Chronic lower back pain and its impact on health-related quality of life among undergraduate students of Gulu University, Uganda: a cross-sectional study

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However, studies concerning the prevalence of CLBP among undergraduate students are scarce. This study aimed to determine the prevalence and factors associated with CLBP and its impact on health-related quality of life (HRQoL) among undergraduate students at Gulu University, Uganda. Methods Between October and November 2023, a cross-sectional study was conducted using self-administered questionnaires. CLBP was defined as non-specific lower back pain lasting more than 12 weeks or more. The Oswestry Disability Index was used to evaluate disability associated with CLBP, and the EuroQoL-5D-5 L was used to evaluate HRQoL (higher scores indicate better HRQoL). Results We enrolled 394 participants, 79.2% (n = 312) were males, with a median age of 23 (IQR: 22–24) years. The prevalence of CLBP was 20.6% (n = 81), and 66.8% (n = 263) of the participants were younger than 24 years. With respect to HRQoL scores (median [IQR]), both overall health (0.83 (0.75–0.9) versus 0.67 (0.61–0.78), p < 0.001) and self-reported health (80 (65–90) versus 65 (50–80), p < 0.001) were worse in participants with CLBP than in those without CLBP. Conclusions Approximately one in every five participants had CLBP. CLBP is a highly prevalent health problem among students at Gulu University, with a significantly negative impact on their daily life. Chronic low back pain university students health-related quality of life prevalence Figures Figure 1 Figure 2 Figure 3 Background Chronic lower back pain (CLBP) is a common health problem that many people experience at some point in their life. Global Burden of Disease studies have defined CLBP as a nonspecific pain in the posterior lower aspect of the body from the lower margin of the twelfth rib to the lower gluteal folds with or without pain in one or both lower limbs that lasts for 12 weeks or more ( 1 ). In 2020, an estimated 619 million people worldwide were affected by low back pain (LBP), with projections suggesting this figure will rise to 843 million by 2050, primarily due to population growth and aging. The prevalence of LBP increases with age, peaking around 80 years, while the highest incidence is observed in individuals aged 50 to 55 years. Women are more commonly affected by LBP than men ( 2 ). A review of the global prevalence of CLBP revealed that CLBP is a major problem throughout the world, with its prevalence being higher among females (35%) compared to males (29%) ( 3 ). Chronic lower back pain is among the four leading musculoskeletal conditions contributing to global impairment. The pain and functional limitations caused by these conditions are significant contributors to reduced quality of life. In developed nations, CLBP stands out as the most prevalent musculoskeletal issue and the primary cause of functional incapacity ( 4 ). Musculoskeletal disorders are estimated to account for around 1% of disability-adjusted life years in developing countries and 4.3% in developed regions ( 5 ). CLBP is considered one of the most common problems in adolescents and is known to affect both young and older adults ( 6 – 8 ). CLBP is no longer considered a disease of elderly individuals, as approximately 39.8% of the adolescent population is also found to suffer from this condition, according to a previous study ( 9 ). According to other studies, approximately 12–80% of the younger population, especially students, experiences CLBP ( 9 – 11 ). In the United States, back pain is the most common cause of activity limitation in people under the age of 45 years, and considered the second most frequent reason for visits to a physician. This condition was also the fifth leading cause of hospital admission. In addition, CLBP is reported to be the second leading cause of work absenteeism and results in greater loss of productivity than any other medical condition ( 12 ).The direct and indirect costs attributable to CLBP are enormous in terms of loss of quality of life, productivity, and absenteeism ( 13 ). Studies in European countries indicate that the total cost associated with CLBP varies between 0.1% and 2% of the gross domestic product. The costs associated with CLBP in low- and middle-income countries (LMICs) are unknown. The costs associated with loss of productivity are likely to be substantial given that the overall prevalence of CLBP in LMICs is estimated to be approximately 52% in workers ( 13 ). Chronic lower back pain has a great economic impact on healthcare systems in many countries. In the United States, total costs related to this condition reportedly exceed one hundred billion dollars per year ( 14 ). In the United Kingdom, it is estimated that 116 million productive days are lost due to CLBP, and the resulting economic cost is estimated at 12 billion GBP annually, whereas in Europe, the direct costs related to CLBP are estimated at 7000 Euros per person per year in Germany and 740 Euros in Sweden. There is a paucity of retrievable research evidence on the economic cost of CLBP in Africa. The financial impact of CLBP is presumed to be enormous on the African continent because of its fragile health systems with limited human and infrastructural resource capacity, amidst a dual burden of infectious and noncommunicable diseases where already restricted funds are directed ( 15 – 17 ). The relevant data highlight the prevalence of CLBP in 29.3% of university students aged 18–29 years. University students have busy lifestyles, juggling between their academics and daily life with alternating postures that cause pain in several joints ( 18 ). Their demanding lifestyles, which involve balancing academic responsibilities with daily activities, often require prolonged sitting during study sessions, frequent bending, or physical exertion from activities like sports or part-time jobs. These varied postures place strain on multiple joints, contributing to pain. Additionally, the presence of CLBPs can affect students’ productivity, attendance at lectures and training, thus affecting their future careers. A higher prevalence of CLBP was observed among students with five or more semesters, more likely attributable to activity levels, suggesting that advanced students, who are most often exposed to practical activities, are at increased risk for the disease ( 19 ). However, there is limited data on the prevalence of CLBP among university students in Uganda, which presents a gap in knowledge. Therefore, the aim of this study was to investigate the prevalence, associated factors, and impact of CLBP on health-related quality of life among undergraduate students at Gulu University, Uganda. Methods Design A cross-sectional study involving undergraduate students of Gulu University, Uganda. Data