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Prevalence and Risk Factors for Low Back Pain Among


Professional Drivers in Kano, Nigeria
ab ab c d
Adamu Ahmad Rufai , Ismaila Adamu Saidu , Rufai Yusuf Ahmad , Omar Salad Elmi ,
a b e
Salamatu Umar Aliyu , Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil
a
Department of Physiotherapy, College of Medical Sciences, University of Maiduguri,
Maiduguri, Nigeria
b
Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
c
Department of Physiotherapy, Faculty of Medicine, Bayero University Kano, Kano, Nigeria
d
Unit of Biostatistics and Research Methodology, School of Medical Sciences, University Sains
Malaysia, Kubang Kerian, Kelantan, Malaysia
e
Click for updates Department of Orthopaedics and Traumatology, College of Medical Sciences, University of
Maiduguri, Maiduguri, Nigeria
Accepted author version posted online: 12 Nov 2013.

To cite this article: Adamu Ahmad Rufai, Ismaila Adamu Saidu, Rufai Yusuf Ahmad, Omar Salad Elmi, Salamatu Umar
Aliyu, Abdurrahman Mohammed Jajere & Abbas Abdullahi Digil (2015) Prevalence and Risk Factors for Low Back Pain
Among Professional Drivers in Kano, Nigeria, Archives of Environmental & Occupational Health, 70:5, 251-255, DOI:
10.1080/19338244.2013.845139

To link to this article: http://dx.doi.org/10.1080/19338244.2013.845139

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Archives of Environmental & Occupational Health (2015) 70, 251255
Copyright  C Taylor & Francis Group, LLC

ISSN: 1933-8244 print / 2154-4700 online


DOI: 10.1080/19338244.2013.845139

Prevalence and Risk Factors for Low Back Pain Among


Professional Drivers in Kano, Nigeria
ADAMU AHMAD RUFAI1,2, ISMAILA ADAMU SAIDU1,2, RUFAI YUSUF AHMAD3, OMAR SALAD ELMI4,
SALAMATU UMAR ALIYU1, ABDURRAHMAN MOHAMMED JAJERE2, and ABBAS ABDULLAHI DIGIL5
1
Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
2
Department of Physiotherapy, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
3
Department of Physiotherapy, Faculty of Medicine, Bayero University Kano, Kano, Nigeria
4
Unit of Biostatistics and Research Methodology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian,
Kelantan, Malaysia
5
Department of Orthopaedics and Traumatology, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria

Received 18 April 2013, Accepted 4 August 2013


Downloaded by [UNSW Library] at 12:10 19 August 2015

This study investigated the prevalence, risk factors, and impact of low back pain (LBP) among professional drivers in Nigeria. Two
hundred male drivers aged 1964 years were recruited in the study. Data regarding prevalence, individual risk factors, and impact of
LBP were obtained. The prevalence rate of LBP was 73.5%, and LBP have affected the driving performance of up to 74% drivers.
After adjustment for age, LBP prevalence was associated with driving for >15 hours/day (odds ratio [OR]; 95% confidence interval
[CI]): (0.04; 0.01, 0.20), driving car (5.52; 1.55, 19.64), and driving bus (10.49; 2.63, 41.82). No association was found between LBP
prevalence and years spent driving. The study found that high prevalence of LBP affected the performance of a substantial percentage
of the participants.
Keywords: long-distance driving, low back pain, prevalence, professional drivers

