Factors associated with musculoskeletal disorders in artisanal fishers from traditional community in Todos-os-Santos Bay, Bahia, BrazilAbstract
Introduction Musculoskeletal disorders (MSD) are one of the leading causes of pain and disability at work, affecting various professional categories, including multipurpose/artisanal fishing workers .
Objective To analyse the factors associated with the prevalence of musculoskeletal disorders, characterized according to occupation, and to draw up a profile of fishermen and shellfish gatherers.
Methods Cross-sectional study with a probabilistic sample of artisanal fishing workers from the municipality of Cachoeira (BA). The Nordic Musculoskeletal Questionnaire was used, in addition to a structured questionnaire. Multiple correspondence analysis and Poisson regression were used.
Results 248 workers participated, n = 78 fishermen and n = 170 shellfish gatherers. The prevalence of MSD was 89.7% among fishermen and 95.3% among shellfish gatherers, with no differences between these groups (prevalence ratio = 1.06). Among the shellfish gatherers, were predominant women aged ≤ 37 years, with children under two years old, incomplete secondary education, who had another activity, with long hours in a squatting position, walking while handling loads and pushing fish. Among the fishermen, the profile was the opposite, they reported taking pain medication and long hours in a sitting position.
Conclusion There was a high prevalence of generalized MSD among multipurpose/artisanal fishers, regardless of gender. This could be explained by the high exposure of both groups to adverse occupational factors and by the sociodemographic profile of the community studied.
Keywords
Musculoskeletal Diseases; Occupational Diseases; Artisanal Fishers; Occupational Health
Resumo
Introdução Distúrbios musculoesqueléticos (DME) são uma das principais causas de dor e incapacidade no trabalho, afetando diversas categorias profissionais, incluindo pescadores polivalentes/artesanais.
Objetivo Analisar os fatores associados à prevalência de DME, conforme a ocupação de pescadores e marisqueiras. Métodos: Estudo transversal, com amostra probabilística de pescadores do município de Cachoeira (BA). Utilizou-se o Questionário Nórdico de Sintomas Osteomusculares, além de questionário estruturado. Empregou-se análise de correspondência múltipla e regressão de Poisson.
Resultados Participaram 248 trabalhadores, n = 78 pescadores e n = 170 marisqueiras. A prevalência de DME foi de 89,7% entre pescadores e de 95,3% entre marisqueiras, sem diferenças entre esses grupos (razão de prevalência = 1,06). Entre as marisqueiras, predominaram mulheres com idade ≤ 37 anos, com filhos menores de dois anos, ensino médio incompleto, que tinham outra atividade, com longas jornadas na postura agachada, deambulando com manuseio de carga e empurrando o pescado. Entre os pescadores, o perfil foi oposto, eles referiram medicamento para dor e longas jornadas na posição sentada.
Conclusão Houve elevada prevalência de DME generalizado entre os pescadores polivalentes/artesanais, independentemente do gênero, isto pode ser explicado pela alta exposição de ambos os grupos aos fatores ocupacionais adversos e pelo perfil sociodemográfico da comunidade estudada.
Palavras-chave
Doenças Musculoesqueléticas; Doenças Profissionais; Pescadores Polivalentes; Saúde do Trabalhador
Introduction
Musculoskeletal disorders (MSD) are characterized as inflammatory and degenerative conditions that affect the musculoskeletal system and its components1. They are a work-related phenomenon, with damage resulting from the overuse of the musculoskeletal system, as well as the lack of time for recovery2. The range of diseases classified as MSD is vast and should be analyzed using specific protocols1,3.
In Brazil, MSD account for 30% or more of all occupational diseases reported to official bodies and are the leading cause of pain and disability in the workplace4. For informal workers, which includes multipurpose fishermenf, it is clear that there are no structured and permanent occupational health surveillance actions aimed at this professional category5.
Multipurpose fishermen, who are characterized as artisanal fishing workers, carry out subsistence fishing and are a traditional category around the world, and are therefore considered an important type of work5with distinct characteristics in their fishing activities. In Brazil, according to data from the 2024 General Fishing Activity Register, there are 1,650,247 registered fishing workers, 99.76% of whom are registered as artisanal fishing workers6and approximately 38 million people in the world are engaged in this activity on a full or part-time basis7.
