work are considered to have experience in the field of work physically and psychologically, so that the work will be easier to complete the work and reduce skeletal muscle complaints due to work processes.

Aging and length of work was a variable that influence the musculoskeletal disorder of the participants PT Sanbe Farma Unit II. Most of the workers PT Sanbe Farma Unit II are over 35 years old. The first complaint of musculoskeletal has been felt when someone enters the age of 35 years and continues to increase with age. Increased age will cause a decrease in physical strength and organs.

This is caused by tissue damage, replacement of competition into scar tissue and reduction in fluid which causes stability in bone and muscle movement (Bridger, 2003). When the body

becomes old, the diameter of musculoskeletal going smaller and its elasticity will decrease (Balaban &

Bobick, 2014). Aging also results in a slow decline in metabolic rate, strength and muscle mass, especially in women but muscles can still be trained even into old age (Saputra, 2014).

The results of this study are in line with Sari research (2017) that age is associated with musculoskeletal disorders in laundry workers with a p value < 0.005. In addition, the work is done using high muscle strength and repetitive movements (Sari, 2017). Same as the research from Prawira (2017) that there is a relationship between age and musculoskeletal complaints (pvalue = 0.016) in students in Bali who are mostly complaints are felt in the back and waist because of must sit for 5-6 hours a day (Prawira, 2017). Long working period will cause someone to experience burnout due to repetitive work. Helmina research (2019) showed that there is a relationship between work period with musculoskeletal disorder in nurses (p Value = 0.014) (Helmina, Diani, & Hanifah, 2019). Same as Tjahayuningtyas research (2019) work period has a relationship with Musculoskeletal disorder (p = 0.019). This happens because workers do repetitive work and take place every day, because the longer work period the more often exposed to risk factors which are also influenced by age (Tjahayuningtyas, 2019).

The statistical test results of body mass index and work position obtained p Value = 1,000 (p> α) so that there is no significant relationship between body mass index and work position with musculoskeletal disorder. Body mass index of packing section workers at PT. Sanbe Farma Unit II varies from thin to fat. Of the 50 participant, 9 men have a working part as a machine operator, quality control (QC) and transport, have low

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musculoskeletal disorders, this is due to the fact that most male workers have normal body mass index, so when working no excessive pressure occurs on the body even in a static position. While 41 female workers were divided into admin, coding, quality control (QC), weighing and packaging workers, having an average body mass index is not normal but the incidence of Musculoskeletal disorders is in the low category. This can occur due to activity during the dominant work process of sitting and active upper extremities, so there is no excessive pressure on the body especially lower extremities, where for obese people it will be difficult to survive in a standing position because they have to hold their weight.

Body mass index with musculoskeletal disorders can be caused by other factors such as bone strength, workload and the use of rest time for relaxation by eating, drinking, praying and doing massages that can reduce muscle complaints (Suma’mur, 2014). According to Davies (2010) rest the sick, drink water, and massage will stimulate circulation and encourage the removal of lactic acid, so that complaints will be reduced (Davies, 2010).

In line with Hadyan's study (2017) there was no relationship between body mass index and LBP (p

= 0.748). Several mechanisms explain as body mass index increases, the perceived power generated at work will be even greater. People with excess body mass index have a tendency to get tired more easily so that resting, circulation works to get rid of lactic acid, supported by a massage that helps improve circulation, this causes pain conditions can be reduced (Hadyan & Saftarina, 2017).

Tjahayuningtyas research results (2019) states there is no relationship between body mass index with Musculoskeletal disorders (p = 0.332). Each increase in the value of the body mass index will decrease musculoskeletal disorders, because someone with nutritional conditions that are met will have good work capacity and endurance (Tjahayuningtyas, 2019).

The unnatural body position while working also greatly influences musculoskeletal disorder.

Excessive work with too heavy a burden will accelerate and aggravate the body's muscle contractions, so that it can affect muscle disorder.

the work method must be done correctly, because in terms of work physiology, it will result in the risk of health problems, disease even disability. The essence of muscle work or physical effort is muscle contraction (Soedirman & Suma’mur, 2014).

Muscle contractions occur when the body moves

using energy ATP (Adenosine tripohosphate) and calcium. When ATP is used by muscles for contraction, it will be replaced by anaerobic metabolism that is metabolism of fuel without oxygen, then the destruction of the fuel is not optimal and lactic acid will form. Lactic acid accumulation is responsible for muscle complaints.

If the muscles continue to contract there will be no chance for relaxation, then muscle complaints occur. This is not in accordance with the theory that an increase in body mass index is related to the severity of musculoskeletal function. Relating to the balance of skeletal structure in accepting weight and other burdens (Tarwaka, 2015).

CONCLUSION

The musculoskeletal disorder was a symptom that the cause of low back pain of the worker. The study identifies that age and long of work were relationship with the musculoskeletal disorder. This study finding suggest that maintain physical strength, with regular physical activity, maintain adequate diet and rest for the worker who risky age and long working period, stretching for 3-5 minutes every 2 hours of work, rotation to reduce worker boredom.

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