were collected in November 2023. Study setting and Participant recruitment The study population comprised undergraduate students enrolled in various programs at Gulu University, located in Gulu City, Northern Uganda. Gulu University has an approximate enrollment of 5,000 students across six faculties: Education and Humanities, Medicine, Science, Law, Business and Development, and Agriculture and Environment. A sample size of 374 students was determined via the Kish-Leslie formula, assuming a 58% prevalence of CLBP based on previous studies ( 20 ). We then recruited 394 participants for the final analysis. The participants were selected via a combination of cluster and systematic sampling. The university’s six faculties served as clusters, and every 15th student on the faculty lists (obtained from the academic registrar’s office) was selected until the desired sample size was reached. The 15th student was chosen based on the sampling interval calculated from total population (5000) and desired sample (374), giving 13.37, since systematic sampling requires a whole number, the interval was rounded up to a convenient number, 15 in this case. The inclusion criteria were as follows: all undergraduate students of any age, sex, and year of study who provided written informed consent. The exclusion criteria included students who were not present during data collection, those with physical injuries (e.g., from road accidents), congenital deformities, mental incapacities, pregnancy, or who did not consent to participate. Data were collected via a self-administered questionnaire and screening tool. Trained research staff guided participants in completing the questionnaires, addressing any questions to provide clarification. The completed questionnaires were stored securely to maintain confidentiality. Variables The primary outcome was the presence of CLBP, defined as pain in the posterior body area from the lower margin of the twelfth rib to the lower gluteal folds, with or without referred pain in one or both lower limbs, lasting for at least one day. The associated factors evaluated included overall health (EuroQoL Index Score), self-reported health (EQ-VAS Score), gender, year of study, and faculty. Health-related quality of life (HRQoL) was assessed using the EuroQoL-5D-5L questionnaire, which measures quality of life across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), as well as the EQ Visual Analog Scale (EQ-VAS), where higher scores indicate better perceived health. Statistical analysis Data were analyzed with descriptive statistics to estimate the prevalence of CLBP and associated factors. T tests and analysis of variance (ANOVA) were used to evaluate the impact of CLBP on health-related quality of life. All the statistical analyses were conducted via SPSS v28 software. Ethical considerations The research proposal was approved by the Gulu University Research Ethics Committee under approval number GUREC-2023-627. All participants provided informed consent before participating in the study. The study adhered to ethical guidelines for research involving human participants, ensuring confidentiality, voluntary participation, and the right to withdraw at any time without penalty. Results Sociodemographic characteristics A sample of 394 eligible participants were evaluated for CLBP, and the median age of all the participants was 23 years (IQR: 22–24). Most of the participants were male, constituting 312 (79.2%), and most of the participants were from the faculty of Agriculture and Environment. Table 1 : Demographic characteristics of the participants. Table 1 Demographic characteristics of the study participants. Variable Frequency Percentage Gender Female Male 82 312 20.8 79.2 Age, median, IQR 23 22–24 =24 263 131 66.8 33.2 Year of study 1 2 3 4 5 151 47 130 54 12 38.3 11.9 33 13.7 3.1 Faculty Agriculture and Environment Business and development studies Education and Humanity Law Medicine Science 116 36 78 46 80 38 29.4 9.1 19.8 11.7 20.3 9.6 Prevalence of CLBP among the participants The prevalence of CLBP was determined via the Oswestry Disability Index Questionnaire. A total of 20.6% (n = 81) of the participants were determined to have experienced nonspecific CLBP lasting more than 12 weeks, whereas 79.4% (n = 313) did not experience nonspecific CLBP (Fig. 2 ). Oswestry CLBP disability index domains. The analysis of the Oswestry CLBP Disability Index highlights varying levels of disability across different functional domains among the participants. Sitting, lifting and personal care were the most affected domains, with participants having a severity level of 5. However, a substantial proportion of participants reported moderate to severe pain. Social life, standing and traveling were the least affected domains. Figure 3 . Disability level among the participants Most participants experienced mild to moderate disability, suggesting that while CLBP was prevalent, it had a manageable impact on most participants. However, a smaller proportion of participants reported severe or complete disability, highlighting that CLBP can significantly impair function in some individuals. Table 2 . Table 2 Disability levels of the participants. Score Freq (%) Disability level 0–4 9(11.1)) No disability 5–14 40(49.4) Mild disability 15–24 27(33.3) Moderate disability 25–34 3(3.7) Severe disability 35–50 2(2.5) Completely disabled/Exaggerated symptoms Quality of life of the participants The overall health index score of the participants was 0.81 (IQR: 0.71–0.86), and the overall self-rated health (EQ VAS) score was 80 (IQR: 60–90). Table 3 . Table 3 EQ-5D-5 L frequencies and proportions of Gulu University students Level Dimension Mobility n (%) Self-care n (%) Usual activities n (%) Pain n (%) Anxiety/Depression n (%) Level 1 (No problems) 285(72.3) 277(70.3) 242(61.4) 148(37.6) 169(42.9) Level 2 (Slight problems) 79(20.1) 92(23.4) 109(27.7) 188(47.7) 163(41.4) Level 3 (Moderate problems) 23(5.8) 11(2.8) 38(9.6) 45(11.4) 42(10.7) Level 4 (Severe problems) 5(1.3) 12(3.0) 3(0.8) 9(2.3) 9(2.3) Level 5 (Extreme problems/unable to do) 2(0.5) 2(0.5) 2(0.5) 4( 1 ) 11(2.8) Factors associated with lower back pain according to bivariate analysis . The factors that were significantly associated with CLBP among the participants included overall health (p = 0.001) and the EQ-VAS score (p = 0.001). Table 4 . Table 4 Factors significantly associated with CLBP among the participants. Variable CLBP p value No (n = 313) Freq (%) Yes (n = 81) Freq (%) Gender Female Male 61(19.5) 252(80.5) 21(25.9) 60(74.1) 0.220 Age, median, IQR 23( 22 – 24 ) 23( 21 – 25 ) 0.825 18–24 25–34 35–44 > 45 240(76.7) 67 (21.4) 5(1.6) 1(0.3) 59(72.8) 21(25.9) 1(.2) 0(0) 0.794 Year of study 1 2 3 4 5 116(37.1) 42(13.4) 97(31) 47( 15 ) 11(3.5) 35(43,2) 5(6.2) 33(40.7) 7(8.6) 1(1.2) 0.080 Faculty Agriculture and Environment Business and development