Artisanal fishing (AF) in Brazil can be subsistence or commercial and can be defined as a simple, low-tech enterprise, carried out individually or as a family, most often by the owner (fisherman), although in certain circumstances the boats may belong to fish traders or outside investors, and they may also rely on family support5. Despite their high share of fish production, AF workers are among the poorest groups in the population8.
AF workers are invisible to the Brazilian health system9. Recognition and monitoring of the worsening of MSD and their causal relationship is still incipient in Brazil, due to the persistent weakness of the epidemiological technical nexus (NTEP); this fact perpetuates the difficulty in diagnosing these diseases4, pointing to the need to include this professional contingent among the social groups most at risk for the occurrence of MSD10.
The symptoms of MSD and their associated factors in Brazilian artisanal fishing workers have already been described11-14, characterized by their severity and occurrence in numerous body regions, although little has been elucidated in male artisanal fishing workers . Among the main factors triggering MSD are aspects of the work process, cognitive demands, and organizational/psychosocial factors3. It is also worth noting that variables such as age, gender, length of time working in the profession, and schooling can be factors associated with MSD, as well as economic activity and occupation15.
It is not yet possible to have a worldwide estimate of the prevalence of MSD and its associated factors among artisanal fishing workers as a whole, although there is already evidence of the magnitude of the occurrence of the condition among professional fishermen16. Therefore, this article aims to analyze the factors associated with the prevalence of MSD, according to the occupation of fishermen and shellfish gatherers, in a traditional fishing community in northeastern Brazil.
Methods
Study design and context
This is a cross-sectional study carried out in 2017 with artisanal fishing workers living in Santiago do Iguape, in the municipality of Cachoeira in the state of Bahia. The initiative to investigate informal workers emerged from the principle of community-based participatory research17.
This geographical area is part of the Baía do Iguape Marine Extractive Reserve (RESEX), which is located on the shores of Baía do Iguape, and fishing is the population’s main source of livelihood18.
Study size
To characterize the fishing population, official RESEX data for 2017 was used. For the sample calculation, a prevalence of MSD of 50% was adopted12-14, with an alpha error of 5% in a total population (N) of 537, calculating a margin of loss or refusal of 10%, resulting in a final sample of 248 artisanal fishing workers, 170 of whom were shellfish gatherers and 78 fishermen.
Participants
The inclusion criteria were: being aged 18 or over, having been working in artisanal fishing for at least a year, and agreeing to take part in the study by signing the Free and Informed Consent Form (FICF).
Exclusion criteria
Artisanal fishing workers were drawn using a random number table for a probabilistic sampling approach, stratified by gender and without replacement.
In this study, we started from the historical assumption of recognizing the centrality of women in shellfish gathering and men in sea fishing with small boats, according to a study carried out in Baía de Todos-os-Santos9.
Data collection
A questionnaire was used for data collection, which took place between May and July 2017. The first block of the questionnaire, which included questions related to the environment, work organization, and individual factors, was used in previous studies11-14. Questionnaires used in previous studies and validated instruments19,20 on the physical demands of work21-23 and MSD symptoms were also used to assess work-related physical factors. The expanded, translated, and validated Brazilian version of the Nordic Musculoskeletal Questionnaire (NMQ)20 was used.
Variables
The variables related to individual factors were: age (in years) dichotomized from the median (< 37, ≥ 37); schooling (complete elementary school, complete or incomplete secondary school)13; marital status (married or single)12; children aged two years or less (presence or absence); self-reported comorbidities (diabetes, hypertension, rheumatoid arthritis, hypothyroidism, and headache - presence or absence of at least one)24; smoking (current smoker and current non-smoker)25; alcohol consumption (frequency of alcohol consumption greater than or equal to once a week, less than once a week)26; and body mass index - BMI (obesity/overweight, normal weight, underweight)27.
The variables related to the work environment and organization were: carrying out activities related to fishing (yes, no)13; weekly hours dedicated to AF (> = 20 hours, < 20); and taking breaks during work activity (yes, no).
The definition of an MSD case was based on reports of pain or discomfort in the last 12 months, lasting more than a week or at least monthly, not caused by an acute injury and with a severity ≥ 3, on an ordinal scale from 0 to 5, with verbal qualifiers at the extremities: 0 = no pain, 5 = unbearable pain, or determining seeking medical attention, or official or unofficial absence from work or change of job, motivated by at least pain or discomfort in one of the following regions: neck, shoulder, elbow, forearm, wrist/hand, upper back, lower back, thigh, knee, leg, ankle, and foot2. Generalized MSD was characterized as the presence of cases in which the number of affected regions was greater than or equal to 1, similar to the criteria used in other studies with artisanal fishing workers14.