Low back pain (LBP) is well known as the most common mus- means of livelihood among the teeming population, we
culoskeletal disorder affecting the general population, with observed dearth of data on the prevalence of LBP and
estimated 80% incidence rate among the active population.16 its associated risk factors among professional drivers. The
It has also been recognized as one of the major causes for concern is particularly high in the industrialized cities of
decreased efficiency and well-being in the working populace, northern Nigeria such as Kano metropolis, where increased
with consequent financial, medical, and socioeconomic im- prevalence of LBP among professional drivers cannot be ruled
plications affecting individuals, employers of organizations, out.
and society at large.79 Absence from work, change of work, Several factors associated with driving vehicles were iden-
restriction to work, low productivity, and loss of work were tified as reasons why driving was rated among the high-risk
noted as the socioeconomic implications of LBP. LBP and its occupations predisposing most drivers to LBP. Among them
associated effects account for most of the regular outpatient is the nature of drivers seat and its back rest that persis-
hospital visits and casual sick leave among employees of orga- tently exert pressure on the lumbar-vertebral spines due to
nizations.1 In several instances, different kind of occupational prolonged hip position at 90 degrees.14 Other notable factors
activities and their related factors contribute significantly to include age of the drivers, numbers of years of driving ex-
the development of LBP or its exacerbation.10,11 perience, prolonged hours of driving per day with constant
High prevalence of LBP among professional drivers has vibrational forces, and frequent twisting of lumbar-vertebral
been reported in many parts of the world. According to spines, among others.12,1517 Moreover, in Nigeria, the charac-
recent surveys conducted among professional drivers at teristic nature of roads and the condition of vehicles could
Israel12 and the United Kingdom,13 prevalence of LBP was add to the risk of LBP among professional long-distance
found to be 45% and 60%, respectively. However, in Nigeria, drivers, because the roads are dilapidated and poorly main-
despite recognizing long-distance commercial driving as tained, whereas the vehicular road worthiness assessments are
not strictly followed.18
The objectives of this study were to determine the preva-
Address correspondence to Adamu Ahmad Rufai, Department lence of LBP and to identify the associated risk factors and its
of Physiotherapy, College of Medical Sciences, University of economic impact among professional drivers in Kano, Nige-
Maiduguri, PMB 1069, Maiduguri, Nigeria. E-mail: adamuar- ria. Kano, the capital of Kano State, is the second largest
ufai@gmail.com commercial city in Nigeria. It is located in the northwestern
252 Rufai et al.

region Nigeria, with a population of 9,401,288 according to Table 1. Demographic Characteristics and Impact of LBP Among
the 2006 Nigerian national census results.19 Professional Drivers (N = 200)

Variable Mean SD Range


Methods Demographic
characteristics
Participants Age (years) 42.45 11.06 1964
The participants surveyed in this cross-sectional study were Driving experience 17.75 7.91 130
(years)
male drivers recruited using the nonprobability sample of con-
Duration of driving/day 13.35 6.28 524
venience from 4 selected motor parks in Kano metropolis,
(hours)
Nigeria. They include Unguwa Uku, Mariri, Kofar Ruwa, and n %
Yan Kaba motor parks. The drivers eligible for the study were Type of vehicle
interstate long-distance drivers who have at least 1 year of Truck 34 17
driving experience and drive for a minimum of 5 hours/day, Car 51 25.5
whereas those with previous history of traumatic injuries and Bus 115 57.5
those with high risk of developing LBP from other secondary
activities were excluded. Using the Taro Yamane formula,
a minimum of 310 participants was determined to be ade- Nature of LBP
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quate.20 The time frame for this study lasted 5 months, between Onset of LBP
April and August 2011. Gradual 91 61.9
Sudden 56 38.1
Severity of LBP
Data Collection Mild 31 21.1
Moderate 72 48.9
A modified Nordic Low Back (MNLB) questionnaire was Severe 44 30.0
used to obtain data on the prevalence of LBP and its im- Impact of LBP
pact.21 LBP was defined as any ache, pain, or discomfort, and Pain experience
the location was defined by the shaded area of a body dia- Was not serious 81 55.1
gram (T12 to gluteal folds).22 The participants were asked if Needed medication 36 24.5
they had experience LBP during the last 12 months for a day Needed hospital visit 30 20.4
or longer, requiring checking a yes/no or multiple-response Effect of LBP
answer choice. Also, the impact of LBP was assessed using Did not affect driving 39 26.0
questions on medication consumption, requiring treatment, Reduced driving 31 21.0
and modification of driving secondary to LBP in the pre- efficiency
ceding 12 months. The LBP is clinically significant if partici- Reduced driving time 33 24.0
pants reported that their LBP required use of medication, or Kept away from driving 44 29.0
if they sought treatment, or if it required a reduction in ac-
tivity of daily living.23 Basic demographic and occupational
profiles, including drivers age, type of vehicle, number of driv-
ing hours per day, years of driving experience (years of pro- in the respective motor parks. All questions were fully clarified
fessional exposure), nature and impact of LBP, as well as to the participants, after which they filled in the questionnaires.
secondary activities (if any), were clearly obtained from the Upon completion, the questionnaires were either retrieved on
respondents. the same day of distribution (n = 189) or within 37 days after
the distribution day (n = 113).
Ethical Consideration
The study was approved by the institutional ethics committee Data Analysis
(according to the Helsinki Declaration) of Bayero University Statistical Package for Social Sciences (SPSS; version 20.0.1;
Kano after duly obtaining permission from executives of the IBM, Armonk, NY, USA) was used for the data entry and
drivers union in the respective motor parks. Individual partic- analyses. The data were double checked and cleaned to en-
ipants were properly counseled on the protocol of the study sure that all variables were properly documented and to detect
and were assured of the confidentiality of their respective in- any missing or erroneous values during data entry. Descrip-
formation throughout the study. A signed informed consent tive statistics of mean and standard deviation or frequency and
was obtained from each participant for documentary and legal percentage were used to summarize the demographic variables
purposes. and nature and impact of reported LBP. Chi-square statistics
was used to determine statistical difference between the pre-
dictors of LBP.
Flow of Work
Univariate logistic regression analysis was applied to de-
The MNLB questionnaires were distributed through personal termine the potential associated risk factors. Variables that
contact with individual drivers and/or their union executives were found to be statistically significant in the univariate anal-
Archives of Environmental & Occupational Health 253