studies Education and Humanity Law Medicine Science 86(27.5) 28( 9 ) 60(19.2) 37(11.8) 73(23.3) 29(9.3) 30(37) 8(9.9) 18(22.2) 9(11.1) 7(8.6) 9(11.1) 0.093 Overall health, median (IQR) 0.83(0.75–0.9) 0.67(0.61–0.78) < 0.001 Self-reported health (EQ VAS). Median (IQR) 80(65–90) 65(50–80) < 0.001 Discussion This study investigated the prevalence of CLBP among university students and explored associated factors. CLBP was identified as a prevalent condition among students and was significantly associated with overall health and health indices. Most participants reported mild to moderate CLBP, whereas severe disability was less common. These findings emphasized the nature of CLBP and its potential impact on academic performance and quality of life. The prevalence of CLBP observed in this study agrees with findings from other student populations globally, reflecting a shared burden of CLBP in young adults. Studies conducted in Serbia ( 20 ), Malaysia ( 21 ), and Saudi Arabia ( 22 ) reported similar prevalence rates, supporting the view that CLBP is a common issue across different educational and cultural settings. The variations in prevalence observed across studies may stem from differences in lifestyle, study environments, and cultural practices. For example, sedentary behavior and prolonged study hours, which are common among university students, are recognized risk factors for CLBP ( 23 ). These findings noting the importance of addressing modifiable risk factors to mitigate the burden of CLBP in this population. Our study identified overall health and health indices as significant factors associated with CLBP. Poorer self-reported health was linked to higher CLBP incidence, which is consistent with evidence that compromised physical well-being exacerbates musculoskeletal conditions ( 24 ). In contrast to some studies ( 23 , 25 , 26 ), age was not significantly associated with CLBP in this population, which may reflect the relatively narrow age range of university students. Similar findings were reported in a study from Nigeria, where no significant association between age and CLBP was observed ( 28 ). Sex was also not significantly associated with CLBP, despite the higher prevalence among males in this study. This contrasts with findings from other studies that reported a higher prevalence among females, attributed to anatomical and functional differences such as smaller stature and less muscle mass ( 13 , 19 ). Further investigations are needed to explore sex-specific patterns of CLBP in this context. The CLBP in this study was characterized primarily by mild to moderate disability, which is consistent with findings from Lahore ( 27 ) and Nigeria ( 28 ). Severe disability was uncommon, studies involving younger participants, such as those conducted among physiotherapy students have reported the same ( 28 ). However, higher levels of disability have been reported in older populations, where chronic and degenerative changes play a more prominent role ( 29 ). These findings reflect the need for early interventions to address CLBP and prevent its progression to more severe disability, particularly among younger populations. Our study provides valuable insights into CLBP among university students in Gulu city, contributing to the limited body of knowledge on this topic. The use of probability sampling enhanced the generalizability of the findings. However, several limitations should be noted. The reliance on self-reported data may have introduced recall bias, and the small sample size limited the ability to conduct advanced statistical analyses. Furthermore, the study did not assess certain risk factors, such as posture, backpack usage, and physical activity, which are known to influence CLBP. Conclusions Approximately one in every five participants had CLBP. Males are predominantly affected. CLBP significantly, negatively impacted on HRQoL of the affected individuals. We recommend health education on posture and exercise. Longitudinal studies are recommended to confirm associations and develop effective prevention measures. Abbreviations CLBP Chronic Lower Back Pain LMICs Low–and middle–income countries HRQoL Health–related quality of life Declarations Ethics Approval and Consent to Participate The research proposal was approved by the Gulu University Research Ethics Committee under approval number GUREC-2023-627. All participants provided informed consent before participating in the study. The study adhered to ethical guidelines for research involving human participants, ensuring confidentiality, voluntary participation, and the right to withdraw at any time without penalty. Consent for Publication All participants provided consent for the publication of the findings from this study. Competing interests The authors declare that they have no competing interests. Clinical trial number not applicable. Funding The study received no specific funding. Author Contribution M.L.T, I.P, L.M.N, J.O, H.P.S, D.S.E, and F.B participated in the conceptualization and design of the study. M.L.T, I.P and F.B performed data collection and initial analysis. M.L.T, I.P, and F.B conducted advanced analysis and interpretation of the results. F.B provided critical revisions. M.L.T, I.P and F.B drafted the manuscript. All authors reviewed and approved the final version of the manuscript. 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The Association between Low Back Pain and Quality of Life among Health Sciences Students. Journal of Clinical and Health Sciences; Vol 8 No 1 (2023): Journal of Clinical and Health SciencesDO – 1024191/jchsv8i118049. 2023. Salvetti Mde G, Pimenta CA, Braga PE, Corrêa CF. [Disability related to chronic low back pain: prevalence and associated factors]. Rev Esc Enferm USP. 2012;46 Spec No:16–23. Additional Declarations No competing interests reported. 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Medicine, Department of Paediatrics, Yale University, New Haven, Connecticut","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"S","lastName":"Ebbs","suffix":""},{"id":403072096,"identity":"a0139044-7279-44a2-b610-95dee63dcaf5","order_by":6,"name":"Felix Bongomin","email":"","orcid":"","institution":"Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu","correspondingAuthor":false,"prefix":"","firstName":"Felix","middleName":"","lastName":"Bongomin","suffix":""}],"badges":[],"createdAt":"2024-11-27 13:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5535821/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5535821/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73993258,"identity":"4cabb808-0bd7-4149-aad4-ac6dc332a8a2","added_by":"auto","created_at":"2025-01-16 17:43:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":146673,"visible":true,"origin":"","legend":"\u003cp\u003eStudy