To characterize the physical demands of fishing workers, the following items were analyzed: posture, muscle strength, load handling, and physical pressure. These variables were measured on a 6-point scale (0 to 5), in terms of frequency, intensity, and duration, with an arbitrary cut-off point of less than 3 (non-existent) and equal to or greater than 3 (unbearable).
Data analysis
The analyses were carried out using the R statistical package version 3.6.3 and multiple correspondence analysis (MCA) was used. At first, all the variables listed were included in the correspondence map and, after analyzing the bivariate correlations, with a cut-off point above 0.23 (half of the highest value of the correlations) and their contributions, the potentially collinear variables were removed.
After the MCA stage, Poisson regression was used to analyze the association between the presence of MSD and individual and occupational characteristics. Crude and adjusted prevalence ratios (PR) were calculated, confidence intervals were estimated, and p-values were calculated from the robust standard error, obtained from the consistent heteroscedasticity covariance matrix of the model coefficients. The goodness-of-fit of the model was assessed using the Akaike Information Criterion (AIC) and residue analysis. To assess the assumption of non-overdispersion, the ratio of the Deviance residuals to the corresponding degrees of freedom was calculated. Even though there was no violation of this assumption, we opted for a robust estimate of the standard errors of the entire model.
Finally, the MCA was performed again on the individuals with MSD to describe the profiles associated with the occupation. Based on this procedure, it was possible to create three zones (profiles) on the map, namely: profile of shellfish gatherers’ occupation variables; profile of fishermen’s occupation variables; and common profile. To this end, the minimum distance between the points corresponding to the levels of the variables was arbitrarily set at 1.5 cm as a strategy to define the relevance of the finding in this analysis.
Ethical considerations
This study was approved by the Research Ethics Committee of the Bahia School of Medicine, Federal University of Bahia, Opinion 1.711.010, on September 3, 2016. All participants signed an informed consent form.
Results
Characterization of the sample
The artisanal fishing workers from Santiago do Iguape investigated in this study comprised 248 individuals, 170 of whom were shellfish gatherers and 78 were fishermen. The sociodemographic characteristics included an average age of 36.7 years (SD = 10.5 years) for shellfish gatherers and 43.3 years (SD = 11.8 years) for fishermen. The average number of hours worked per day was 8.8 hours (SD = 1.9) for shellfish gatherers and 9.1 hours (SD = 3.0) for fishermen. In both occupations, they started work at an average of around 11 years old. The average weekly income ranged from R$ 57.00 (SD = 35.7) to R$ 94.60 (SD= 55.9). There was also a predominance of black/brown self-declared race/ethnicity (96.4% and 94.9%) in both occupations and marital status categorized as single/separated or widowed. In terms of schooling, both groups had incomplete primary education, approximately 30% of the sample studied. More details on the characterization of the sample can be found in a previous study28.
The MCA was carried out according to the graphic representation on the map in Figure 1, showing the joint assessment between the variables listed in this study in a two-dimensional plane. Thus, there was no association between MSD and occupation, i.e. the occupations of shellfish gatherer and fisherman on small boats were located on the map with similar proximities to the centroid presence of MSD which, in turn, has a coordinate on the map with values close to zero for the first and second dimensions (-0.026 and 0.003), indicating that the presence of MSD is not discriminatory in favor of any variable, including occupation. However, the centroid with no MSD is excessively outside the map’s point cloud (coordinate pair equal to 0.423 and -0.056, for the first and second dimensions, respectively), indicating that it is an outlier.
Multiple correspondence analysis of musculoskeletal disorders by occupation, including all the non-collinear variables listed in this study, among artisanal fishing workers from Santiago do Iguape, Bahia, 2017
Also as shown in Figure 1, it is clear that all the points of the variables included are close to the presence of generalized MSD (DME_1), thus considering the generalized MSD variable as the centroid of this MCA. The absence of MSD (DME_0) in this context appears as an outlier, evidenced by the distance in the graphical representation.
