Prevalence and Environmental Correlates of Back Pain among Schoolchildren in Maiduguri Metropolis, North-Eastern Nigeria: A Cross-Sectional Multi-Stage Survey

Background Low back pain (LBP) among adolescents represents a significant but understudied public health challenge in Sub-Saharan Africa. This study investigated the prevalence and multi-factorial determinants of LBP among secondary school students in Maiduguri Metropolis, North-Eastern Nigeria. Methods Using a multi-stage stratified sampling technique, this cross-sectional survey recruited 1,012 adolescents from both public and private schools. Participant demographics, commuting characteristics, carrying habits, and spinal pain histories were assessed via a validated questionnaire. Objective measurements of standing height, body mass, and absolute backpack weight were taken using calibrated equipment to determine relative load percentage (% body weight [%BW]). Statistical analyses included Spearman rank correlations and multivariable binary logistic regression to evaluate independent risk factors (aOR, 95 CI). Results Among analyzed respondents (N = 1,005), overall LBP prevalence was 55.6% (n = 559), with within-sex rates of 58.4% for males (272/466) and 53.2% for females (287/539). Unadjusted correlation analysis showed mild positive associations between pain severity and both absolute bag weight (r s = + 0.120, p < 0.001) and relative bag load (r s = + 0.103, p = 0.001). However, after multivariable adjustments (chi 2 = 28.44, p < 0.001), carrying loads > 10% BW failed to maintain independent statistical significance (aOR = 1.21, 95% CI: 0.91–1.61, p = 0.188). The principal independent determinants of LBP were female sex (aOR = 1.42, 95% CI: 1.08–1.87, p = 0.012), overweight/obese BMI (aOR = 1.54, 95% CI: 1.10–2.16, p = 0.011), and daily carriage times exceeding 30 minutes (aOR = 1.45, 95% CI: 1.09–1.93, p = 0.010). Conclusion Spinal discomfort is widespread among Nigerian secondary school students and driven by complex interactions. Isolated schoolbag weight is a weaker predictor of pain than physical exposure duration (> 30mins/day) and personal attributes (sex and BMI). Preventative school ergonomics should prioritize active transit planning and physical wellness over strict weight limits alone.