enrollment\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5535821/v1/930f5fc73316b3475d739e25.png"},{"id":73993259,"identity":"8bbe3824-ea5f-4354-b57c-5b6497f59514","added_by":"auto","created_at":"2025-01-16 17:43:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22098,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of CLBP among the participants\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5535821/v1/bd31e1cc7f453d4ef584c6b7.png"},{"id":73993482,"identity":"fa88f8c1-d59a-4ef9-9319-6f7f546f2d0c","added_by":"auto","created_at":"2025-01-16 17:51:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":67275,"visible":true,"origin":"","legend":"\u003cp\u003eOswestry CLBP disability index domains\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5535821/v1/ca72fde7a4c70eb4320e6ce4.png"},{"id":73994187,"identity":"e907905d-84db-415c-a160-179f22223e1c","added_by":"auto","created_at":"2025-01-16 18:07:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":967244,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5535821/v1/4e541ec4-76d1-42dd-9741-84ed3dd3c95a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Chronic lower back pain and its impact on health-related quality of life among undergraduate students of Gulu University, Uganda: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic lower back pain (CLBP) is a common health problem that many people experience at some point in their life. Global Burden of Disease studies have defined CLBP as a nonspecific pain in the posterior lower aspect of the body from the lower margin of the twelfth rib to the lower gluteal folds with or without pain in one or both lower limbs that lasts for 12 weeks or more (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2020, an estimated 619\u0026nbsp;million people worldwide were affected by low back pain (LBP), with projections suggesting this figure will rise to 843\u0026nbsp;million by 2050, primarily due to population growth and aging. The prevalence of LBP increases with age, peaking around 80 years, while the highest incidence is observed in individuals aged 50 to 55 years. Women are more commonly affected by LBP than men (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A review of the global prevalence of CLBP revealed that CLBP is a major problem throughout the world, with its prevalence being higher among females (35%) compared to males (29%) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Chronic lower back pain is among the four leading musculoskeletal conditions contributing to global impairment. The pain and functional limitations caused by these conditions are significant contributors to reduced quality of life. In developed nations, CLBP stands out as the most prevalent musculoskeletal issue and the primary cause of functional incapacity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Musculoskeletal disorders are estimated to account for around 1% of disability-adjusted life years in developing countries and 4.3% in developed regions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCLBP is considered one of the most common problems in adolescents and is known to affect both young and older adults (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). CLBP is no longer considered a disease of elderly individuals, as approximately 39.8% of the adolescent population is also found to suffer from this condition, according to a previous study (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). According to other studies, approximately 12\u0026ndash;80% of the younger population, especially students, experiences CLBP (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In the United States, back pain is the most common cause of activity limitation in people under the age of 45 years, and considered the second most frequent reason for visits to a physician. This condition was also the fifth leading cause of hospital admission. In addition, CLBP is reported to be the second leading cause of work absenteeism and results in greater loss of productivity than any other medical condition (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).The direct and indirect costs attributable to CLBP are enormous in terms of loss of quality of life, productivity, and absenteeism (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Studies in European countries indicate that the total cost associated with CLBP varies between 0.1% and 2% of the gross domestic product. The costs associated with CLBP in low- and middle-income countries (LMICs) are unknown. The costs associated with loss of productivity are likely to be substantial given that the overall prevalence of CLBP in LMICs is estimated to be approximately 52% in workers (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChronic lower back pain has a great economic impact on healthcare systems in many countries. In the United States, total costs related to this condition reportedly exceed one hundred billion dollars per year (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In the United Kingdom, it is estimated that 116\u0026nbsp;million productive days are lost due to CLBP, and the resulting economic cost is estimated at 12\u0026nbsp;billion GBP annually, whereas in Europe, the direct costs related to CLBP are estimated at 7000 Euros per person per year in Germany and 740 Euros in Sweden. There is a paucity of retrievable research evidence on the economic cost of CLBP in Africa. The financial impact of CLBP is presumed to be enormous on the African continent because of its fragile health systems with limited human and infrastructural resource capacity, amidst a dual burden of infectious and noncommunicable diseases where already restricted funds are directed (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relevant data highlight the prevalence of CLBP in 29.3% of university students aged 18\u0026ndash;29 years. University students have busy lifestyles, juggling between their academics and daily life with alternating postures that cause pain in several joints (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Their demanding lifestyles, which involve balancing academic responsibilities with daily activities, often require prolonged sitting during study sessions, frequent bending, or physical exertion from activities like sports or part-time jobs. These varied postures place strain on multiple joints, contributing to pain. Additionally, the presence of CLBPs can affect students\u0026rsquo; productivity, attendance at lectures and training, thus affecting their future careers. A higher prevalence of CLBP was observed among students with five or more semesters, more likely attributable to activity levels, suggesting that advanced students, who are most often exposed to practical activities, are at increased risk for the disease (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, there is limited data on the prevalence of CLBP among university students in Uganda, which presents a gap