Another important analysis refers to the spatial projection of fishing occupations in opposite quadrants, thus demonstrating the differences in the profiles of artisanal fishing workers in Santiago do Iguape. In addition, the Poisson regression technique was used to model the association between occupation and MSD, adjusted for all the variables in the map in Figure 1.
Table 1 shows all the PRs, confidence intervals, and p-values for all the covariates in the study for the adjusted model. The crude PR between occupation and MSD found was 1.06, close to the adjusted PR of 1.04, coinciding with the absence of an association between occupation and MSD reported by the MCA and objectively indicating the lack of contribution of the covariates to the main association.
The covariates marital status, torso tilted forward, and weekly working hours showed PRs of less than 1 and a probability of less than 5% that these negative associations were the result of the study’s random selection. There was also a good fit of the estimated Poisson model, with a small AIC and residual deviation close to zero.
The prevalence of MSD among the fishing workers reached a significant 93.5%, with the presence of MSD in at least one body region. Therefore, almost all the artisanal fishing workers studied had generalized MSD and, as a result, it was possible to draw up a profile for each occupation and common aspects of artisanal fishing workers affected by MSD, as illustrated in Figure 2.
Multiple correspondence analysis of musculoskeletal disorders characterized by occupation, according to study covariates, among artisanal fishing workers from Santiago do Iguape, Bahia, 2017
Figure 2 also shows the location of the Cartesian pairs corresponding to the occupations, occupying the odd quadrants in spatial opposition, with the shellfish gatherers’ Cartesian pair located in the 3rd quadrant and the fishermen’s in the 1st quadrant, showing profiles that are not similar.
The greatest distances between the points of the levels of each variable were also evaluated from the line of occupation (Figure 2). It should be noted that some distances were very close, confirming the non-variability of these findings and therefore not belonging to any profile.
When observing the variables associated with the profile of artisanal shellfish gatherers who had generalized MSD, the following individual factors were associated: young women under 37 years of age, with children under two years of age, incomplete high school education, practicing physical activity, smokers, absence of headaches and, despite reporting musculoskeletal pain, not using medication to control the pain and self-reporting comorbidities such as diabetes; physical factors related to fishing work were associated: carrying out another work activity concurrently with shellfish gathering, handling loads with the act of pushing the fish throughout the work activity, with a squatting position also throughout the work activity, as well as walking all the time and never using the sitting position during the work activity.
In the group of artisanal fishing workers, made up of men, who had generalized MSD, the following individual factors were associated: older fishermen aged 37 years or more, without children aged two years or more, with complete high school, not practicing physical activity, not smoking, having a headache and using medication to control the pain, and without diabetes comorbidities. Physical factors were associated with: not doing another work activity together with fishing, never handling the fish load by pushing it during work, never in the squatting position, never walking during work and always in the sitting position down during work.
For both occupations, the individual factors relating to BMI and self-reported comorbidities, hypertension, and rheumatoid arthritis, were similar. Regarding the work environment, the factors in common were the hours dedicated to fishing and the physical demands related to it: working in a standing position, with the torso leaning forward and with arms above shoulder height. Muscle strength in the arms and/or hands, time pressure and the pace of work were also similar.
Discussion
The fundamental finding of this article is the high prevalence of MSD in artisanal fishing workers in the target community, with no distinction between men (small boats fishermen) and women (shellfish gatherers). It was also observed that the occurrence of MSD and musculoskeletal pain is frequent in more than one body region.
The locality studied is a typical example of fishing communities in the Recôncavo region of Bahia. In these communities, AF is one of the survival strategies of low-income families in an exclusionary and crisis-prone economic system29, exacerbating poverty and the occurrence of occupational diseases due to the absence and/or very few therapeutic and preventive measures, primarily due to the lack of identification of the condition by the Brazilian health information system and also due to the invisibility of the main health surveillance demands specifically for artisanal fishing workers30.
The results found suggest, in an unprecedented way, that there is no difference in the occurrence of MSD between the occupational categories of shellfish gatherer and small boat fisherman. This result diverges from previous studies, in which women were more affected by MSD than men31,32. This was due to the high occurrence of the condition, which affected almost all the artisanal fishing workers in this study.
