Work-related musculoskeletal disorders in agriculture: Ergonomics risk assessment and its prevention among Indian farmers

Abstract

BACKGROUND:

Indian farmers have musculoskeletal disorders as agriculture is a physically demanding occupation.

OBJECTIVES:

The main aim of this study is to identify ergonomic and psychosocial risk factors associated with musculoskeletal disorders (MSDs) among different groups of farmers. The other objective is to investigate how MSDs affect farmers’ daily lives and interfere with their activities.

METHODS:

Farmers were evaluated for the repetitiveness of work and MSDs using the standard Nordic questionnaire, ergonomic assessment tool (REBA), and ART tool.

RESULTS:

Low back portions were the most affected body parts, followed by the knees (OR = 0.352; 95% CI = 0.280–0.598), shoulder (OR = 0.657; 95% CI = 0.405–1.066), neck (OR = 0.510; 95% CI = 0.350–0.743), ankle or foot (OR = 0.815; 95% CI = 0.556–1.196), and upper back region (OR = 0.681; 95% CI = 0.463–1.002). The REBA method found that most of the postures in farming are very dangerous. The ART tool showed that most of the activities are repetitive. Working long hours (90%) and monotony at work (87.5%) are the main psychosocial factors, followed by pressure to finish within a given timeframe (71.4%) and injuries related to MSDs.

CONCLUSION:

Farmers suffer from musculoskeletal disorders in various body parts (lower back, knee, neck, shoulder, and upper back) due to squatting, stooping, and other constrained working postures during agricultural activities. rolonged working hours, repetitive movements, and MMH are ergonomic risk factors forFurthermore, p MSDs.

Keywords

Ergonomic risk factors ART manual material handling posture analysis psychosocial risk factors

1 Introduction

Millions of Indian farmers rely on agriculture for their livelihoods. However, farmers had musculoskeletal disorders and injuries due to farming’s physical demands [1]. About half (1.3 billion workers) of the world’s workforce is employed in agriculture [2]. In terms of agricultural production, India ranks second worldwide. 50% of the Indian workforce is used in agriculture, contributing 17–18% to the country’s Gross Domestic Product (GDP) [3]. According to the Census report, approximately 43.35% of men and 46.3% of women are employed in agriculture in West Bengal [4].

Agricultural works are hazardous to farmers’ health; therefore, safety and health sciences, such as ergonomics, are crucial to injury prevention and health promotion [5]. An ergonomic evaluation should include an assessment of the constrained working posture that are associated with agricultural work. The majority of farming activities are performed manually, especially in developing countries. The manual handling of the material is also a significant risk factor for musculoskeletal disorders [6].

A growing number of agricultural occupations are associated with musculoskeletal disorders (MSDs) [7]. Several risks associated with agriculture work contribute to the development of low back pain (LBP). Different types of farming require farmers to perform various kinds of strenuous work in their field of work. MSDs may be caused by farmers committing strenuous physical work in a different working posture (standing, squatting, stooping, and constrained working posture) for a prolonged period. MSDS among farmers is also associated with manual material handling (MMH), rotation, repetitive trunk flexion, and vibration [8, 9]. Farmers may suffer from severe musculoskeletal problems from long periods of constrained working posture and repetitive work with excessive force [10 –15].

The main risk factors for reported MSDs are repetitive work, repetitive lifting and moving of heavy loads, prolonged trunk flexion (also known as stooping), intensive hand work, and constrained working postures of wrists and trunks [16, 17]. As a result, agricultural workers in developed and developing countries frequently suffer from low back pain (LBP) [17 –19]. Low back pain is primarily caused by repetitive and sustained stooping posture [17, 19].

There have also been studies investigating the prevalence and risk factors of symptoms of musculoskeletal disorders in agricultural workers [20 –23]. A substantial amount of hand labor is needed in agriculture in India, particularly in rice and potato cultivation, such as lifting, carrying, bending, or pulling heavy loads (harvesting, sowing, and watering) [23, 24].

The study evaluated i) potential ergonomic and psychosocial factors associated with MSDs among different groups of farmers, ii) frequency and severity of musculoskeletal symptoms among different groups of farmers, iii) the causes of discomfort caused by constrained working postures using different posture analysis methods, iv) evaluation and comparison of musculoskeletal disorders among different farmer groups. v) The gender effect of prevalence of musculoskeletal symptoms (MSS) and disruption of everyday work caused by MSS.

2 Methods

2.1 Research design and setting

A random sampling of four hundred and seventy-two farmers from Chowtara, Banna, Gopinagar, and Ichhapur of the Hooghly district near Tarakeswar, West Bengal, was conducted in this study. For this cross-sectional study, West Bengal, India, was chosen to avoid bias. Due to unwillingness to share data and other factors, 37 farmers declined to participate, and 23 were excluded due to random sampling. The four hundred and seventy-two farmers are divided into two groups: 235 work on their farms, while 237 are paid, farmers (who work as a paid labors). Out of 472 farmers in this study, 213 are rice farmers, 206 are potato farmers, and 56 are groundnut farmers.This study included only farmers with at least two years of farming practice. In addition, farmers with a history of occupational injuries were excluded from the study. A questionnaire was used to gather this information, which included years of experience and previous occupational injury history. Performed the interview among farmers during recess (without obstructing their work) and after the participants had completed their day’s work. The Indian Council of Medical Research Guidelines Institutional Human Ethical Clearance Committee approved (Approval number 01/2019, dated 12.03.2019) the study before it was conducted.

2.2 Nordic modified questionnaire (NMQ) study

For analyzing the different types of discomfort (pain, numbness, tingling, swelling, etc.) in the other parts of the body, the Nordic questionnaire [25] was used among the study participants. Before the survey was conducted, the farmers gave individual explanations of the procedure. While farming was in recess, interviews were conducted confidentially. A variety of objective questions are included in this questionnaire, written in the local language (Bengali). Farmers were asked about their details, socioeconomic conditions, types of activities they perform, and the types of pain they feel in various parts of their bodies. The first part of the process involves identifying the symptoms of discomfort (pain) in different body parts of the body and pain experienced for the past 24 hours, 7 days, and the past 12 months.

The NMQ includes questions pertaining to musculoskeletal problems during the past 24 hours, past 7 days, and past 12 months in nine anatomical areas of the body (neck, shoulders, upper back, elbows, wrists/hands, lower back, hips/thighs, knees, and ankles/feet). Regarding discomfort or pain in these areas, only a “yes” or “no” response was needed by the farmers to assess the pain or discomfort.

