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American Journal of  Medical 
Science and Innovation (AJMSI) 

Prevalence of  Joint Pain is Higher Among Housewives of  Urban 
than Rural Housewives in Bangladesh

Md. Omar Sharif  Ahmmed Chowdhury1*, Supranto Sutra Dhar2, Mithun Sikder3, 
Arafath Hossain4, Most. Rumpa Khatun4

Volume 2 Issue 1, Year 2023
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Article Information ABSTRACT

Received: January 26, 2023

Accepted: March 06, 2023

Published: March 09, 2023

Activities, environment, work style, living standards of  housewives in Bangladesh vary from 
place to place. Housewives face many musculoskeletal problems related to housework and 
quality of  life. Hence the aim of  our investigation is to investigate the prevalence of  joint 
pain among rural and urban housewives of  Bangladesh. An attempt was made to compare 
joint pain in urban and rural housewives. A sample was selected to assess and comparison 
of  joint pain prevalence among 400 unemployed urban and rural housewives aged 25–60 
years in Bangladesh. Regression analysis was performed on their socio-economic and joint 
pain information through interviews with questionnaires. Data analysis shows that urban 
housewives have relatively higher prevalence of  joint pain than rural housewives and it is 
70.5% and 58.5% respectively. Odds ratio (OR) and 95% confidence interval (CI) comparing 
joint pain in Bangladeshi housewives adjusted for age and BMI showed that the prevalence of  
knee and low back pain was highest and was associated with age and BMI. This study showed 
that joint pain was significantly higher in urban housewives compared to rural housewives. 
Bangladeshi housewives suffer from knee and lower back pain the most. Their joint pain 
prevalence is increases with age and BMI. Joint pain in housewives may be related to obesity, 
occupational differences and environmental factors. In addition to daily household work, 
urban housewives can perform some simple physical exercise regularly, which can improve 
their mobility and strength as well as reduce the rate of  obesity.

Keywords
Bangladesh, Prevalence, 
Joint Pain, Urban and 
Rural Housewives, 
Different Lifestyle 

1  Administration Department, Walton Group, Dhaka, Bangladesh
2 Department of  Physiotherapy, Mymensingh College of  Physiotherapy and Health Sciences, Mymensingh, Bangladesh
3 Riand Bangladesh Neuro Hospital, Mirpur, Dhaka, Bangladesh
4 Gono Bishwabidyalay, Savar, Dhaka, Bangladesh
* Corresponding author’s e-mail: omotayolydiamojisola@gmail.com

INTRODUCTION
Joint pains are more usually among the senior citizen, 
which is lead to movement difficulty, loss of  quality of  life, 
and enhancement health care costs. (Kiyoshi et al., 1999) 
Joint pain can be perceived in several parts of  the body. 
Mobility problems are mass common physical problems 
of  the elderly. Many elderly person suffer from many 
health related issues and complexity due to prolonged 
inactivity such as musculoskeletal pain, bony and postural 
deformities and ADL problems. (Chowdhury et al., 2021) 
A previous study investigating men and women found 
that women had a higher prevalence of  musculoskeletal 
pain than men. (Bihari et al., 2011) A previous worldwide 
research exhibited that female are physically more 
deactivate than male in Bangladesh as in m several 
countries, for which the possibility of  contracting many 
non-communicable diseases increases. (WHO, 2018)
Joint pain are discommodity, pain or inflammation that 
originates from any portion of  the joint-such as bone, 
tendons or muscles, cartilage and ligaments. But joint 
pain generally refers to include clinical syndromes such 
as inflammation, osteoarthritis or degenerative disorders, 
nerve compression conditions and,  as well as low well 
standard disorders like as myalgia, other body area pain 
and low back pain are not responsible to pathology. Body 
areas usually involved are the Neck, low back, upper 
limb (shoulder, forearm, and wrist) though at present the 
lower extremity has obtained more attention. (Punnett & 
Wegman., 2004) 
Various factors influence women’s health are lack of  