Table 2. Prevalence of LBP in the Last 12 Months Among Professional Drivers (N = 200)

LBP history

Yes (n = 143) No (n = 57)


Variable n % n % p value

Age (years) .019


24 4 2.7 6 11.3
2544 73 49.7 31 58.5
4560 53 36.1 14 26.4
>60 17 11.6 2 3.8
Driving experience (years) .046
10 22 17.5 13 24.5
1120 53 36.1 20 37.7
>20 72 49 20 37.7
Duration of driving (hours) <.001
<10 39 26.5 29 54.7
1015 38 25.9 15 28.3
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>15 70 47.6 9 17.0


Type of vehicle .697
Truck 23 15.6 11 20.8
Bus 86 58.5 29 54.7
Car 38 25.9 13 24.5
Significance at p < .05.

ysis (p < .05) and also proven to be biologically significant 61.9% of the respondents had LBP of gradual onset with ei-
and clinically important were included in the multivariate ther mild pain (21.1%) or pain moderate in severity (48.9%).
analysis. Generally, the LBP was found to reduce driving efficiency
For the multivariate logistic regression analysis, backward in about 74% of the respondents, although only 20.4% vis-
stepwise logistic regression was applied to determine the ited hospitals as outpatients, whereas 55.1% were free of any
significance of the model and the enter method was applied to medication.
process the preliminary main effect model. Multicolinearity Table 2 shows the 12-month prevalence rate of LBP and
and interaction terms were checked; for the biologically the differences among potential associated risk factors of its
meaningful variable, 2-way interactions was applied and was occurrence. Out of 73.5% (147) drivers with LBP, 49% (72) had
not found significant. The Hosmer-Lemeshow test (p = .984) 20 years driving experience and 47.6% (70) had history of
classification table (overall correctly classified percentage >15 hours driving per day. In addition, up to 58.5% (86) were
= 80.5%) and area under the curve and receiver operating found to be bus drivers, in contrast to the car or truck drivers.
characteristic (ROC) curve (70.5%) were performed to check Significant differences were found in LBP prevalence for all
the model adequacy and fitness. Multiple logistic regressions the predictors except type of vehicle ( 2 = 0.72, p = .697).
were applied to present the final model with adjusted odds Similarly, results of risk factors interaction in Table 3
ratio. Alpha level of significance was set at <.05. indicated that older drivers had higher risk of developing
LBP, with ages 4560 years having 0.18 odds of developing
LBP (95% confidence interval [CI]: 0.40, 0.71; p = .015) and
Results >60 years with 0.09 times crude odds of having LBP (95%
CI: 0.01, 0.54; p = .010). Likewise, those who drive for longer
A total of 350 questionnaires were distributed; however, only hours/day were more vulnerable, with 1015 hours/day hav-
86.3% were successfully retrieved. Out of these, only 66.2% ing 0.39 times crude odds of getting LBP (95% CI: 0.19, 0.81;
(200) met the inclusion criteria and were thus enrolled in p = .011). The multivariate analysis of independent risk factors
the study. The remaining respondents were excluded from showed the significant variables in Table 3. Duration of driv-
the data analysis for various reasons: 31 (10.3%) had other ing (hours/day) was found to be a significant risk factor for
jobs/activities risk for LBP, 38 (12.6%) had previous history LBP in drivers; those driving for the duration >15 hours/day
of traumatic injury, 14 (4.6%) had inconsistency of response, have 0.04 odd chances of LBP (95% CI: 0.01, 0.20; p = .001).
and 19 (6.3%) had missing data. Also found to be a significant risk factor for LBP in drivers
As shown in Table 1, the participants had mean age of is the type of vehicle driven, with those who drive cars hav-
42.45 (11.6) years and driving experience between 1 and ing 5.52 times odds of LBP occurrence (95% CI: 1.55, 19.64;
30 years and duration of driving about 524 hours/day. About p = .008).
254 Rufai et al.