2.3 Assessment of repetitive tasks (ART) tool

ART is a tool designed to assess repetitive upper-limb tasks. This study examines common risk factors associated with repetitive work contributing to upper limb disorders. Upper Limb Disorders (ULDs) can be diagnosed by assessing common risk factors related to repetitive work [26]. Generally, used this tool to determine how often work processes were repeated. ART identifies the common risk factors in repetitive work related to upper limb development disorders and assesses tasks that require repetitive movement of upper body parts (arms and hands).

The assessment of ART tool is split into four stages: Stage A: Frequency and repetition of movements; Stage B: Force; Stage C: Awkward postures; Stage D: Additional factors.

Moreover, in Stage A, there is mainly two divisions, A1 = Arm movements (Observe the movement of the arm and select the category that is most appropriate) and A2 = Repetitions (This refers to movement of the arm and hand, but not the fingers). Stage B: Force (This mainly determine the level of force exerted with the hand and the amount of time that the force is exerted).

2.4 Examination of working posture

This study investigated several agricultural activities, including weeding, spading, ridging, carrying, sowing, sprinkling water, harvesting, threshing, and winnowing. The farmers performed all these activities in a constrained working posture. The postural analysis was performed using the Rapid Entire Body Assessment (REBA) method [27] to analyze different working postures in other activities in rice farming, potato farming, and groundnut farming in all the experimental farmers. First, the analysis of different working postures of the diverse group of farmers with the REBA method was carried out with digital photography (Sony Handycam 360X, Japan). Later on, stick diagrams were drawn from frozen frame video records and eventually subjected to analysis. All the farmer working postures were analyzed based on the most frequent ones.

In the REBA, the neck, trunk, and leg are scored (score A), the arm, forearm, and wrist are scored (score B), as well as the final score (grand score). Scores A and B were also calculated based on force, grip type, and muscle activity. As a result, a final score was calculated based on the proportion of musculoskeletal risks to each individual. Five action levels were created to represent the risk level: action level 0 (REBA score of 1), which indicates negligible risks; action level 1 (REBA score of 2–3), which indicates low risks; action level 2 (REBA score of 4–7), which indicates a medium level of risk, action level 3 (REBA score of 8–10), which indicates a high level of risk, and action level 4 (REBA score of 11–15), which indicates a very high level of risk.

REBA method has the advantage of evaluating different body parts at once: the upper limbs (arms, forearms, and wrists), the lower extremities, and the trunk. This method helps identify workers’ forced postures and develop improvement measures if necessary [28]. The REBA method has some advantages and limitations. i) It has a good cost-effectiveness ratio. ii) Easy to implement. While pen and paper are sufficient for data collection, computer applications can speed up/facilitate the process. iii) after assessing each body part, individual scores are used to identify the most conflicting ergonomic aspects [29]. The limitations of this method are as follows: i) cannot analyze sequences or sets of postures. ii) The researchers will determine how to evaluate the different constrained working postures. It may or may not be possible to examine some positions adopted. In addition, it only measures the intensity of the effort. The exposure duration and postures frequency throughout the working day are not considered [28].

2.5 Borg’s CR 10 scale

A Borg scale CR10 was used to measure the farmers’ perceived discomfort across different body parts, including their shoulders, hands, wrists, elbows, and lower extremities, including their low backs, hips, thighs, legs, and feet. The Borg CR10 scale [30] has been used in different studies to measure perceived discomfort subjectively. According to the Borg CR10 scale, 0 represents no discomfort, 5 represents intense discomfort, and 10 represents extreme discomfort. Many studies have confirmed the validity and reliability of the scale [31, 32].

2.6 Data analysis

The study involves a total of 472 farmers. The data were analyzed with Primer of Biostatistics (5.0.msi, MSI version = 1.20.1827.0; McGraw-Hill). The data were summarized using descriptive statistics (frequency and percentage). Multiple logistic regression models were used to assess the prevalence of MSDs in various body parts, their odds ratios (ORs), and 95% confidence intervals (CIs). P-values less than 0.05 were considered statistically significant for all statistical tests.

3 Results

3.1 Sociodemographic variables and work-related details

According to Table 1, 45.1% of rice farmers, 43.6% of potato farmers, and 11.3% of groundnut farmers participated in the study. According to Table 1, 52.8 % of farmers are male, while 47.2 % are female. MSDs are prevalent in 69% of female farmers, while only 66.3% of male farmers. According to Table 1, people aged 40–49 (87.9%) are more likely to suffer from most MSDs than others. Most farmers (48.9%) work 8 hours a day, 27.3% work 9 hours a day, and 23.8% work 7 hours a day. Table 1 shows that 89.4% of farmers work with repetitive hand movements, while 8.5% report occasionally performing repetitive hand movements. According to the study, 92.6% of the farmers reported working awkwardly while farming, whereas only 4.9% reported sometimes adopting a constrained working posture. As a result of working with a constrained working posture and repetitive tasks, MSDs are more prevalent among different groups of farmers.

Table 1
Socio-demographic variables and work-related details of different types of farmers (n = 472)

Socio-demographic variables N (%) No. of workers Prevalence rate (%) Unadjusted OR (95% CI) P value

With MSD

Total 472 100 319 67.60%

Gender

Male farmers 249 52.8 165 66.3 1

Female farmers 223 47.2 154 69 0.880 (0.598,1.296) 0.583

Age (years)

≤30 159 33.7 62 39 1

3139 161 34.1 126 78.3 0.178 (0.109,0.290) 0.001

4049 116 24.6 102 87.9 0.088 (0.046,0.167) 0.001

≥50 36 7.6 29 80.5 0.154 (0.064, 0.374) 0.001

BMI (kg / m²)