It is therefore very likely that all artisanal fishing workers in this traditional community have similar MSD in all body regions, so this finding demonstrates the seriousness of the problem, which can culminate in situations of permanent functional incapacity. Another aspect to consider is that artisanal workers cannot be measured only by the occurrence of MSD in just one anatomical site, as there is already evidence that workers subjected to high levels of physical demand in the workplace, including manual handling of materials and the adoption of strenuous positions, influence the occurrence of MSD and pain in several anatomical areas concomitantly32. Moreover, the type of work activity requires maintaining health for survival, which is a factor that differentiates this professional category, but this knowledge is sparse and lacks due attention for informal workers, especially in Brazil.
Regarding the factors associated with the exclusive occupation of shellfish gatherers in Baía de Todos-os-Santos, a previous study13showed the presence of MSD in the lumbar region, associated with working time in fishing of more than 26 years, sitting with torso flexion during work, and manual movement and muscle strength with the arms; and MSD in the neck/shoulder and distal upper limbs, associated with daily working time of more than 11 hours and performing another work activity concomitantly with AF33.
However, the results of a systematic review16showed that there is very little current evidence on the factors associated with the onset of MSD in fishing workers, in the case of industrial fishermen, with the only consistent evidence found being working part-time during the day.
In Brazil, the profile of individuals affected by MSD4unfortunately does not include informal workers but highlights that economic activity and occupation can be determining variables for the development of this disorder1; thus, it is noteworthy that artisanal fishing workers are among the poorest labor occupations in the world population7.
Various scientific studies have revealed numerous factors associated with the onset and worsening of MSD and their main anatomical sites of occurrence, with the physical demands of work being constant evidence in epidemiological studies in a wide range of professional categories1,23,34-36. Therefore, the profile of artisanal fishing workers with MSD in this study made it possible to analyze these factors, given the gap and fragility of knowledge about this professional category. It should also be noted that the analysis of the physical demand of work is recognized in the context of studies with populations of workers, especially in studies on MSD and their predictors23. According to Fernandes22, the description of the physical demand of this work and its particularities effectively demonstrates individual information, work experience, and its variable demands, and is especially relevant in the most dynamic occupations.
The results revealed the following profile of shellfish gatherers affected by MSD: younger women, with young children, incomplete secondary education, who do other work concurrently with fishing, squatting, walking for long hours, and handling loads by pushing the fish. This information highlights the variety of factors that can interfere in the occurrence and worsening of MSD.
Associations between the physical demands of work and MSD symptoms have been studied since the 2000s1,37. In the exclusive analysis of the physical demands of work, related to the occupation of shellfish gatherer, it is worth noting that, in addition to individual factors, associations were found in the physical factors arising from the three dimensions of the instrument applied, such as: general posture (walking), segmental posture (squatting), and load handling (pushing). These dimensions are similar to those found in a study of shellfish gatherers from Ilha de Maré-BA11, who also had abnormal postures and long walking times during their fishing activities.
Regarding the profile of fishermen with MSD, different characteristics were found, such as: older fishermen, no children under the age of two, complete high school education, no physical activity, non-smokers, presence of headaches and use of medication to control pain. Regarding physical factors, there was only one association found, and that was always sitting during work, so the physical demands of the job were only associated with one dimension: segmental posture.
The profiles of shellfish gatherers and small boats fishermen with MSD showed differences in both individual aspects and those related to the physical demands of the job. The study by Maneschy and collaborators37reports that the main differences between the genders in fishing are: subordination, the invisibility of women in the activity, and the historical change that has been taking place since the 1980s, with the need to include fisherwomen in policies to empower them and guarantee their social rights.
One of the hypotheses for these findings historically reflects the role of women in these traditional communities, who usually combine different types of activities in their daily lives, with double/triple working hours, and use the product obtained from fishing partly for family consumption and partly for resale and to generate income for the family. It is therefore understandable that there is a greater musculoskeletal burden on these workers and difficulty in changing their reality, given that maternal, household, and income-generating responsibilities are almost inseparable in these communities, which have very little infrastructure and a lack of health and education management.
The profile of small boats fishermen comprised males, with a higher age range (> 37 years) and no young children, thus suggesting that fishing customs are maintained among older people or due to a lack of opportunities in other work activities. In terms of the physical demands of the job, the result found reinforces the difference between fishermen with MSD and women, given that the work activity in this community is related to the use of small, rustic boats (camboas), with sitting prevailing most of the time. In a study of industrial workers38, for example, occupational exposure was insufficient to explain the higher occurrence of MSD in women than in men.