Table 3. Risk Factors for LBP Among Professional Drivers (N = 200)

Variable Crude odds ratio 95% CI p value Adjusted odds ratio 95% CI p value

Age (years)
24 1
2544 0.28 0.08, 1.07 .064
4560 0.18 0.40,0.71 .015
>60 0.09 0.01,0.54 .010
Driving experience (years)
10 1
1020 0.64 0.27,1.51 .305
>20 0.47 0.20,1.10 .080
Driving duration (hours)
<10 1 1
1015 0.39 0.19,0.81 .011 0.01 0.00, 0.06 .001
>15 0.03 0.01,0.13 .001 0.04 0.01,0.20 .001
Type of vehicle
Truck 1 1 .008
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Car 0.71 0.31,1.62 .411 5.52 1.55,19.64 .001


Bus 0.72 0.28,1.86 .492 10.49 2.63,41.82

Note. Backward LR multiple logistic regression was applied.


Multicolinearity and interaction were checked and no interaction was found.
Hosmer-Lemeshow test was p = .681.
Classification table (overall correct classification percentage was 78.5%).
Area under curve ROC (81.7%) was applied to check the final model.

Comment Longer duration of driving has been reported to be a major


risk factor for LBP among drivers.28 The minimum duration
The prevalence of LBP was observed to continually rise in of driving (hours/day) in this study was 5 hours/day. It was
many countries. Several risk factors associated with different not surprising, therefore, that the prevalence of LBP was high,
kinds of occupation, particularly in major commercial cities, since continuous driving for 4 hours or more have been re-
were found to play a pivotal role in the development of LBP. ported to increase the risk of LBP.29 Similarly, the present
In this cross-sectional survey, the burden of LBP among pro- study found that LBP increased with increasing number of
fessional drivers in Kano metropolis, a major commercial city driving hours per day. This finding supported a study that
in Nigeria, was reported. Also, the individual potential risk reported a strong relationship between increased risk of occu-
factors for and the impact of LBP among the professional pational injuries and long working hours such as long-distance
drivers are presented. driving.30
Previous reports have shown that about 60%80% of all The majority of the drivers reported LBP onset as gradual,
adults have experienced or will experience LBP, and associa- which means it is the result of repeated trauma.31 A substan-
tion between driving as an occupation and symptoms of low tial number of drivers with LBP were either on self-prescribed
back pain have been documented.2,6,24 An overwhelming ma- medication or simply visit hospital as outpatients for medical
jority (73.5%) of the drivers in the present study reported LBP advice. This finding supports the fact that LBP accounts for
as a result of driving, and LBP prevalence increases with age, more sick leave and disabilities, thereby resulting in substan-
increasing number of years spent driving, number of driving tial economic loss to both individuals and community.32 LBP
hours per day, and the type of vehicle being driven. The find- significantly affected the driving efficiency of the majority of
ings of LBP prevalence in up to 74% long-distance drivers long-distance drivers in several ways. These include reducing
and its association with >20 years of driving experience were their driving time or keeping them away from driving for some
supported by similar data reported elsewhere.3,12 time. This supports the assertion that LBP is a common cause
Studies conducted in the UK, Taipei, and Sweden reported of occupational injuries and absenteeism from work amongst
LBP prevalence rates of 60%, 51%, and 81% among truck, taxi, the productive populations2 and buttresses further the eco-
and bus drivers, respectively.13,25,26 Similarly, prevalence rates nomic implications of LBP.
of 67.7, 74.5%, and 74.8% for truck, car, and bus drivers, re-
spectively, were found. The relatively lower prevalence among Study Limitations
truck drivers in this study may be because unlike the bus and
taxi drivers, truck drivers have several stopover places along This study reported for the first time the prevalence and
their routes.27 Also, contrary to their counterparts in the West- associated factors of LBP among professional long-distance
ern world, truck drivers in this area do not take part in the drivers and its economic implications in Nigeria. However,
manual work of loading and unloading trucks. the findings need to be interpreted with caution due to some
Archives of Environmental & Occupational Health 255