≤18.5 38 8 2 5.3 1

18.524.9 225 52.7 116 51.6 0.052 (0.012, 0.222) 0.001

25 29.9 179 37.9 173 96.6 0.002 (0.001, 0.010) 0

≥30 30 6.4 28 93.3 0.004 (0.001, 0.030) 0.001

Education

Illiterate 131 27.8 63 48 1

Primary 227 48 188 82.8 0.192 (0.118 to 0.313) 0.001

Secondary 95 20.1 51 53.7 0.836 (0.494 to 1.414) 0.592

Higher secondary 19 4.1 17 89.5 0.109 (0.024 to 0.491) 0.002

Duration of work

7 hours / day 112 23.8 49 43.8 1

8 hours / day 231 48.9 159 68.8 0.352 (0.221, 0.561) 0

9 hours / day 129 27.3 111 86 0.126 (0.068 to 0.236) 0

Types of farmers

Working in his/her farm 235 49.8 202 86 1

Works a daily wage farmers 237 50.2 117 49.4 6.278 (4.013, 9.822) 0

Occupations

Rice farmers 213 45.1 171 80.3 1

Potato farmers 206 43.6 133 64.6 2.235 (1.436, 3.477) 0

Groundnut farmers 53 11.3 15 28.3 10.314 (5.192, 20.490) 0

Previous work experience

Yes 411 87.1 264 64.2 1

No 61 12.9 55 90.2 0.196 (0.082 to 0.466) 0

Injury history

Yes 36 7.6 31 86.1 1

No 436 92.4 288 66 3.18 (1.214, 8.364) 0.022

Repetitive hand movement during work

Yes 422 89.4 292 69.2 1

Occasionally 40 8.5 25 62.5 1.348 (0.688,2.641) 0.488

No 10 2.1 2 20 8.895 (1.882,42.895) 0.003

Awkward postures while performing work

Yes 437 92.6 312 71.4 1

Occasionally 23 4.9 5 21.7 8.986 (3.265,24.728) 0

No 12 2.5 2 16.7 12.48 (2.696, 57.769) 0

Socio-demographic variables	N	(%)	No. of workers	Prevalence rate (%)	Unadjusted OR (95% CI)	P value
Total	472	100	319	67.60%
Gender
Male farmers	249	52.8	165	66.3	1
Female farmers	223	47.2	154	69	0.880 (0.598,1.296)	0.583
Age (years)
≤30	159	33.7	62	39	1
3139	161	34.1	126	78.3	0.178 (0.109,0.290)	0.001
4049	116	24.6	102	87.9	0.088 (0.046,0.167)	0.001
≥50	36	7.6	29	80.5	0.154 (0.064, 0.374)	0.001
BMI (kg / m²)
≤18.5	38	8	2	5.3	1
18.524.9	225	52.7	116	51.6	0.052 (0.012, 0.222)	0.001
25 29.9	179	37.9	173	96.6	0.002 (0.001, 0.010)	0
≥30	30	6.4	28	93.3	0.004 (0.001, 0.030)	0.001
Education
Illiterate	131	27.8	63	48	1
Primary	227	48	188	82.8	0.192 (0.118 to 0.313)	0.001
Secondary	95	20.1	51	53.7	0.836 (0.494 to 1.414)	0.592
Higher secondary	19	4.1	17	89.5	0.109 (0.024 to 0.491)	0.002
Duration of work
7 hours / day	112	23.8	49	43.8	1
8 hours / day	231	48.9	159	68.8	0.352 (0.221, 0.561)	0
9 hours / day	129	27.3	111	86	0.126 (0.068 to 0.236)	0
Types of farmers
Working in his/her farm	235	49.8	202	86	1
Works a daily wage farmers	237	50.2	117	49.4	6.278 (4.013, 9.822)	0
Occupations
Rice farmers	213	45.1	171	80.3	1
Potato farmers	206	43.6	133	64.6	2.235 (1.436, 3.477)	0
Groundnut farmers	53	11.3	15	28.3	10.314 (5.192, 20.490)	0
Previous work experience
Yes	411	87.1	264	64.2	1
No	61	12.9	55	90.2	0.196 (0.082 to 0.466)	0
Injury history
Yes	36	7.6	31	86.1	1
No	436	92.4	288	66	3.18 (1.214, 8.364)	0.022
Repetitive hand movement during work
Yes	422	89.4	292	69.2	1
Occasionally	40	8.5	25	62.5	1.348 (0.688,2.641)	0.488
No	10	2.1	2	20	8.895 (1.882,42.895)	0.003
Awkward postures while performing work
Yes	437	92.6	312	71.4	1
Occasionally	23	4.9	5	21.7	8.986 (3.265,24.728)	0
No	12	2.5	2	16.7	12.48 (2.696, 57.769)	0

3.2 Sociodemographic variables among the different group’s farmers

Table 2 provides a comparative analysis of the three groups based on the results of farmers. As a result of the study, rice farmers are most affected (80.3%) by MSDs, whereas potato and groundnut farmers have prevalence rates of 64.6% and 28.3%, respectively. In addition to BMI, education, household income, previous work experience, and MSDs, there was a significant difference between the three groups of farmers at p < 0.05.

Table 2
Comparative analysis of sociodemographic variables among the different group’s farmers

Socio-demographic variables Rice farmers Potato farmers Groundnut farmers P value

N = 213 (%) N = 206 (%) N = 53 %

Age (years) 0.124

≤30 72 (33.8) 67 (32.5) 20 (37.7)

31–39 78 (36.6) 65 (31.6) 18 (34.0)

40–49 52 (24.4) 51 (24.8) 13 (24.5)

≥50 11 (5.2) 23 (11.1) 02 (3.8)

BMI (kg / m²) 0.000

≤18.5 11 (5.2) 21 (10.2) 06 (11.3)

18.5–24.9 104 (48.8) 111 (53.9) 10 (18.9)

25 –29.9 89 (41.8) 70 (34.0) 20 (37.7)

≥30 09 (4.2) 04 (1.9) 17 (32.1)

Education 0.000

Illiterate 61 (28.6) 52 (25.3) 18 (34.0)

Primary 95 (44.6) 107 (51.9) 25 (47.2)

Secondary 55 (25.8) 32 (15.5) 08 (15.1)

Higher secondary 02 (1.0) 15 (7.3) 02 (3.7)

Household Income (in Rupees/ year) 0.003

≤100000.00 104 (48.8) 107 (52.0) 26 (49.1)

100001–200000 82 (38.5) 50 (24.2) 21 (39.6)

≥200001.00 27 (12.7) 49 (23.8) 06 (11.3)

Duration of work 0.142

7 hours / day 52 (24.4) 44 (21.4) 16 (30.2)

8 hours / day 102 (47.9) 111 (53.9) 18 (34.0)

9 hours / day 59 (27.7) 51 (24.7) 19 (35.8)

Previous work experience 0.000

Yes 201 (94.4) 163 (79.1) 47 (88.7)

No 12 (5.6) 43 (20.9) 06 (11.3)

Suffers from MSD 0.000

Yes 171 (80.3) 133 (64.6) 15 (28.3)

No 42 (19.7) 73 (35.4) 38 (71.7)

Injury history 0.964

Yes 17 (8.0) 15 (7.3) 04 (7.5)

No 196 (92.0) 191 (92.7) 49 (92.5)

