Ategeka says at times, he treats pupils with chest pain resulting from the strain the backpacks inflict on the upper parts of the body.
A CHILD's backpack is part of daily school life. But it can also be dangerous if not handled well.
New studies now show that what may be seen as normal and always ignored — the weight of the backpack and the way it is worn by a pupil — is responsible for the frequency of children complaining of back pain nowadays, writes
For every 28 patients with back-related complications Cedrak Ategeka, a physiotherapist in Kampala treats at his clinic, about 12 (42%) are pupils battling with back pain.
Ategeka, says he treats more children in upper primary (P5-P7). The number accounts for almost 70% of all the pupils he treats with back pain. He says the most affected parts are the neck, shoulders and lower back.
The children have spine deformities, which lead to severe lower back pain, he explains. Others suffer from severe pain because of curved in and straightened backs. If left untreated, the complication can become chronic.
Ategeka says at times, he treats pupils with chest pain resulting from the strain the backpacks inflict on the upper parts of the body. The pain sometimes extends to the costal cartilages (front of the chest). Consequently, if not treated earlier, children develop chronic chest pain.
Pupils in day school are more affected than those in the boarding school, he adds.
Ategeka says children who walk long distances to and from school tend to have more complications than those who move shorter distances to school.
"Boys are less likely to have back pains than girls because they engage in sports, such as swimming and football. It is the constant exercise that strengthens the boys' muscles.
Therefore, the muscles can withstand injury more than those of the girls," he says. What studies show Ategeka's medical experience of such patients is linked to a study done in Uganda in 2014.
The study: Musculoskeletal pain and school bag use: A cross-sectional study among Ugandan pupils was conducted by Makerere University lecturer Erisa Mwaka et al. The findings indicate that about 88.2% of pupils who carried backpacks, reported having body pain, especially in the neck, shoulders and upper back.
The same study shows about 30.8% of the pupils carry schoolbags, which are more than 10% of their body weight. The recommended weight should not exceed 10% of the child's body weight.
The prevalence of children carrying school bags, having back pain, was at 37.8%.
The study concluded that there was a significant association between lower backache, method of carrying the bag and walking long distances.
They said pupils in urban areas who were younger carried significantly heavier bags. The pupils were less likely to complain about the heavy bags than the rural pupils. The study is confirmed by another done in the UK this year by a team of senior surgeons — Backpack forces on the spine published in Surgical Technology International. The surgeons conclude that backpacks, if not well used, are associated with back pain, neck pain, and altered posture.
Real trouble behind bags Dr. Jessica Sosso of Mayo Clinic Health System, UK says: "Many students carry backpack loads weighing more than 10 percent of their body weight, and parents are starting to hear their school-age children complaining of back pain."
Uganda's researchers also said the most common bag carried by students in Uganda are the backpacks, with 57.3% of all pupils having them. The other types of bags carried included shoulder bags and rucksacks.
"All pupils from urban areas had school bags of which 79.9% were backpacks. For the rural pupils, only 36.7% had backpacks, while 15.5% had no school bags," the report reads.
Of the few pupils who had bags with the recommended safety features, for comfortable bag carriage, only 4.5% routinely used them. The study also shows that for backpacks, 51.9% used two shoulder straps to carry their bags while 28.7% used one shoulder strap. Ategeka says girls tend to prefer, single strapped bags that they wear on one shoulder. This, in the long run, causes a strain to the shoulder and
Accumulatively injures the muscles causing pain.
Usually, the backpack has two straps that should be worn on both shoulders to give even balance to muscle action of the back once the weight is evenly distributed.
"This allows the muscles on the back to share the load, hence reducing the chances of injuring the back on one side due to muscle imbalance," he says. Ategeka warns that wearing a single strap will likely curve the spine towards one side, causing a deformity of an S shape. He says under normal circumstances, the back should curve inwards. If the back loses its normal curve, it causes tension and spasms to develop on the structures of the back, such as muscles, ligaments discs and bones and consequently severe pain.
Why heavy backpacks?
When asked why she has to carry a heavy bag to school every day, a Primary Five pupil of St. Immaculate Day and Boarding School in Kasubi, Wakiso district said sometimes the teachers change the school timetables abruptly. This makes the pupils carry all the books, to cater to the sudden changes.
Violet Ssentongo, a former headteacher of Kibuuka Mixed Primary School in Wakiso district, blames it on limited space. "Some schools have small classrooms and adding lockers to the already limited space would make the classrooms congested," Ssentongo notes.
She also says at times, some parents want to check on their children's books daily. Therefore, the children are compelled to carry all their books to and from home every day.
Meanwhile, Sarah Nampiima, another headteacher, blames it on limited finances that cannot allow the provision of lockers. "In some Universal Primary Education schools, pupils study under trees. So, how can they have storage facilities?" Nampiima asks.
Schools speak out
Gusta Mufumu, a teacher at Tororo Parents Primary School in Tororo district, says the school administration urges teachers to allow the pupils to carry only the required exercise books according to the timetable of the day.
Robert Buzu, a Primary Seven teacher at Elyon Kindergarten and Primary school in Mutungo, Kampala, says for the previous terms, they often received complaints from parents concerning their children developing back and chest pain.
The school, after a meeting with parents, decided to set up shelves in classrooms.
What should be done?
Emmanuel Odhiambo, a physiotherapist in Kampala, says children should carry weight load on their backs not exceeding 10-15% of their body weight. Odhiambo says this will mitigate the chances of the heavy loads wearing out their back muscles and causing pain.
To help distribute the weight to the back evenly, Ategeka says the children are encouraged to wear both straps of the backpacks and to also fasten the strap around the waist. This helps the bag to directly rest on the back.
Additionally, parents are encouraged to buy backpacks that are well padded or cushioned, especially in the areas that rest on the upper and lower parts of the back. "This prevents friction and irritation of the skin surface that in the long run can injure the soft muscles that cover the spine," he says.
Odhiambo encourages parents to regularly check their children's bags and empty them of unnecessary items such as used up exercise books. Odhiambo says the weight of the backpack when empty should be considered. For example, a canvas backpack will be lighter than a leather one.
"For pupils who often walk to school near traffic, parents may want to find a backpack that has reflective strips that make their child more noticeable to drivers," he says.
Education ministry speaks out
The state minister for higher education, Dr. John Chrysostom Muyingo, says: "Parents need to ensure that their children's bags are kept light and with only what is necessary. Even without a policy in place, parents need to know what is best for their children," he says.
He adds that much as it is good for all pupils to have lockers at school, it is a costly venture to invest in now, considering the tough realities of the financial constraints and what is on the priority list.
The acting director in charge of basic and secondary education, at the education ministry, Ismael Mulindwa acknowledges that the ministry does not have a policy in place regulating the carrying of heavy school bags among schoolchildren.
"We do not think that is necessary as of now. Parents should be able to guide their children, especially if they know what to do," he says.