limitations in the study. First, the causality of associations 11. Marras WS, Lavender SA, Leurgans SE, et al. The role of dynamic
may not be concluded, as is the case with cross-sectional three-dimensional trunk motion in occupationally-related low back
studies; likewise, information bias may occur due to recall disorders: the effects of work place factors, trunk position, and trunk
motion characteristics on risk of injury. Spine. 1993;18:617628.
bias, as is the case with self-reports. In addition, the validity of
12. Alperovitch-Najenson D, Santo Y, Masharawi Y, Katz-Leurer M,
the inferential statistics may not be justified, since participants Ushvaev D, Kalichman L. Low back pain among professional bus
were recruited through sample of convenience. drivers: ergonomic and occupational-psychosocial risk factors. Isr
Med Assoc J. 2010;12:2631.
13. Robb MJM, Mansfield NJ. Self-reported musculoskeletal problems
Conclusion amongst professional truck drivers. Ergonomics. 2007;50:814827.
There was high prevalence of LBP among professional long- 14. Boshuizen HC, Bongers PM, Hulshof CT. Self-reported back pain
in tractor drivers exposed to whole-body vibration. Int Arch Occup
distance drivers that had affected the drivers performance Environ Health. 1990;62:109115.
with attendant negative economic implications. The study 15. Odebiyi DO, Ogwezi DC, Adegoke BOA. The prevalence of LBP
found duration of driving and type of vehicle as risk factors in commercial motor drivers & private automobile drivers. Niger J
for LBP among the participants. It is recommended that fur- Med Rehabil. 2007;12:2124.
ther studies should assess the ergonomic and psychosocial risk 16. Bovenzi M. A longitudinal study of low back pain and daily vibration
factors. Furthermore, awareness campaign program should be exposure in professional drivers. Ind Health. 2010;48:584595.
17. Tamarin SB, Yokoyama K, Jalaludin J, et al. The association be-
organized for drivers on the importance of proper ergonomics
tween risk factors and Low Back Pain among commercial vehicle
to reduce the risk of LBP. Also collaboration between health drivers in Peninsular Malaysia: a preliminary result. Ind Health.
Downloaded by [UNSW Library] at 12:10 19 August 2015

policy makers and road transport unions is highly important 2007;45:268278.