coordination of  work of  men, women and family, 
considering the role of  the leadership of  the household as 
well as women’s service as a minor role, patriarchal society 
etc. Interest has been expressed in conducting research 
in many countries to identify symptoms of  joint pain 
and to identify its relationship with occupational factors. 
(Tinubu et al., 2010) It is trustify that employment is one 
of  the major effective factors on housewives quality of  
life, (Farlinger S., 1996) the main point being that women’s 
empowerment is directly related to a woman’s educational 
status and her job and thus is expected to affect her 
quality of  life. (Harriet and Sen., 2000) Housewives are 
often responsible for works like as sweeping, cleaning 
the garbage, cleaning bathrooms and toilets, cooking, 
cleaning door and windows, washing clothes and beds, 
and taking care of  the needs of  the entire family, which 
can be associated with various physical contact stresses 
and result in joint pain. (Kalra1 & Bhatnagar., 2017)
A prior research showed that the prevalence of  joint 
pain is higher in women than in men. Elderly male suffer 
from MS pain less often than normal and aged women. 
The prevalence of  pain in women in Quebec, Canada 
and Ontario, USA was reported to be 50%, 65% and 
79%, respectively. (Fazli B et al., 2016) There had been 
several studies on the prevalence of  joint pain in specific 
groups and populations, (Andersson et al., 1999) but 
comparatively small number of  comparisons between 
populations. (Hameed and Gibson., 1997) If  clear variety 
in the prevalence of  joint pain symptoms among the 
populations can be shown, this may assistance guide 

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to investigate of  significant etiological factors. In this 
investigation, we compared the proportion of  specific 
joint pain among Bangladeshi housewives in a rural 
district of  Bangladesh with that of  urban/city women in 
Bangladesh, adjusted for age and body mass index.

Operational Definitions 
Joint Pain
Participants were illustrated with a basic diagram of  the 
human skeleton (a stick person) and were asked for each 
joint ‘Do you regularly suffer from any swelling, pain or 
stiffness?’. Data is collect on the neck, back, and separately 
for the both sides of  the body for shoulders, elbows, 
wrists, hand/fingers, hips, knees, ankle, and feet/toes. 
Joint pain was assessed as a problem with respondents 
recording whether they had or had previously had mild, 
moderate or severe pain in any joint.

LITERATURE REVIEW
Aoyagi K et al. (2020) conducts a study in Hawaii, 
Japan to find out that joint pain prevalence is higher 
in rural Japanese housewives than in urban Japanese-
American housewives. Social factors such as agricultural 
performance to the range of  joint symptoms. The aim 
of  their study was to explore joint pain prevalence and 
the probable role of  the environment in Japanese urban 
and rural housewives of  Hawaii. They surveyed 222 
rural housewives and 638 urban housewives aged 60-79 
to explore pain in specific joints. Their results showed 
that 70% of  Japanese and 50% of  Hawaiian housewives 
had one or more joint pain. Among the joints, 36% of  
Japanese housewives aged 60-69 and 53% of  housewives 
aged 70-79 had knee pain, whereas in Hawaii knee pain 
affected only 20% of  housewives of  both age groups. 
The odds ratios (and 95% CI) for knee pain in Hawaii 
compared with Japan were 4.0 (2.2, 7.4) and 3.2 (2.1, 4.8). 
Ankle, elbow, and shoulder pain were abnormally high in 
Japan compared to Hawaii.
In 2015, this year to propulsion a study in India to find 
out the outbreak of  pain in the lower back of  non-
working rural housewives. Living, working, and social 
traditions differ significantly between housewives in 
urban and rural areas, so it is impossible to generalize 
between rural and urban housewives. Therefore, the 
objective of  their study was to investigate the outbreak 
of  lower back pain among rural-unemployed housewives. 
The researchers took a population of  301 non-working 
rural housewives between the ages of  30-70 in Kanpur. 
They observed and interviewed all housewives about low 
back pain, disability, and musculoskeletal discomfort, 
using the Hindi version of  the Nordic Musculoskeletal 
Scale questionnaire. Their study showed LBP prevalence 
in 83% of  rural housewives and more than 50% of  these 
women had severe disabilities. Back pain in housewives 
has been shown to have a social burden associated with 
their disability.

