Associations between school backpack loading, sitting time and low back pain among schoolchildren in Gaborone, Botswana.

Background: Low back pain (LBP) is increasingly reported among school-aged children, a population vulnerable to musculoskeletal strain as a result of growth-related changes, developing spinal structures and school demands such as heavy backpacks and prolonged sitting. Although international evidence highlights these risk factors, data from African contexts, particularly Botswana, remain limited. Aim: This study investigated associations between school backpack loading, sitting time and the prevalence and intensity of LBP among 10-12-year-old schoolchildren. Setting: Primary schools in Gaborone, Botswana. Methods: A cross-sectional study was conducted among 521 children (46% boys; mean age = 11.1 ± 0.7 years). Backpack and body mass were measured using calibrated scales, and sitting time was self-reported using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). Low back pain frequency and intensity were assessed using the Young Spine Questionnaire (YSQ). Chi-square tests examined associations between LBP outcomes and independent variables, and Cramér's V interpreted effect sizes. Results: Approximately 43% carried backpacks exceeding 10% of body mass; 34% reported frequent LBP and 14% moderate-to-severe intensity. Heavier loads were weakly but significantly associated with more frequent LBP (χ Conclusion: Heavier backpack loads were associated with higher LBP frequency among Gaborone schoolchildren, although the effect size was small. These findings highlight the importance of addressing modifiable ergonomic factors, particularly load management, in school health strategies. Contribution: This study highlights modifiable ergonomic risk factors for LBP in Botswana and supports the inclusion of load management and posture education in school health programmes.