Considering the common profile of the two occupations, we highlight the physical factors associated with working in a standing position, with the torso tilted forward, and arms above shoulder height, as well as exacerbated muscle strength in the arms and/or hands and the pressure of time and the constantly fast pace of work. It should be noted that the torso tilted forward position is associated with lumbar dysfunctions and there is a relationship between increased flexion amplitude and the level of discomfort, as well as rotational movements, factors that can become a biomechanical risk for this region38.
Thus, individual factors, inappropriate postures, and high force intensities, such as those identified in this study, can cause physical and metabolic overload in the tissues and exceed the limits of stress, causing tissue macro-injuries39and favoring the occurrence and worsening of MSD, given its multi-causal nature. It is also worth noting that exposure to individual and work-related predictors of AF begins in childhood and adolescence, when work plays a cultural and social role.
Finally, the importance of demonstrating the seriousness of the occurrence of widespread MSD in both occupations is highlighted, as well as characterizing the profile of these workers. Therefore, there is a clear need for in-depth studies into all aspects of the work environment and its conditions, to strengthen the urgent need to recognize MSD, improve reporting and understanding of predictors, while ensuring health care and decent work for this important contingent of Brazilian workers.
Conclusion
The study revealed a high prevalence of MSD among artisanal fishing workers, with no differences between the categories of shellfish gatherers and small boat fishermen. It also made it possible to characterize the profiles of artisanal fishing workers with MSD in the locality in question. The difference in the profiles of these workers was demonstrated. The shellfish gatherers are: younger, with young children, incomplete high school education, they do other work concurrently with fishing, with a squatting working position, and long hours of walking, as well as handling loads by pushing the fish. As for the fishermen: they were older, had no young children, had completed high school, did not practice physical activity, were non-smokers, had headaches and used medication to control the pain, and were always seated while working.
The results indicated a high prevalence of generalized MSD among artisanal fishing workers, regardless of gender. This can be explained by the high exposure of both groups to adverse occupational factors and by the sociodemographic profile of the community studied.
The study has some limitations, such as: the cross-sectional nature of the research, which prevents us from determining the temporal relationship between the independent variables and the outcomes analyzed; the data collection based on participants’ self-reports, which may be subject to information bias; and, finally, the restriction of the sample to a specific community, limiting the generalization of the results to other regions and contexts of AF.
It is suggested that longitudinal studies be carried out to better understand the evolution of MSD over time and their relationship with working conditions in the fishing industry, as well as research involving the analysis of preventive strategies and interventions to minimize the impact of MSD on artisanal fishing workers. Finally, there is a need for public policies aimed at the occupational health of workers in the fishing industry, with a view to improving the working conditions and quality of life of this historically neglected professional group.
References
-
1 Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kinesiol. 2004 Feb;14(1):13-23. https://doi.org/10.1016/j.jelekin.2003.09.015
» https://doi.org/10.1016/j.jelekin.2003.09.015 - 2 Kuorinka I, Forcier L. Work-related musculoskeletal disorders: a reference book for prevention. London: Taylor & Francis; 1995.