MATERIALS AND METHODS
Study design and participants
In this cross-sectional study, participants were 
housewives living in rural and urban Bangladesh. Data 
was collected from 400 participants (200 urban and 
200 rural housewives) aged 25 to 60 years in rural and 
urban Bangladesh who were apparently healthy, mobile 
housewives. Regarding the specific eligibility criteria for 
participants in this investigation, we included housewives 
aged 25 to 60 years and currently living in rural and urban 
Bangladesh, and we excluded men as well as unmarried 
and pregnant women. All data collected from August 
2022 to December 2022.

Data Measurements 
A face-to-face interview was conducted while collecting 
data for this study and adequate precautions against 
COVID-19 were taken. The questionnaire was first 
developed in English and later translated into Bengali. 
However, the local language was used to communicate 
with the respondents. Then an orientation was organized 
among the collectors along with field tests and finally 
data was collected through door to door questionnaires 
from the housewives. The project was organized in 
Dhanmondi, Mirpur, Uttara, Shyamoli, Mohammadpur, 
Newmarket, Kalyanpur areas of  Dhaka city, Bangladesh 
and rural areas of  Cox’s Bazar, Charfashion, Feni, Pabna, 
Gaibandha and Dinajpur districts of  Bangladesh. We 
collected data from them with their permission. The 
survey asked subjects, using only Bengali words, “Have 
you had pain, swelling, pain, or tenderness in your joints 
most days for at least a month (currently or in the past)?”. 
1 response box on each sides of  the body (yes and 
no) for each joint (shoulder, elbow, wrist, hand/finger, 
neck, upper back, middle, lower back, hip, knee, ankle 
and foot). We measured housewives’ weight and height 
without shoes in light clothing. Weight (kg)/height (m)2 
was measured and then converted to body mass index 
(BMI).

Statistical Analysis
Investigators were used t test to evaluation statistical 
importance when comparing the characteristics of  
subjects between urban and rural Bangladeshi areas. The 
χ2 test was used to evaluate between-group differences 
for categorical variables. All answer sheets were checked 
for exactness, completeness and internal consistency. 
Inconsistent data is discarded. Accurate data were entered 
into SPSS version 23 for analysis. Logistic regression was 
used to evaluate the prevalence of  specific joint pain 
in two populations, age and BMI (both as continuous 
variables), with interaction tests.  Qualitative data were 
used for thematic content analysis. Analyzes were limited 
to 200 urban Bangladeshi housewives and 200 rural 
housewives aged 25 to 60 years, to provide a comparable 
age range for both populations.

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RESULTS
Characteristic of  Respondents 
Table 1 showing the characteristics of  urban and rural 
participants in Bangladesh. The mean age and height of  
urban and rural housewives were similar but the mean 
weight of  urban housewives was five kg higher than 
rural and BMI was significantly higher than that of  rural 
housewives (p<0.05)

Prevalence of  joint pain
The prevalence of  one or more joint pain was 
approximately 70.5% in urban and 58.5% in rural 
housewives. All other joint pains except elbow, upper 
back and ankle joint pain were discover to be significantly 
different in Bangladeshi housewives. Shoulder, wrist and 
hand pain in rural women was twice or more than that 
of  urban women and on the other hand urban women 

Table 1: Age, BMI characteristic of  the Respondents
In urban Bangladesh                                 In rural Bangladesh