in knowledge. Therefore, the aim of this study was to investigate the prevalence, associated factors, and impact of CLBP on health-related quality of life among undergraduate students at Gulu University, Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA cross-sectional study involving undergraduate students of Gulu University, Uganda. Data were collected in November 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting and Participant recruitment\u003c/h3\u003e\n\u003cp\u003eThe study population comprised undergraduate students enrolled in various programs at Gulu University, located in Gulu City, Northern Uganda. Gulu University has an approximate enrollment of 5,000 students across six faculties: Education and Humanities, Medicine, Science, Law, Business and Development, and Agriculture and Environment. A sample size of 374 students was determined via the Kish-Leslie formula, assuming a 58% prevalence of CLBP based on previous studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). We then recruited 394 participants for the final analysis.\u003c/p\u003e \u003cp\u003eThe participants were selected via a combination of cluster and systematic sampling. The university\u0026rsquo;s six faculties served as clusters, and every 15th student on the faculty lists (obtained from the academic registrar\u0026rsquo;s office) was selected until the desired sample size was reached. The 15th student was chosen based on the sampling interval calculated from total population (5000) and desired sample (374), giving 13.37, since systematic sampling requires a whole number, the interval was rounded up to a convenient number, 15 in this case.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: all undergraduate students of any age, sex, and year of study who provided written informed consent. The exclusion criteria included students who were not present during data collection, those with physical injuries (e.g., from road accidents), congenital deformities, mental incapacities, pregnancy, or who did not consent to participate.\u003c/p\u003e \u003cp\u003eData were collected via a self-administered questionnaire and screening tool. Trained research staff guided participants in completing the questionnaires, addressing any questions to provide clarification. The completed questionnaires were stored securely to maintain confidentiality.\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the presence of CLBP, defined as pain in the posterior body area from the lower margin of the twelfth rib to the lower gluteal folds, with or without referred pain in one or both lower limbs, lasting for at least one day. The associated factors evaluated included overall health (EuroQoL Index Score), self-reported health (EQ-VAS Score), gender, year of study, and faculty.\u003c/p\u003e \u003cp\u003eHealth-related quality of life (HRQoL) was assessed using the EuroQoL-5D-5L questionnaire, which measures quality of life across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), as well as the EQ Visual Analog Scale (EQ-VAS), where higher scores indicate better perceived health.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed with descriptive statistics to estimate the prevalence of CLBP and associated factors. T tests and analysis of variance (ANOVA) were used to evaluate the impact of CLBP on health-related quality of life. All the statistical analyses were conducted via SPSS v28 software.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The research proposal was approved by the Gulu University Research Ethics Committee under approval number GUREC-2023-627. All participants provided informed consent before participating in the study. The study adhered to ethical guidelines for research involving human participants, ensuring confidentiality, voluntary participation, and the right to withdraw at any time without penalty.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSociodemographic characteristics\u003c/h3\u003e\n\u003cp\u003eA sample of 394 eligible participants were evaluated for CLBP, and the median age of all the participants was 23 years (IQR: 22\u0026ndash;24). Most of the participants were male, constituting 312 (79.2%), and most of the participants were from the faculty of Agriculture and Environment. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Demographic characteristics of the participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the study participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003cp\u003e312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, median, IQR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e \u003cp\u003e\u0026gt;=24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e263\u003c/p\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.8\u003c/p\u003e \u003cp\u003e33.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003cp\u003e47\u003c/p\u003e \u003cp\u003e130\u003c/p\u003e \u003cp\u003e54\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003cp\u003e11.9\u003c/p\u003e \u003cp\u003e33\u003c/p\u003e \u003cp\u003e13.7\u003c/p\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFaculty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgriculture and Environment Business and development studies Education and Humanity\u003c/p\u003e \u003cp\u003eLaw\u003c/p\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003cp\u003eScience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e78\u003c/p\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003cp\u003e9.1\u003c/p\u003e \u003cp\u003e19.8\u003c/p\u003e \u003cp\u003e11.7\u003c/p\u003e \u003cp\u003e20.3\u003c/p\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003ePrevalence of CLBP among the participants\u003c/h3\u003e\n\u003cp\u003eThe prevalence of CLBP was determined via the Oswestry Disability Index Questionnaire. A total of 20.6% (n\u0026thinsp;=\u0026thinsp;81) of the participants were determined to have experienced nonspecific CLBP lasting more than 12 weeks, whereas 79.4% (n\u0026thinsp;=\u0026thinsp;313) did not experience nonspecific CLBP (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eOswestry CLBP disability index domains.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe analysis of the Oswestry CLBP Disability Index highlights varying levels of disability across different functional domains among the participants. Sitting, lifting and personal care were the most affected domains, with participants having a severity level of 5. However, a substantial proportion of participants reported moderate to severe pain. Social life, standing and traveling were the least affected domains. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDisability level among the participants\u003c/h2\u003e \u003cp\u003eMost participants experienced mild to moderate disability, suggesting that while CLBP was prevalent, it had a manageable impact on most participants. However, a smaller proportion of participants reported severe or complete disability, highlighting that CLBP can significantly impair function in some individuals. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDisability levels of the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFreq (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDisability level\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(11.1))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo disability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40(49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMild disability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate disability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSevere disability\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompletely disabled/Exaggerated symptoms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eQuality of life of the participants\u003c/h2\u003e \u003cp\u003eThe overall health index score of the participants was 0.81 (IQR: 0.71\u0026ndash;0.86), and the overall self-rated health (EQ VAS) score was 80 (IQR: 60\u0026ndash;90). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEQ-5D-5 L frequencies and proportions of Gulu University students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMobility\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelf-care\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUsual activities\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAnxiety/Depression\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 1\u003c/p\u003e \u003cp\u003e(No problems)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e285(72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e277(70.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e242(61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e148(37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e169(42.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 2\u003c/p\u003e \u003cp\u003e(Slight problems)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79(20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92(23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e109(27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e188(47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e163(41.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 3\u003c/p\u003e \u003cp\u003e(Moderate problems)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42(10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 4\u003c/p\u003e \u003cp\u003e(Severe problems)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9(2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 5\u003c/p\u003e \u003cp\u003e(Extreme problems/unable to do)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11(2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with lower back pain according to bivariate analysis\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe factors that were significantly associated with CLBP among the participants included overall health (p\u0026thinsp;=\u0026thinsp;0.001) and the EQ-VAS score (p\u0026thinsp;=\u0026thinsp;0.001). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors significantly associated with CLBP among the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCLBP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;313)\u003c/p\u003e \u003cp\u003eFreq (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003cp\u003eFreq (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61(19.5)\u003c/p\u003e \u003cp\u003e252(80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(25.9)\u003c/p\u003e \u003cp\u003e60(74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, median, IQR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240(76.7)\u003c/p\u003e \u003cp\u003e67 (21.4)\u003c/p\u003e \u003cp\u003e5(1.6)\u003c/p\u003e \u003cp\u003e1(0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(72.8)\u003c/p\u003e \u003cp\u003e21(25.9)\u003c/p\u003e \u003cp\u003e1(.2)\u003c/p\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear of study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116(37.1)\u003c/p\u003e \u003cp\u003e42(13.4)\u003c/p\u003e \u003cp\u003e97(31)\u003c/p\u003e \u003cp\u003e47(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e11(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(43,2)\u003c/p\u003e \u003cp\u003e5(6.2)\u003c/p\u003e \u003cp\u003e33(40.7)\u003c/p\u003e \u003cp\u003e7(8.6)\u003c/p\u003e \u003cp\u003e1(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFaculty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgriculture and Environment Business and development studies Education and Humanity\u003c/p\u003e \u003cp\u003eLaw\u003c/p\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003cp\u003eScience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86(27.5)\u003c/p\u003e \u003cp\u003e28(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e60(19.2)\u003c/p\u003e \u003cp\u003e37(11.8)\u003c/p\u003e \u003cp\u003e73(23.3)\u003c/p\u003e \u003cp\u003e29(9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(37)\u003c/p\u003e \u003cp\u003e8(9.9)\u003c/p\u003e \u003cp\u003e18(22.2)\u003c/p\u003e \u003cp\u003e9(11.1)\u003c/p\u003e \u003cp\u003e7(8.6)\u003c/p\u003e \u003cp\u003e9(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall health, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83(0.75\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67(0.61\u0026ndash;0.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-reported health (EQ VAS). Median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80(65\u0026ndash;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(50\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the prevalence of CLBP among university students and explored associated factors. CLBP was identified as a prevalent condition among students and was significantly associated with overall health and health indices. Most participants reported mild to moderate CLBP, whereas severe disability was less common. These findings emphasized the nature of CLBP and its potential impact on academic performance and quality of life.\u003c/p\u003e \u003cp\u003eThe prevalence of CLBP observed in this study agrees with findings from other student populations globally, reflecting a shared burden of CLBP in young adults. Studies conducted in Serbia (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), Malaysia (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), and Saudi Arabia (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) reported similar prevalence rates, supporting the view that CLBP is a common issue across different educational and cultural settings. The variations in prevalence observed across studies may stem from differences in lifestyle, study environments, and cultural practices. For example, sedentary behavior and prolonged study hours, which are common among university students, are recognized risk factors for CLBP (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These findings noting the importance of addressing modifiable risk factors to mitigate the burden of CLBP in this population.