in order to initiate proper medical intervention at the right 18. Akinpelu AO, Oyewole, OO, Odole AC, Olukoya, RO. Prevalence of
time when early symptoms of LBP manifest. This will surely musculoskeletal pain and health seeking behaviour among occupa-
assist in mitigating the potential hazards. tional drivers in Ibadan, Nigeria. Afr J Biomed Res. 2011;14:8994.
19. National Bureau of Statistics, Nigeria. Provisional results of the
2006 population census. Annual Abstr Stat. 2010;1763. Available
at: www.nigerianstat.gov.ng/pages/download/71.
Acknowledgments 20. Okeke AO. Foundation Statistics for Business Decisions. Enugu: High
Mega System; 1995:25.
The authors would like to sincerely acknowledge the road 21. Kuorinka I, Jonsson B, Kilbom A, et al. Standardized Nordic ques-
transport union executives for their kind permission and the tionnaires for the analysis of musculoskeletal symptoms. Appl Ergon.
1987;18:233237.
drivers who voluntarily participated in this study.
22. Mitchell T, OSullivan PB, Burnett AF, Straker L, Rudd C. Low
back pain characteristics from undergraduate student to work-
References ing nurse in Australia: a cross-sectional survey. Int J Nurs Stud.
2008;45:16361644.
1. Saidu IA, Utti VA, Jaiyesimi AO, et al. Prevalence of musculoskele- 23. Mitchell T, OSullivan PB, Burnett AF, Straker L, Smith A. Regional
tal injuries among factory workers in Kano Metropolis, Nigeria. Int differences in lumbar spinal posture and the influence of low back
J Occup Saf Ergon. 2011;17:99102. pain. BMC Musculoskelet Disord. 2008;9:152.
2. Alexopoulos EC, Tanagra D, Konstantinou E, Burdorf A. Mus- 24. Salminen JJ, Erkintalo M, Laine M, Pentti J. Low back pain in the
culoskeletal disorders in shipyard: prevalence, health care use, and young: a prospective three-year follow-up study of subjects with and
absenteeism. BMC Musculoskelet Disord. 2006;7:88. without low back pain. Spine. 1995;19:21012108.
3. Szeto GP, Lam P. Work related musculoskeletal disorders in 25. Chen JC, Chang WR, Chang W, Christiani D. Occupational factors
urban bus drivers of Hong Kong. J Occup Rehabil. 2007;17: associated with low back pain in Urban taxi drivers. Occup Med.
181198. 2005;55:535540.
4. Sanya AO, Ogwumike OO. Low back pain prevalence amongst in- 26. Magnusson ML, Pope MH, Wilder DG, Areskoug B. Are occupa-
dustrial workers in the private sector in Oyo state, Nigeria. Afr J tional drivers at an increased risk for developing musculoskeletal
Med Med Sci. 2005;34:245249. disorders? Spine. 1996;21:710717.
5. Charizani F, Moysiadou I, Siarkos E, Alexopolous EC. Subjective 27. Erhabor O, Azuonwu O, Frank-Peterside, N. Malaria parasitaemia
risk assessment of industry employees. Rev Clin Pharmacol Pharma- among long distance truck drivers in the Niger delta of Nigeria. Afr
cokinet. 2005;19:8792. Health Sci. 2012;12:98103.
6. Urquhart DM, Hoving JL, Assendelft WW, Roland M, van Tul- 28. Pietri F, Leclerc A, Boitel L, Chastang JF, Morcet JF, Blondet
der MW. Antidepressants for non-specific low back pain. Cochrane M. Low back pain in commercial travellers. Scand J Work Environ
Database Syst Rev. 2008;(1):CD001703. Health. 1992;18:5258.
7. Miyamoto M, Konno S, Gembun Y, et al. Epidemiological study of 29. Porter GM, Gyi GE. The prevalence of musculoskeletal troubles
low back pain and occupational risk factors among taxi drivers. Ind among car drivers. Occup Med. 2002;52:412.
Health. 2008;46:112117. 30. Dembe AE, Erickson JB, Delbos RG, Banks SM. The impact of
8. Dagenais S, Caro J, Haldeman S. A systematic review of low back overtime and long work hours on occupational injuries and ill-
pain cost of illness studies in the United States and internationally. nesses: new evidence from the United States. Occup Environ Med.
Spine. 2008;8:820. 2005;62:588597.
9. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of 31. Lis AM, Black KM, Korn H, Nordin M. Association between sitting
back pain in The Netherlands. Pain. 1995;62:233240. and occupational LBP. Eur Spine J. 2007;16:283298.
10. Adigun N. Physiotherapy in the Management of Back Pain. Ikeja, 32. Anderson, R. The back pain of bus drivers; prevalence in an urban
Nigeria: Adtools; 1999. area of California. Spine. 1992;17:14811488.