Characteristic Range Median Range Median
Age (years) 25 – 60                   45                      25 – 60 44.50
Height (cm)                       153 – 165              158 147 – 165                                    158
Weight (kg)                         48 – 86                  60 40 – 85                       55
Body mass index (kg/m2) 18.3 – 33.3          24.25                   16 – 35.4                       22.2

had significantly more neck, mid back, lower back, hip, 
knee and foot joint pain than rural women, which was 
significantly higher in the 43–60 age group than in the 
25–42 year group (Table 2)

Low back pain was the most common places of  joint pain 
in each urban and rural women in Bangladesh, affecting at 
least 25% of  women in both populations. Other common 
locations of  joint pain in both urban and rural Bangladeshi 

Table 2: Frequency (%) of  housewives with joint pain in rural and urban housewives in Bangladesh
In urban Bangladesh In rural Bangladesh      

Age group (y)                                                                         25 - 42 43 – 60 Total 25 – 42 43 – 60  Total    
Number of  participants                                                                                         76    124 200 96 104 200
Any joint pain                                                                           49 (64.5) 92 (74.2) 141 (70.5) 41 (42.7) 78 (75.0) 117 (58.5)   
Shoulder                                                           4 (5.3) 13 (10.5) 17 (8.5) 12 (12.5) 22 (21.2) 34 (17.0)
Elbow                                                                           4 (5.3) 6 (4.8) 10 (5.0) 5 (5.2) 6 (5.8) 11 (5.5)
Wrist                                                                             1 (1.3) 4 (3.2) 5 (2.5) 4 (4.2) 10 (9.6) 14 (7.0)
Hand                                                                               3 (3.9) 2 (0.8) 4 (2.0) 6 (6.3) 7 (6.7) 13 (6.5)
Neck                                                                       6 (7.9) 21 (16.9) 27 (13.5) 6 (6.3) 8 (7.8) 14 (7.0)
Upper back                                                                      1 (1.3) 6 (4.8) 7 (3.5) 4 (4.2) 4 (3.8) 8 (4.0)
Mid-back                                                              8 (10.5) 15 (12.1) 23 (11.5) 6 (6.3) 6 (5.8) 12 (6.0)
Low back                                                   25 (32.9) 44 (35.5) 69 (34.5) 16 (16.7) 35 (33.7) 51 (25.5)
Hip                                                                             11 (14.5) 6 (4.8) 17 (8.5) 1 (1.0) 6 (5.8) 7 (3.5)
Knee                                                               11 (14.5) 28 (22.6) 39 (19.5) 4 (4.2) 19 (18.3) 23 (11.5)
Ankle                                                                                3 (3.9) 3 (2.4) 6 (3.0) 3 (3.1) 5 (4.8) 8 (4.0)
Foot                                                                              8 (10.5) 9 (7.3) 17 (8.5) 2 (2.0) 4 (3.8) 6 (3.0)

women were shoulder, neck and knee pain, affecting 
around 10% of  women in both populations. Bangladeshi 
City women were twofold as likely to have back, hip and 
foot pain as rural women, but the shoulder, hand and wrist 
pain prevalence was significantly higher in rural women.

The prevalence of  joint pain increased with age; For 
example, neck pain in urban women increased from 8% 
between 25-42 years to 17% between 43-60 years, and knee 
pain from 14.5% between 25-42 years and 22.6% between 
43-60 years (for all ages combined 19 .5%). Again, shoulder 

Table 3: Odds ratios (95% confidence intervals) of  joint pain comparing women in urban Bangladesh with women 
in rural Bangladesh

Age Adjusted BMI Adjusted     
Any joint pain                               1.064 (1.039, 1.090)                          1.229 (1.140, 1.326)
Shoulder                                                                     1.038 (1.005, 1.071) 0.978 (.895, 1.068)
Elbow                                                                          1.035 (.987, 1.085) 1.004 (.883, 1.143)
Wrist                                                                              1.039 (.988, 1.092) 0.994 (.866, 1.140)
Hand                                                                               0.999 (.952, 1.048) 0.878 (.750, 1.028)

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pain in rural women ranged from 12.5% between 25-42 
years to 21.2% between 43-60 years and LBP ranged from 
16.7% between 25-42 years to 33.7% between 43-60 years 
(crude prevalence of  25.5% for all ages combined). The 
prevalence of  hip and foot pain did not vary consistently 
between age groups in urban communities with higher 
prevalence in younger age groups ranging from 14.5% to 
4.8% and 10.5% to 7.3%, respectively.