Socio-demographic variables	Rice farmers	Potato farmers	Groundnut farmers	P value
Age (years)							0.124
≤30	72	(33.8)	67	(32.5)	20	(37.7)
31–39	78	(36.6)	65	(31.6)	18	(34.0)
40–49	52	(24.4)	51	(24.8)	13	(24.5)
≥50	11	(5.2)	23	(11.1)	02	(3.8)
BMI (kg / m²)							0.000
≤18.5	11	(5.2)	21	(10.2)	06	(11.3)
18.5–24.9	104	(48.8)	111	(53.9)	10	(18.9)
25 –29.9	89	(41.8)	70	(34.0)	20	(37.7)
≥30	09	(4.2)	04	(1.9)	17	(32.1)
Education							0.000
Illiterate	61	(28.6)	52	(25.3)	18	(34.0)
Primary	95	(44.6)	107	(51.9)	25	(47.2)
Secondary	55	(25.8)	32	(15.5)	08	(15.1)
Higher secondary	02	(1.0)	15	(7.3)	02	(3.7)
Household Income (in Rupees/ year)							0.003
≤100000.00	104	(48.8)	107	(52.0)	26	(49.1)
100001–200000	82	(38.5)	50	(24.2)	21	(39.6)
≥200001.00	27	(12.7)	49	(23.8)	06	(11.3)
Duration of work							0.142
7 hours / day	52	(24.4)	44	(21.4)	16	(30.2)
8 hours / day	102	(47.9)	111	(53.9)	18	(34.0)
9 hours / day	59	(27.7)	51	(24.7)	19	(35.8)
Previous work experience							0.000
Yes	201	(94.4)	163	(79.1)	47	(88.7)
No	12	(5.6)	43	(20.9)	06	(11.3)
Suffers from MSD							0.000
Yes	171	(80.3)	133	(64.6)	15	(28.3)
No	42	(19.7)	73	(35.4)	38	(71.7)
Injury history							0.964
Yes	17	(8.0)	15	(7.3)	04	(7.5)
No	196	(92.0)	191	(92.7)	49	(92.5)

3.3 Reported musculoskeletal symptoms

The results of the univariate logistic regression analyses are shown in Table 3. According to the results of the logistic regression analyses, more females than males reported pain in their neck (OR = 0.51, 95% CI: 0.350–0.743, p < 0.001), shoulders (OR = 0.65, 95% CI: 0.405–1.066, p = 0.122), lower back (OR 0.181, 95% CI: 0.069–0.477), knees (OR 0.352, 95% CI: 0.280–0.598). Disruption of normal activities due to such symptoms and the severity of complaints are also presented in Table 3. The reported symptoms were mostly significant different between males and females. However, more females than males reported disruption of normal activities due to neck, shoulder, elbows, upper back, low back, and knees (p < 0.05) symptoms.

Table 3
Reported musculoskeletal symptoms among male and female farmers

Body regions Sex Prevalence of musculoskeletal symptoms (MSS) Disruption of normal work due to MSS

N % OR 95% CI P value N % OR 95% CI P value

Neck Male 130 52.2 0.510 (0.350–0.743) 0.000 72 28.9 0.624 (0.425, 0.916) 0.020

Female 152 68.2 88 39.5

Shoulder Male 190 76.3 0.657 (0.405–1.066) 0.112 90 36.1 0.671 (0.464, 0.971) 0.043

Female 192 86.0 102 45.7

Elbows Male 25 10.0 0.580 (0.336, 1.001) 0.066 14 5.6 0.415 (0.213, 0.810) 0.013

Female 36 16.1 28 12.6

Hands Male 27 10.8 0.726 (0.420, 1.255) 0.312 25 10.0 0.718 (0.408, 1.263) 0.313

Female 32 14.3 30 13.5

Upperback Male 72 28.9 0.681 (0.463, 1.002) 0.064 14 5.6 0.356 (0.184, 0.686) 0.002

Female 84 37.6 32 14.3

Lower back Male 221 88.8 0.181 (0.069, 0.477) 0.000 144 57.8 0.516 (0.351, 0.761) 0.001

Female 218 97.8 162 72.6

Hip/Thigh/Buttock Male 10 4.0 0.541 (0.240, 1.219) 0.194 01 0.4 0.296 (0.031, 2.864) 0.539

Female 16 7.2 03 1.3

Knees Male 190 76.3 0.352 (0.280, 0.598) 0.001 132 53.0 0.434 (0.296, 0.638) 0.000

Female 201 90.1 161 72.2

Ankle/feet Male 78 31.3 0.815 (0.556, 1.196) 0.343 25 10.0 0.561 (0.326, 0.966) 0.049

Female 80 35.9 37 16.6

Body regions	Sex	Prevalence of musculoskeletal symptoms (MSS)	Disruption of normal work due to MSS
Neck	Male	130	52.2	0.510 (0.350–0.743)	0.000	72	28.9	0.624 (0.425, 0.916)	0.020
	Female	152	68.2			88	39.5
Shoulder	Male	190	76.3	0.657 (0.405–1.066)	0.112	90	36.1	0.671 (0.464, 0.971)	0.043
	Female	192	86.0			102	45.7
Elbows	Male	25	10.0	0.580 (0.336, 1.001)	0.066	14	5.6	0.415 (0.213, 0.810)	0.013
	Female	36	16.1			28	12.6
Hands	Male	27	10.8	0.726 (0.420, 1.255)	0.312	25	10.0	0.718 (0.408, 1.263)	0.313
	Female	32	14.3			30	13.5
Upperback	Male	72	28.9	0.681 (0.463, 1.002)	0.064	14	5.6	0.356 (0.184, 0.686)	0.002
	Female	84	37.6			32	14.3
Lower back	Male	221	88.8	0.181 (0.069, 0.477)	0.000	144	57.8	0.516 (0.351, 0.761)	0.001
	Female	218	97.8			162	72.6
Hip/Thigh/Buttock	Male	10	4.0	0.541 (0.240, 1.219)	0.194	01	0.4	0.296 (0.031, 2.864)	0.539
	Female	16	7.2			03	1.3
Knees	Male	190	76.3	0.352 (0.280, 0.598)	0.001	132	53.0	0.434 (0.296, 0.638)	0.000
	Female	201	90.1			161	72.2
Ankle/feet	Male	78	31.3	0.815 (0.556, 1.196)	0.343	25	10.0	0.561 (0.326, 0.966)	0.049
	Female	80	35.9			37	16.6

3.4 Musculoskeletal symptoms reported by different types of farmers

Table 4 states that there are two types of farmers in this study. Group A farmers work on their agricultural land, and Group B farmers generally work as daily wage labor. The study also found that both groups of farmers are affected among these two groups, especially in the low back, 98.7% and 87.3%, followed by 89.7% and 77.2%, respectively, shoulder 89.4% and 72.6%, respectively. The result of the study also shows that farmers works in his/her farm reported more discomfort feeling (pain) than farmers works as daily wage labour in their neck (OR = 7.293, 95% CI: 4.782 –11.123, p < 0.001), shoulders (OR = 3.174, 95% CI: 1.919–5.251, p < 0.001), lower back (OR = 11.208, 95% CI: 3.371–37.268), knees (OR = 2.455, 95% CI: 1.468–4.105).