\u003c/p\u003e \u003cp\u003eOur study identified overall health and health indices as significant factors associated with CLBP. Poorer self-reported health was linked to higher CLBP incidence, which is consistent with evidence that compromised physical well-being exacerbates musculoskeletal conditions (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In contrast to some studies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), age was not significantly associated with CLBP in this population, which may reflect the relatively narrow age range of university students. Similar findings were reported in a study from Nigeria, where no significant association between age and CLBP was observed (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Sex was also not significantly associated with CLBP, despite the higher prevalence among males in this study. This contrasts with findings from other studies that reported a higher prevalence among females, attributed to anatomical and functional differences such as smaller stature and less muscle mass (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Further investigations are needed to explore sex-specific patterns of CLBP in this context.\u003c/p\u003e \u003cp\u003eThe CLBP in this study was characterized primarily by mild to moderate disability, which is consistent with findings from Lahore (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and Nigeria (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Severe disability was uncommon, studies involving younger participants, such as those conducted among physiotherapy students have reported the same (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, higher levels of disability have been reported in older populations, where chronic and degenerative changes play a more prominent role (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). These findings reflect the need for early interventions to address CLBP and prevent its progression to more severe disability, particularly among younger populations.\u003c/p\u003e \u003cp\u003eOur study provides valuable insights into CLBP among university students in Gulu city, contributing to the limited body of knowledge on this topic. The use of probability sampling enhanced the generalizability of the findings. However, several limitations should be noted. The reliance on self-reported data may have introduced recall bias, and the small sample size limited the ability to conduct advanced statistical analyses. Furthermore, the study did not assess certain risk factors, such as posture, backpack usage, and physical activity, which are known to influence CLBP.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eApproximately one in every five participants had CLBP. Males are predominantly affected. CLBP significantly, negatively impacted on HRQoL of the affected individuals. We recommend health education on posture and exercise. Longitudinal studies are recommended to confirm associations and develop effective prevention measures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCLBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Lower Back Pain\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow\u0026ndash;and middle\u0026ndash;income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth\u0026ndash;related quality of life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics Approval and Consent to Participate\u003c/h2\u003e \u003cp\u003eThe research proposal was approved by the Gulu University Research Ethics Committee under approval number GUREC-2023-627. All participants provided informed consent before participating in the study. The study adhered to ethical guidelines for research involving human participants, ensuring confidentiality, voluntary participation, and the right to withdraw at any time without penalty.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication\u003c/strong\u003e \u003cp\u003eAll participants provided consent for the publication of the findings from this study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003enot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study received no specific funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.L.T, I.P, L.M.N, J.O, H.P.S, D.S.E, and F.B participated in the conceptualization and design of the study. M.L.T, I.P and F.B performed data collection and initial analysis. M.L.T, I.P, and F.B conducted advanced analysis and interpretation of the results. F.B provided critical revisions. M.L.T, I.P and F.B drafted the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used during the study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal regional, national burden of low back pain. 1990\u0026ndash;2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrennan G, Shafat A, Donncha CM, Vekins C. Lower back pain in physically demanding college academic programs: a questionnaire based study. BMC Musculoskelet Disord. 2007;8(1):67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoyte PC, Asche CV, Croxford R, Chan B. The economic cost of musculoskeletal disorders in Canada. Arthritis Care Res. 1998;11(5):315\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelsey JL, White AA 3. Epidemiology and impact of low-back pain. Spine (Phila Pa 1976). 1980;5(2):133\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalozzi P, Maghini I, Bakdounes L, Ferlito E, Lazzari V, Ermani M, et al. Prevalence of low back pain and its effect on health-related quality of life in 409 scholar adolescents from the Veneto region. Reumatismo. 2019;71(3):132\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurton AK, Clarke RD, McClune TD, Tillotson KM. The natural history of low back pain in adolescents. Spine (Phila Pa 1976). 1996;21(20):2323\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith D, Leggat P. Back Pain in the Young: A Review of Studies Conducted Among School Children and University Students. Curr Pediatr Reviews. 2007;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ed'Errico A, Viotti S, Baratti A, Mottura B, Barocelli AP, Tagna M, et al. Low back pain and associated presenteeism among hospital nursing staff. J Occup Health. 2013;55(4):276\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrow WT, Willis DR. Estimating cost of care for patients with acute low back pain: a retrospective review of patient records. J Am Osteopath Assoc. 2009;109(4):229\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJuniper M, Le TK, Mladsi D. The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother. 