Comparison of  joint pain between urban Bangladeshi 
and rural Bangladeshi women 
The odds ratio (OR) and 95% confidence interval (CI) 
comparing joint pain in Bangladeshi housewives adjusted 
for age and BMI are shown in Table 3. The age adjusted 
OR for knee pain was 1.075, and BMI was 1.331 and age 
adjusted OR for lower back pain was 1.030, and BMI was 
1.060. BMI-adjusted prevalence of  cervical, hip and feet 
pain was lower in rural than urban women (BMI AOR 
= 1.070, 1.273 and 1.086 respectively) Moreover, age-
adjusted prevalence of  shoulder, wrist and upper back pain 
was richer in rural than in urban women (age-adjusted OR 
= 1.038, 1.039 and 1.070, respectively). The prevalence of  
lower back and knee joint pain was common in urban and 
rural women compared to other joints. Shoulder, elbow, 
and wrist pain were more common in rural than urban 
areas, but mid-back, hip, and foot joint pain were more 
common in urban than rural areas.

DISCUSSION   
Comparing urban and rural populations among country 
residents by birth can help identify factors accountable 
for assessed distinctions in disease by receiving benefits of  
increased variability in social and environmental factors. 
(Harriet and Sen Presser, 2000) Finding that pain frequency 
distinctions are limited to specific joints advices potential 
advantages to find etiological factors. Prior research have 
shown that mental factors (include factor connected to job 
services) are related with joint pain outcomes. (Bongers et 
al., 1993) Our investigation excludes employed housewives, 
hence information on employment of  housewives is not 
available. 
However, rural areas of  Bangladesh are primarily 
agricultural, whereas Dhaka is an urban/municipal area. 
In rural areas, many housewives have to be attached to 
housework, livestock rearing and agriculture, whereas 
housewives in Dhaka city have improved living conditions 
compared to villages, so their housework is much easier 

and they can spend enough free time. Thus, the differences 
in joint pain frequencies reported here may be partially 
attributable to work differences such as current work 
inactivity, work style, sedentary lifestyle, work length, or 
psychosocial factors.
Cultural distinctions another than work may also inhibit 
the tendency to report symptoms and can partially 
account for the observed variation in joint pain prevalence. 
Differences in social disadvantage between city and 
rural Bangladesh may partially demonstrate variation in 
reported joint pain rather than distinction in diseases such 
as fractures or degenerative disease. However, such a bias 
would be identical to the observed differences in joints for 
both urban and rural areas, so such cultural attributer are 
possibly not significant in this case. 
In this investigation, we used logistic regression for 
prevalence of  certain joints pain in between urban and 
rural housewives to compare, adjusting for age and BMI. 
Adjustment effect of  BMI on association of  joint pain 
among housewives in Dhaka city. Those with a higher 
BMI had a higher prevalence of  joint pain. However joint 
pain was related with BMI in our research, and obesity is 
one of  the risk factors for knee and other joint pain in 
housewives, (Aro and Leino., 1985) obesity is slightly more 
likely than other (as yet unknown) risk factors to explain 
the difference in joint pain prevalence between urban and 
rural women in Bangladesh seems important.
Logistic regression evaluated the efficiency to control of  
age differences for any potential confounders. We found 
some evidence in our investigations that the prevalence 
of  joint pain enhancement with age in urban and rural 
Bangladesh, as previously found, and these may influence 
the estimated proportion of  knee pain and other joint 
prevalence. In logistic regression, adjustment for age of  
housewives suggests that the relation between age and joint 
pain is same for both rural and urban women.  To compare 
these data, the reciter may also compare the particular 
age prevalence rate given in Table 2, which estimates are 
unaffected by the logistic regression.