-
3 Ministério da Saúde (BR). Dor relacionada ao trabalho: lesões por esforços repetitivos (LER): distúrbios osteomusculares relacionados ao trabalho (Dort). Brasília, DF; Ministério da Saúde; 2012 [citado 3 mar 2025]. Disponível em: https://www.gov.br/servidor/pt-br/siass/centrais_conteudo/artigos/dor-relacionada-ao-trabalho-lesoes-por-esforcos-repetitivos-ler-disturbios-osteomusculares-relacionados-ao-trabalho-dort/view
» https://www.gov.br/servidor/pt-br/siass/centrais_conteudo/artigos/dor-relacionada-ao-trabalho-lesoes-por-esforcos-repetitivos-ler-disturbios-osteomusculares-relacionados-ao-trabalho-dort/view -
4 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Saúde Brasil 2018: uma análise de situação de saúde e das doenças e agravos crônicos: desafios e perspectivas. Brasília, DF: Ministério da Saúde; 2019 [citado 9 jun2020]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/saude_brasil_2018_analise_situacao_saude_doencas_agravos_cronicos_desafios_perspectivas.pdf
» https://bvsms.saude.gov.br/bvs/publicacoes/saude_brasil_2018_analise_situacao_saude_doencas_agravos_cronicos_desafios_perspectivas.pdf -
5 Rêgo RF, Müller JS, Falcão IR, Pena PG. Vigilância em saúde do trabalhador da pesca artesanal na Baía de Todos os Santos: da invisibilidade à proposição de políticas públicas para o Sistema Único de Saúde (SUS). Rev Bras Saude Ocup. 2018;43 suppl 1:1-9. https://doi.org/10.1590/2317-6369000003618
» https://doi.org/10.1590/2317-6369000003618 -
6 Ministério da Pesca e Aquicultura (BR). Painel unificado do registro geral da atividade pesqueira. Brasília, DF: Ministério da Pesca e Aquicultura; 2023 [citado 4 fev 2024].. Disponível em: https://www.gov.br/mpa/pt-br/assuntos/cadastro-registro-e-monitoramento/painel-unificado-do-registro-geral-da-atividade-pesqueira
» https://www.gov.br/mpa/pt-br/assuntos/cadastro-registro-e-monitoramento/painel-unificado-do-registro-geral-da-atividade-pesqueira -
7 Food and Agriculture Organization of the United Nations. Towards gender-equitable small-scale fisheries governance and development: a: handbook: in support of the implementation of the Voluntary Guidelines for Securing Sustainable Small-Scale Fisheries in the Context of Food Security and Poverty Eradication. Rome: Food and Agriculture Organization of the United Nations; 2017 [citado 18 mai 2020]. Disponível em: http://www.fao.org/3/i7419en/I7419EN.pdf
» http://www.fao.org/3/i7419en/I7419EN.pdf -
8 The World Bank. Economic and Sector Work. Hidden harvest: the global contribution of capture fisheries. Washington, DC: World Bank; 2012 [citado 1 set 2025]. (Report, v. 66469-GLB. Disponível em: http://documents.worldbank.org/curated/en/515701468152718292/pdf/664690ESW0P1210120HiddenHarvest0web.pdf
» http://documents.worldbank.org/curated/en/515701468152718292/pdf/664690ESW0P1210120HiddenHarvest0web.pdf -
9 Pena PG, Martins V, Rego RF. Por uma política para a saúde do trabalhador não assalariado: o caso dos pescadores artesanais e das marisqueiras. Rev Bras Saude Ocup. 2013;38(127):57-68. https://doi.org/10.1590/S0303-76572013000100009
» https://doi.org/10.1590/S0303-76572013000100009 -
10 Jensen O, Flores A, Bygvraa DA, Baygi F, Charalambous G. A review of epidemiological studies in Latin American fishing. J Agromedicine. 2019 Oct;24(4):341-50. https://doi.org/10.1080/1059924X.2019.1639575
» https://doi.org/10.1080/1059924X.2019.1639575 -
11 Pena PG, Freitas MCS, Cardim A. Trabalho artesanal, cadências infernais e lesões por esforços repetitivos: estudo de caso em uma comunidade de mariscadeiras na Ilha de Maré, Bahia. Cienc Saude Coletiva. 2011;16(8):3383-92. https://doi.org/10.1590/S1413-81232011000900005
» https://doi.org/10.1590/S1413-81232011000900005 -
12 Falcão IR, Couto MC, Pena VM, Andrade LL, Müller J S, Alves IB, et al. Prevalence of neck and upper limb musculoskeletal disorders in artisan fisherwomen/shellfish gatherers in Saubara, Bahia, Brazil. Cienc Saude Coletiva. 2015;20(8):2469-80. https://doi.org/10.1590/1413-81232015208.17272014
» https://doi.org/10.1590/1413-81232015208.17272014 -