Table 4
Musculoskeletal symptoms reported by different groups of farmers

Body regions Group A farmers Group B farmers OR 95% CI P value

Farmers works in Farmers works as a

his/her farm a daily wage labor

(N = 235) (N = 237)

N (%) N (%)

Neck 192 (81.7) 90 (38.0) 7.293 (4.782, 11.123) 0.000

Shoulder 210 (89.4) 172 (72.6) 3.174 (1.919, 5.251) 0.000

Elbows 41 (17.4) 20 (8.4) 2.293 (1.299, 4.049) 0.005

Hands 37 (15.7) 22 (9.3) 1.826 (1.041, 3.203) 0.047

Upper back 83 (35.3) 73 (30.7) 1.227 (0.835, 1.801) 0.344

Lower back 232 (98.7) 207 (87.3) 11.208 (3.371, 37.268) 0.000

Hip/Thigh/Buttock 15 (6.4) 09 (3.8) 1.727 (0.741, 4.029) 0.285

Knees 208 (89.7) 183 (77.2) 2.455 (1.468, 4.105) 0.000

Ankle/feet 81 (34.5) 77 (32.5) 1.093 (0.746, 1.602) 0.720

Body regions	Group A farmers	Group B farmers	OR 95% CI	P value
Neck	192	(81.7)	90	(38.0)	7.293 (4.782, 11.123)	0.000
Shoulder	210	(89.4)	172	(72.6)	3.174 (1.919, 5.251)	0.000
Elbows	41	(17.4)	20	(8.4)	2.293 (1.299, 4.049)	0.005
Hands	37	(15.7)	22	(9.3)	1.826 (1.041, 3.203)	0.047
Upper back	83	(35.3)	73	(30.7)	1.227 (0.835, 1.801)	0.344
Lower back	232	(98.7)	207	(87.3)	11.208 (3.371, 37.268)	0.000
Hip/Thigh/Buttock	15	(6.4)	09	(3.8)	1.727 (0.741, 4.029)	0.285
Knees	208	(89.7)	183	(77.2)	2.455 (1.468, 4.105)	0.000
Ankle/feet	81	(34.5)	77	(32.5)	1.093 (0.746, 1.602)	0.720

Fig. 1

Comparative analysis of percentage of discomfort feeling (Pain) in different body parts among different group of farmers.

Fig. 2

Comparative study of feelings of discomfort (pain) at different times among the different groups of farmers.

3.5 Assessment repetitive task (ART) analysis

Table 5 shows the ART tool’s analysis of repetitive tasks. According to the results, pain in different body parts, specifically A1, A2, and B, was represented as Arm movements, repletion, and force, respectively, and showed the highest values due to high repetitive movements of the respective body parts and in some cases due to constrained static postures. ART analysis revealed a high exposure level in rice and potato farmers, requiring urgent investigation. The exposure level of groundnut farmers is medium and requires further research.

Table 5
Result of the repetitiveness of work (ART Analysis) in different group of farmers

Sl No. Category Rice farmers Potato farmers Groundnut farmers

Sub Category Score Sub Category Score Sub Category Score

A1 Arm movements Very frequent (e.g. almost continuous movement) 06 Very frequent (e.g. almost continuous movement) 06 Frequent (eg regular movement with some pauses) 03

A2 Repetition More than 20 times per minute 06 More than 20 times per minute 06 10 times per minute or less 00

B Force Force is obviously high, strong or heavy 06 Force is obviously high, strong or heavy 06 There is no indication of any particular effort 00

Awkward Posture

C1 Head/neck posture Bent or twisted more than half of the time (more than 50%) 02 Bent or twisted more than half of the time (more than 50%) 02 Bent or twisted more than half of the time (more than 50%) 02

C2 Back posture Bent forward, sideways or twisted for more than half of the time 02 Bent forward, sideways or twisted for more than half of the time 02 Bent forward, sideways or twisted for more than half of the time 02

C3 Arm posture Raised away from the body part of the time 02 Raised away from the body part of the time 02 Kept close to the body or supported 00

C4 Wrist posture Bent or deviated more thanhalf of the time 02 Bent or deviated more than half of the time 02 Bent or deviated more than half of the time 02

C5 Hand/Finger grip Pinch or wide finger grip for more than half of the time 02 Pinch or wide finger grip for more than half of the time 02 Pinch or wide finger grip for more than half of the time 02

Additional Factors

D1 Breaks 3 hours to less than 4 hours 06 3 hours to less than 4 hours 06 3 hours to less than 4 hours 06

D2 Work pace Not difficult to keep up with the work 00 Not difficult to keep up with the work 00 Not difficult to keep up with the work 00

D3 Other factors Two or more factors are present 02 Two or more factors are present 02 Two or more factors are present 02

D4 Durations 4 hours to 8 hours 1 4 hours to 8 hours 1 4 hours to 8 hours 1

D5 Psychosocial factor monotonous work; excessive work demands monotonous work; excessive work demands monotonous work; excessive work demands

Task Score = A1 + A2 + B+C1 + C2 + C3 + C4 + C5 + D1 + D2 + D3 36 36 19

Exposure Score = Task Score x D4 361 = 36 19*1 = 19

Proposed exposure level: HIGH; Further investigation required urgently Medium: Further investigation required

Sl No.	Category	Rice farmers	Potato farmers	Groundnut farmers
A1	Arm movements	Very frequent (e.g. almost continuous movement)	06	Very frequent (e.g. almost continuous movement)	06	Frequent (eg regular movement with some pauses)	03
A2	Repetition	More than 20 times per minute	06	More than 20 times per minute	06	10 times per minute or less	00
B	Force	Force is obviously high, strong or heavy	06	Force is obviously high, strong or heavy	06	There is no indication of any particular effort	00
Awkward Posture
C1	Head/neck posture	Bent or twisted more than half of the time (more than 50%)	02	Bent or twisted more than half of the time (more than 50%)	02	Bent or twisted more than half of the time (more than 50%)	02
C2	Back posture	Bent forward, sideways or twisted for more than half of the time	02	Bent forward, sideways or twisted for more than half of the time	02	Bent forward, sideways or twisted for more than half of the time	02
C3	Arm posture	Raised away from the body part of the time	02	Raised away from the body part of the time	02	Kept close to the body or supported	00
C4	Wrist posture	Bent or deviated more thanhalf of the time	02	Bent or deviated more than half of the time	02	Bent or deviated more than half of the time	02
C5	Hand/Finger grip	Pinch or wide finger grip for more than half of the time	02	Pinch or wide finger grip for more than half of the time	02	Pinch or wide finger grip for more than half of the time	02
Additional Factors
D1	Breaks	3 hours to less than 4 hours	06	3 hours to less than 4 hours	06	3 hours to less than 4 hours	06
D2	Work pace	Not difficult to keep up with the work	00	Not difficult to keep up with the work	00	Not difficult to keep up with the work	00
D3	Other factors	Two or more factors are present	02	Two or more factors are present	02	Two or more factors are present	02
D4	Durations	4 hours to 8 hours	*1	4 hours to 8 hours	*1	4 hours to 8 hours	*1
D5	Psychosocial factor	monotonous work; excessive work demands		monotonous work; excessive work demands		monotonous work; excessive work demands
Task Score = A1 + A2 + B+C1 + C2 + C3 + C4 + C5 + D1 + D2 + D3 36	36		19
Exposure Score = Task Score x D4 36*1 = 36	19*1 = 19
Proposed exposure level:	HIGH; Further investigation required urgently	Medium: Further investigation required