CONCLUSIONS
The findings of  this study investigated the prevalence 
of  joint pain among housewives in Dhaka city and rural 
areas in Bangladesh. In summary, this study showed that 
the important difference between housewives aged 25-60 
years was that urban housewives had significantly higher 
prevalence of  joint pain than rural housewives. Bangladeshi 

Neck                                                                          1.043 (1.006, 1.081) 1.070 (.976, 1.173)
Upper back                                      1.070 (1.007, 1.138)                            0.979 (.837, 1.144)
Mid-back                                                                     1.012 (.976, 1.049) 1.060 (.961, 1.169)
Low back                                   1.030 (1.007, 1.054)                               1.060 (.995, 1.129)
Hip                                                0.992 (.950, 1.036)                             1.273 (1.135, 1.428)
Knee                                                                        1.075 (1.039, 1.112) 1.331 (1.215, 1.459)
Ankle                                                                         0.979 (.927, 1.034) 1.158 (1.003, 1.337)
Foot                                                                            1.002 (.959, 1.046) 1.086 (.966, 1.220)

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housewives are most prone to knee and lower back pain. 
Neck, middle back, hip and foot pain were significantly 
higher among urban housewives than rural housewives 
respectively and correlated with BMI. On the other hand, 
shoulder, wrist and hand pain was relatively higher among 
rural housewives than urban housewives. Joint pain was 
more likely to increase with increasing age and BMI. Joint 
pain may be related to obesity, environmental factors and 
occupational differences. In addition to housework, general 
urban housewives can do some physical exercise, which can 
increase their lateral mobility and reduce the obesity rate. 

Limitation of  the Study
Limitations of  the study several limitations are present in 
our study. Our research had financial limitations as there 
was no funding. So our study was organized among only 
400 people in remote areas of  Bangladesh. We conduct 
physical examinations and preliminaries we detected 
joint pain by radiographs, radiographs were not available 
to evaluate degenerative changes, arthritis or fractures. 
As the study was a cross-sectional method, we cannot 
prove whether there was any difference between body 
weight, disability and size at the onset of  joint pain. 
Potential differences in joint pain between urban and rural 
housewives in Bangladesh are a potential source of  bias.

Ethical Approval
The motive and goals toward with its benefits, risks 
and procedure was explained in the research to the 
respondents in easily. Information was accepted from 
every respondents by use perceive native language. The 
researcher first introduced himself  with respondents. Then 
the researchers was give them the assurance this facts of  
the responders will be usage just for the research purpose. 
The researchers tell them that their name will be hidden 
secret. All kind of  privacy is confirmed and any resections 
from the respondent are first priority. They also told this 
information will only use for benefit of  Physiotherapy 
profession and the improve health with decrease hazard. 

Declaration of  Competing Interest
The authors have no competing interests to declare.

Funding
This research did not receive any specific grant from 
funding agencies in the public, commercial or not-for 
profit sectors.

Acknowledgement
Special thanks to Almighty Allah for give us a great 
opportunities to complete our research. We sincerely 
respect the respondents for participating in this study. We 
deeply respect our household members for inspiring our 
survey.

Author Contributions
Corresponding author: conceived and designed the paper; 
analyzed and interpreted the data; contributed materials, 

analysis tools, or data; and wrote the paper. All co-authors: 
performed experiments, collected and analysis the data.
Data access, responsibility, and analysis
Corresponding author had full access to all the data in the 
study and took responsibility for the integrity of  the data 
and the accuracy of  the data analysis.

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