2009;10(16):2581\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlafsson G, Jonsson E, Fritzell P, H\u0026auml;gg O, Borgstr\u0026ouml;m F. Cost of low back pain: results from a national register study in Sweden. Eur Spine J. 2018;27(11):2875\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang H, Haldeman S, Lu ML, Baker D. Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey. J Manipulative Physiol Ther. 2016;39(7):459\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoszczowski N, Pinto R, Araujo Junior F. LOW BACK PAIN IN MEDICAL STUDENTS: PREVALENCE AND RELATED FACTORS. Coluna/Columna. 2021;20:197\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVujcic I, Stojilovic N, Dubljanin E, Ladjevic N, Ladjevic I, Sipetic-Grujicic S. Low Back Pain among Medical Students in Belgrade (Serbia): A Cross-Sectional Study. Pain Res Manag. 2018;2018:8317906.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIlic I, Milicic V, Grujicic S, Zivanovic Macuzic I, Kocic S, Ilic MD. Prevalence and correlates of low back pain among undergraduate medical students in Serbia, a cross-sectional study. PeerJ. 2021;9:e11055.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlshagga MA, Nimer AR, Yan LP, Ibrahim IA, Al-Ghamdi SS, Radman Al-Dubai SA. Prevalence and factors associated with neck, shoulder and low back pains among medical students in a Malaysian Medical College. BMC Res Notes. 2013;6:244.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlShayhan FA, Saadeddin M. Prevalence of low back pain among health sciences students. Eur J Orthop Surg Traumatol. 2018;28(2):165\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoroder P, Runer A, Resch H, Tauber M. Low back pain among medical students. Acta Orthop Belg. 2011;77(1):88\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ. 1999;318(7199):1662\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkherayf F, Agbi C. Cigarette smoking and chronic low back pain in the adult population. Clin Invest Med. 2009;32(5):E360\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIssa LF, Seleem NA, Bakheit AM, Baky AA, Fahad A, Alotaibi, editors. Low back pain among undergraduate students at Taif University-Saudi Arabia2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherazi S, Tanveer F. Association of Non Specific Lower Back Pain with Level of Disability among medical students of Lahore. Pakistan J Med Health Sci. 2017;11:253\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZulkifli MN, Saat NZM, Hanawi SA, May Ing JB, Pearanpan L, Suhaimi T et al. The Association between Low Back Pain and Quality of Life among Health Sciences Students. Journal of Clinical and Health Sciences; Vol 8 No 1 (2023): Journal of Clinical and Health SciencesDO \u0026ndash;\u0026thinsp;1024191/jchsv8i118049. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalvetti Mde G, Pimenta CA, Braga PE, Corr\u0026ecirc;a CF. [Disability related to chronic low back pain: prevalence and associated factors]. Rev Esc Enferm USP. 2012;46 Spec No:16\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Chronic low back pain, university students, health-related quality of life, prevalence","lastPublishedDoi":"10.21203/rs.3.rs-5535821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5535821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChronic lower back pain (CLBP) is a common health problem that affects both young and old individuals worldwide and remains a significant global public health concern. However, studies concerning the prevalence of CLBP among undergraduate students are scarce. This study aimed to determine the prevalence and factors associated with CLBP and its impact on health-related quality of life (HRQoL) among undergraduate students at Gulu University, Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eBetween October and November 2023, a cross-sectional study was conducted using self-administered questionnaires. CLBP was defined as non-specific lower back pain lasting more than 12 weeks or more. The Oswestry Disability Index was used to evaluate disability associated with CLBP, and the EuroQoL-5D-5 L was used to evaluate HRQoL (higher scores indicate better HRQoL).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe enrolled 394 participants, 79.2% (n\u0026thinsp;=\u0026thinsp;312) were males, with a median age of 23 (IQR: 22\u0026ndash;24) years. The prevalence of CLBP was 20.6% (n\u0026thinsp;=\u0026thinsp;81), and 66.8% (n\u0026thinsp;=\u0026thinsp;263) of the participants were younger than 24 years. With respect to HRQoL scores (median [IQR]), both overall health (0.83 (0.75\u0026ndash;0.9) versus 0.67 (0.61\u0026ndash;0.78), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and self-reported health (80 (65\u0026ndash;90) versus 65 (50\u0026ndash;80), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were worse in participants with CLBP than in those without CLBP.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eApproximately one in every five participants had CLBP. CLBP is a highly prevalent health problem among students at Gulu University, with a significantly negative impact on their daily life.\u003c/p\u003e","manuscriptTitle":"Chronic lower back pain and its impact on health-related quality of life among undergraduate students of Gulu University, Uganda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-16 17:43:34","doi":"10.21203/rs.3.rs-5535821/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-09T08:52:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T17:54:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-10-06T12:49:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-20T07:46:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39375760150205822485530237643863851677","date":"2025-01-20T06:11:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-19T22:31:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-17T15:16:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14771368810746460911358615723900799480","date":"2025-01-16T08:25:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302329086114014426682615488291869947927","date":"2025-01-09T22:10:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253378429332814087460192485142428811179","date":"2025-01-09T15:18:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-09T07:16:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-29T07:19:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-28T07:07:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-28T07:06:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-11-27T13:24:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f60e2bf-0928-4511-b8be-e96af7f2b272","owner":[],"postedDate":"January 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T09:38:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-16 17:43:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5535821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5535821","identity":"rs-5535821","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}