3.6 Ergonomic exposures

Farmers are exposed to different ergonomic hazards due to various agricultural activities. Among all groups of farmers, repetitive extension and flexion of the elbow for more than one hour/day (64.4%) is the highest risk factor (64.4%), followed by squatting or kneeling for more than one hour/day (63.3%), moving wrists and fingers for more than four hours per day (54.9%), and working with hands above shoulder height for more than one hour/day (44.5%) (Table 6).

Table 6
Ergonomic exposures among different group of farmers

Risk factors Rice farmers Potato farmers Groundnut farmers All farmers P value

N = 213 N = 206 N = 53 N = 472

N % N % N % N %

Ergonomic exposures at work

Repetitive extension &flexion of elbow for > 1 h/day 123 55.4 138 67.0 43 81.1 304 64.4 0.004

Moving wrist and fingers for > 4 h/day 87 40.8 147 71.4 25 47.2 259 54.9 0.000

Squatting or kneeling for > 1 h/day 118 55.4 133 64.6 48 90.6 299 63.3 0.000

Working with hand above shoulder height for > 1 h/day 102 47.9 75 36.4 33 62.3 210 44.5 0.001

Lifting loads weighing≥25 kg 92 43.2 67 32.5 12 22.6 171 36.2 0.007

Risk factors	Rice farmers	Potato farmers	Groundnut farmers	All farmers	P value
Ergonomic exposures at work
Repetitive extension &flexion of elbow for > 1 h/day	123	55.4	138	67.0	43	81.1	304	64.4	0.004
Moving wrist and fingers for > 4 h/day	87	40.8	147	71.4	25	47.2	259	54.9	0.000
Squatting or kneeling for > 1 h/day	118	55.4	133	64.6	48	90.6	299	63.3	0.000
Working with hand above shoulder height for > 1 h/day	102	47.9	75	36.4	33	62.3	210	44.5	0.001
Lifting loads weighing≥25 kg	92	43.2	67	32.5	12	22.6	171	36.2	0.007

3.7 Psychosocial factors

Table 7 presents psychosocial factors related to WMSDs among all farmer groups. Again, psychosocial factors like long working hours (90%) dominate the study results. Furthermore, monotony at work (87.5%), working despite severe pain because of fear of losing a job (83.0%), being required to finish a specific number of items/days (71.4%), and being pressured to finish the job on time (67.2%) are also critical psychosocial factors.

Table 7
Work organization and work behaviour, work stress among different group of farmers

Risk factors Rice farmers Potato farmers Groundnut farmers All farmers P value

(N = 213) (N = 206) (N = 53) (N = 472)

N % N % N % N %

Work organization and work behaviour

Rigidity in work methods and procedure 188 88.3 180 87.4 44 83.0 412 87.3 0.590

Lack of frequent rotation for task and place 173 81.2 145 68.0 41 77.4 359 76.0 0.033

Job demands repetitive motions of body segments 192 90.1 195 94.7 48 90.6 435 92.2 0.205

Psychosocial factors

Work under pressure to finish job on time 133 62.4 147 71.4 37 69.8 317 67.2 0.138

Required to finish a specific number of items/days 145 68.0 152 73.8 40 75.5 337 71.4 0.340

Worked despite severe pain due to fear of losing job 173 81.2 182 88.3 37 69.8 392 83.0 0.004

Monotony at work 188 88.3 180 87.4 45 84.9 413 87.5 0.802

Long working hours 195 91.5 182 88.3 48 90.6 425 90.0 0.545

Lack of rest break 72 33.8 83 40.3 36 67.9 191 40.5 0.000

Risk factors	Rice farmers	Potato farmers	Groundnut farmers	All farmers	P value
Work organization and work behaviour
Rigidity in work methods and procedure	188	88.3	180	87.4	44	83.0	412	87.3	0.590
Lack of frequent rotation for task and place	173	81.2	145	68.0	41	77.4	359	76.0	0.033
Job demands repetitive motions of body segments	192	90.1	195	94.7	48	90.6	435	92.2	0.205
Psychosocial factors
Work under pressure to finish job on time	133	62.4	147	71.4	37	69.8	317	67.2	0.138
Required to finish a specific number of items/days	145	68.0	152	73.8	40	75.5	337	71.4	0.340
Worked despite severe pain due to fear of losing job	173	81.2	182	88.3	37	69.8	392	83.0	0.004
Monotony at work	188	88.3	180	87.4	45	84.9	413	87.5	0.802
Long working hours	195	91.5	182	88.3	48	90.6	425	90.0	0.545
Lack of rest break	72	33.8	83	40.3	36	67.9	191	40.5	0.000

3.8 Posture analysis

In REBA, the upper limbs (arm, forearm, wrist), trunk, neck, and lower extremities can be assessed together. Additionally, it distinguishes between different types of grips and muscle activities. There are five levels of risk, ranging from negligible to very high. By applying the REBA method, postural disorders of the whole body can be identified in relation to muscular action, external loads applied to the body, and grip type. Additionally, these methods are widely applied in several working contexts, primarily in agriculture [10]. As a result of the difficulty in evaluating the biomechanical overload risk in primary sector activities, REBA have been adopted a few times in the agricultural sector. Due to the wide variability of tasks the operators must perform, REBA has been adopted a few times in the agricultural sector [33].

The REBA method is used to assess the different body postures involved in different agricultural activities in rice, potato and groundnut farming. REBA method is applied to identify postural disorders of the whole body, in relation to the muscular action, to the external loads applied to the body and to the type of grip. A score is assigned to each of the following body regions: neck, shoulders, wrists, forearms, elbows, trunk, back, legs, and knees.

The analysis of posture by REBA method is outlined in Table 8. The result of the study shows that weeding, digging or spading, sowing, sprinkling water for better germination of the seeds, harvesting, and uprooting are considered as a very high risk of injury and required immediate action to be changed. Whereas, the other agricultural activities like: carrying crops, threshing, winnowing are the agricultural activities are considered as a high risk of injury and required action needs to take very soon. The ridging activity in potato and groundnut farming are medium risk level. According REBA method ridging activity requires further investigation requires and take necessary action.

Table 8
Comparative analysis of working posture of the farmers involved in different activities in farm

Activities REBA

Postures REBA Score Action Level Risk Level

Weeding 11 Very high LWork must cease until a safer solution can be found

Digging or Spading 11 Very high Work must cease until a safer solution can be found

Carrying 10 High Action needs to take very soon

Ridging 05 Medium Further consideration should be given as to how risk can be lowered

Sowing 11 Very high Work must cease until a safer solution can be found

Sprinkling water 11 Very high Work must cease until a safer solution can be found

Uprooting 11 Very high Work must cease until a safer solution can be found

Harvesting 11 Very high Work must cease until a safer solution can be found

Threshing 10 High Action needs to take very soon

Winnowing 10 High Action needs to take very soon

Activities
Weeding	11	Very high	LWork must cease until a safer solution can be found
Digging or Spading	11	Very high	Work must cease until a safer solution can be found
Carrying	10	High	Action needs to take very soon
Ridging	05	Medium	Further consideration should be given as to how risk can be lowered
Sowing	11	Very high	Work must cease until a safer solution can be found
Sprinkling water	11	Very high	Work must cease until a safer solution can be found
Uprooting	11	Very high	Work must cease until a safer solution can be found
Harvesting	11	Very high	Work must cease until a safer solution can be found
Threshing	10	High	Action needs to take very soon
Winnowing	10	High	Action needs to take very soon

In Fig. 3, some of the agricultural activities of rice farming (spading, sowing seeds, harvesting, and carrying crops), groundnut farming (sowing, weeding, and harvesting) and potato farming (spading activities) has been shown, where the farmers are working in a constrained working postures with a bending, twisting, stooping, and squatting position.

Fig. 3

Different agricultural activities.

Fig. 4

According to Borg’s CR 10 scale for the assessment of severity of musculoskeletal symptoms reported by farmers.

3.9 Borg’s CR 10 scale

A higher percentage of female farmers rated their pain severity at CR10 than male farmers, according to Borg’s scale (figure 3). There may be a reason these female farmers have to do more work at home than male farmers. Furthermore, the study shows that the low back region of the body is most affected. On a scale of 1 to 10, female farmers rated 9.1, and male farmers rated 7.9, indicating severe pain. In addition to knees, female farmers rated 8.1 while male farmers rated 7.2, showing extreme pain.

4 Discussion

Agriculture in India is considered one of the most critical and physically demanding jobs performed by farmers throughout the year. Therefore, the study focused mainly on musculoskeletal disorders in Indian farmers and the factors contributing to their occurrence.

4.1 Prevalence of MSDs

The study found that musculoskeletal disorders were prevalent among the study population (67.6%). Based on the study results, farmers diagnosed with musculoskeletal symptoms most often in the low back (OR = 0.181; 95% CI = 0.069–0.477), then knees (OR = 0.352; 95% CI = 0.280–0.598), shoulder (OR = 0.657; 95% CI = 0.405–1.066), neck (OR = 0.510; 95% CI = 0.350–0.743), ankle or foot (OR = 0.815; 95% CI = 0.556–1.196), and upper back region (OR = 0.681; 95% CI = 0.463–1.002). Other researchers have also found similar findings [34 –38]. Farmers have been found to have a higher prevalence of lower back, shoulder, neck, and upper back pain and knee pain due to ergonomic risk factors. Das and Gangopadhyay [10] and Gangopadhyay et al. [14] concluded that potato farmers in India have a higher prevalence of musculoskeletal symptoms in the low back region due to constrained working posture for an extended period. According to Keawduangdee et al., the majority of low back pain (LBP) among Thai rice farmers is high (83.14%) [9]. According to the study, LBP is also significantly associated with male and female rice farmers. In addition, there was a high prevalence of knee pain among farmers. As a result of the study, knee pain was the second most prevalent pain after low back pain. These findings indicate that farmers perform several agricultural activities in a squatting posture for long periods. Farmers may suffer from knee pain because of this. A similar result was found by Dianat et al. [34] and Das et al. [38]. They also reported that knee pain plagued farmers.

4.2 Factors affecting MSDs

This study analyzes risk factors such as age, gender, BMI, duration of work, repetition of work, constrained working posture, and manual material handling (MMH), which affect MSDs among farmers.

4.2.1 Age

Farmers between the ages of 40 and 49 are more likely to suffer from MSDs (87.9%), followed by those between 50 and 49 years of age (80.5%) and those between 31 and 39 years of age (78.3%). According to this study, older farmers had a higher risk of developing MSDs than younger farmers. Other researchers have shown that male farmers between 40 and 49 years of age and those over 50 are at risk of developing MSDs, especially knee and lower back pain [39]. The study shows that the risk factors associated with MSDs in farmers were increased with age (P < 0.001, OR = 0.154; 95% CI = 0.064, 0.374). Our study was consistent with early studies in that a number of factors are associated with MSDs, including increased age and increased BMI [40].

4.2.2 Gender

According to the study, female farmers are more likely to suffer MSDs than their male counterparts. In addition to their regular work activities in the agricultural field, female farmers are also required to perform numerous household tasks, further enhancing their discomfort in different parts of their bodies. Similar findings were found in the work of other researchers [24, 41]. According to them, women workers suffer more discomfort than men. Similarly, other researchers found that female farmers felt more pain than male farmers in all body parts due to the extra household work [42]. Among brick field workers, similar findings have been found. Female brickfield workers experienced more discomfort than male brickfield workers [43].

4.2.3 BMI

As a result of the study, farmers with a higher BMI are at greater risk of developing MSDs. The risk factors associated with MSDs in farmers were increased with BMI also (P < 0.001, OR = 0.004; 95% CI = 0.001, 0.030). In addition, the study indicates that BMI contributes to low back pain (LBP). The result of the study shows that the prevalence rate of MSDs with high BMI is OR = 0.004 and 95% CI = 0.001–0.030 with p < 0.001. Researchers from other institutions supported the results of the investigation. Furthermore, BMI was also cited as a risk factor for low back pain [40 , 45].

4.2.4 Duration of work

The duration of work is another contributing factor to the development of MSDs among farmers. The study shows that work time per day correlates significantly with MSD development. The result of the study shows that the prevalence rate of MSDs with most duration of work is OR = 0.126 and 95% CI = 0.068 to 0.236) with p < 0.001. The same types of findings have been reported by other researchers [46]. According to them, MSD development is caused by long working in a constrained working posture with heavy manual material handling (MMH) [47, 48].

4.2.5 Repetitiveness of work

Repetition is one of the contributing factors to MSDs. Furthermore, most agricultural activities in rice, potato, and groundnut farming are repetitive. Using the Assessment Repetitive Task (ART) tool, the present study mainly assessed the repetitiveness of work. Rice and potato farming were found to be highly repetitive, which urgently calls for further research. Groundnut farming found the repetitiveness of work to be medium, and further investigation is needed. In the case of rice farmers, potato farmers, and groundnut farmers, it has been found that most agricultural activities are repetitive, requiring further investigation [9 , 49]. Similar findings were found among brass metal workers, who reported repetitive work as the leading cause of upper-limb disorders [46].

4.2.6 Working posture in an awkward position

Agriculture is one of the most demanding and strenuous jobs, which farmers perform in constrained working postures for prolonged periods, which is the primary cause of the development of musculoskeletal disorders. Most working postures performed by rice, potato, and groundnut farmers are high risk and require immediate correction. Other researchers support the findings presented here. Farmers who work in a stooped or squatting posture for prolonged periods are also more likely to develop MSDs [13 , 49–52]. Various researchers have reported the same findings in different sectors, stating that working in a constrained working posture for a long time can lead to musculoskeletal disorders [53, 54].

4.2.7 Manual material handling (MMH)

Other ergonomic risk factors (MMH) contributed significantly to MSD development. There is a significant relationship between lifting loads (MMH), carrying loads (MMH), and pushing loads (MMH) and MSDs among farmers. In addition to carrying, moving, and pulling loads on several occasions, farmers also suffer from MSDs. Other researchers have made similar findings [8 , 15]. One of the study’s main findings was identifying lifting, pulling, pushing, and carrying activities as the most common cause of MSDs among farmers. Similar types of findings found by Suman et al. [55]. They reported the lifting and carrying of loads in agriculture may responsible for MSDs among the farmers. They also stated that in agriculture female respondents played a key role in MMH tasks in land preparation, manuring, sowing, fertilizer broadcasting.

4.3 Limitations

The present study had some limitations that should take into account. First, this study used self-reported questionnaires to collect data, which may have resulted in bias. A second limitation of the study is that it was cross-sectional, so causal draw causal conclusions from it. A direct measurement technique (such as electrogoniometry or inclinometry) may be necessary to confirm the findings of the present study based on the REBA technique. Muscle fatigue was not assessed through the EMG study in this study. Furthermore, the hand grip strength of the farmers is not assessed in this study. Lastly, this study does not provide injury data, which is considered a major limitation.

4.4 Recommendations for future research

Future research needs identified are as follows: i. Studies should be undertaken that look at modifications of agricultural hand tools such that the forward bending posture and different awkward postures can be modified to reduce musculoskeletal pain. ii. Future research regarding accident and injury analysis is required to assure the health and safety among the Indian farmers.

4.5 Prevention and ergonomics intervention

According to the present study, prevention is essential in the agricultural field to reduce MSDs among different farmer groups.

Using modified and properly designed hand tools may prevent farmers’ injuries and musculoskeletal disorders. Handling tools are more accessible and safer with grips. Tool grips should be shaped correctly and have adequate friction.

It is essential to ensure that the handles of tools have appropriate sizes and friction since they are used in different field conditions, often in wet weather.

Farmers are advised to take rest pauses during work periods since they work in prolonged squatting and stooping postures to avoid musculoskeletal disorders. Additionally, farmers are advised to change their posture frequently while performing agricultural fieldwork to avoid static postures.

In their work schedules, farmers are advised to avoid high repetition. It is also recommended that farmers try to keep repetitive work below 50%.

Avoid manual material handling using cattle-drawn carts and hand trucks to transport heavy objects and farm products.

Rotating jobs (weeding, spading for land preparation, sowing seeds, etc.) reduces boredom and monotony of a job, as well as fatigue.

5 Conclusion

The results of the study conclude that the rice farmers are most affected prevalence (80.3%) by MSDs, whereas potato and groundnut farmers have prevalence rates of 64.6% and 28.3%, respectively. Moreover, this study shows that BMI, education, household income, previous work experience, and MSDs, there was a significant difference between the three groups of farmers at p < 0.05. The results reported that musculoskeletal symptoms were significantly different between males and females. However, more females than males reported disruption of normal activities due to neck, shoulder, elbows, upper back, low back, and knees (p < 0.05) symptoms due to extra household work. As a result of working in a constrained (squatting, stooping) working posture during a specific activity in the agricultural field, farmers suffered musculoskeletal disorders in various parts of their bodies. REBA posture analysis showed that most of the postures in the different agricultural activities are very high risk and need to change immediately. ART analysis revealed a high exposure level of repetitive work in rice and potato farming, requiring urgent investigation. The exposure level of repetition of work in groundnut farming is medium and requires further research. MMH repeated movements and working in a constrained (stooped, squatting) working posture were significant ergonomic risk factors associated with musculoskeletal disorders among all farmers. To prevent musculoskeletal disorders and injuries handling tools are more accessible and safer with grips. Hand tool grips should be shaped correctly, with appropriate sizes and adequate friction. Moreover, to avoid MSDs, the farmers have to get rid of working in a constrained working posture, avoid MMH, and avoid repetition of work.

Ethical approval

Ethical approval was obtained from the Indian Council of Medical Research Guidelines Institutional Human Ethical Clearance Committee (Approval number 01/2019, date 12.03.2019) before the study was conducted.

Footnotes

Acknowledgments

The author would like to thank all rice, potato, and groundnut farmers for their extensive cooperation during this study.

Conflict of interest

None declared.

Funding

None declared.

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Activities	REBA
	Postures	REBA Score	Action Level	Risk Level
Weeding		11	Very high	LWork must cease until a safer solution can be found
Digging or Spading		11	Very high	Work must cease until a safer solution can be found
Carrying		10	High	Action needs to take very soon
Ridging		05	Medium	Further consideration should be given as to how risk can be lowered
Sowing		11	Very high	Work must cease until a safer solution can be found
Sprinkling water		11	Very high	Work must cease until a safer solution can be found
Uprooting		11	Very high	Work must cease until a safer solution can be found
Harvesting		11	Very high	Work must cease until a safer solution can be found
Threshing		10	High	Action needs to take very soon
Winnowing		10	High	Action needs to take very soon