13 Couto MCBM, Falcão IR, Müller JS, Alves IB, Viana WS, Lima VMC, et al. Prevalence and work-related factors associated with lower back musculoskeletal disorders in female shellfish gatherers in Saubara, Bahia-Brazil. Int J Environ Res Public Health. 2019 Mar;16(5):1-15. https://doi.org/10.3390/ijerph16050857
» https://doi.org/10.3390/ijerph16050857 -
14 Müller JS, Falcão IR, Couto MC, Viana WS, Alves IB, Viola DN, et al. Health-related quality of life among artisanal fisherwomen/shellfish gatherers: lower than the general population. Int J Environ Res Public Health. 2016 May;13(5):1-12. https://doi.org/10.3390/ijerph13050466
» https://doi.org/10.3390/ijerph13050466 -
15 Scopel J, Oliveira PA, Wehrmeister FC. LER/DORT na terceira década da reestruturação bancária: novos fatores associados? Rev Saude Publica. 2012 Oct;46(5):875-85. https://doi.org/10.1590/S0034-89102012000500015
» https://doi.org/10.1590/S0034-89102012000500015 -
16 Remmen NL, Heiberg RF, Christiansen DH, Herttua K, Berg-Beckhoff G. Work-related musculoskeletal disorders among occupational fishermen: a systematic literature review. Occup Environ Med. 2021;78:522-9. https://doi.org/10.1136/oemed-2020-106675
» https://doi.org/10.1136/oemed-2020-106675 -
17 Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19(1):173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173
» https://doi.org/10.1146/annurev.publhealth.19.1.173 -
18 Unidades de Conservação no Brasil. Reserva extrativista marinha da Baía do Iguape. [citado 20 nov 2018]. Disponível em: https://uc.socioambiental.org/pt-br/arp/2584
» https://uc.socioambiental.org/pt-br/arp/2584 -
19 Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987 Sep;18(3):233-7. https://doi.org/10.1016/0003-6870 (87)90010-X
» https://doi.org/10.1016/0003-6870 (87)90010-X -
20 Pinheiro FA, Tróccoli BT, Carvalho CV. Validação do Questionário Nórdico de Sintomas Osteomusculares como medida de morbidade. Rev Saude Publica. 2002 Jun;36(3):307-12. https://doi.org/10.1590/S0034-89102002000300008
» https://doi.org/10.1590/S0034-89102002000300008 -
21 Stock SR, Fernandes R, Delisle A, Vézina N. Reproducibility and validity of workers' self-reports of physical work demands. Scand J Work Environ Health. 2005 Dec;31(6):409-37. https://doi.org/10.5271/sjweh.947
» https://doi.org/10.5271/sjweh.947 -
22 Fernandes RC, Cunha LP, Lima VM, Santos KO. Mensurando a demanda física no trabalho: estrutura fatorial e confiabilidade de itens sobre posturas, manuseio de carga e repetitividade. Cad Saude Publica. 2019;35(1):e00123218. https://doi.org/10.1590/0102-311x00123218
» https://doi.org/10.1590/0102-311x00123218 -
23 Fonseca NR, Fernandes RC. Factors related to musculoskeletal disorders in nursing workers. Rev Lat Am Enfermagem. 2010;18(6):1076-83. https://doi.org/10.1590/S0104-11692010000600006
» https://doi.org/10.1590/S0104-11692010000600006 - 24 Gómez-Galán M, Pérez-Alonso J. Musculoskeletal disorders: Owas review. Industrial Health. 2017;55:314-7.
-
25 Palmer KT, Syddall H, Cooper C, Coggon D. Smoking and musculoskeletal disorders: findings from a British national survey. 2003;33-6. https://doi.org/10.1136/ard.62.1.33
» https://doi.org/10.1136/ard.62.1.33 -
26 Fernandes RC, Carvalho FM, Assunção AA. Prevalence of musculoskeletal disorders among plastics industry workers. Cad Saude Publica. 2011 Jan;27(1):78-86. https://doi.org/10.1590/S0102-311X2011000100008
» https://doi.org/10.1590/S0102-311X2011000100008 - 27 World Health Organization. The international classification of adult underweight, overweight and obesity according to BMI. Geneva: World Health Organization; 2004.
-
28 Müller JD, Silva EM, Rego RF. Prevalence of musculoskeletal disorders and self-reported pain in artisanal fishermen from a traditional community in Todos-os-Santos Bay, Bahia, Brazil. Int J Environ Res Public Health. 2022 Jan;19(2):908. https://doi.org/10.3390/ijerph19020908
» https://doi.org/10.3390/ijerph19020908 - 29 Caroso C, Tavares F, Pereira OC, organizadores. Baía de Todos os Santos: aspectos humanos. Salvador: EDUFBA; 2011.
- 30 Ministério da Saúde (BR). Departamento de Vigilância em Saúde Ambiental e Saúde do Trabalhador. Nota informativa nº 5/2018-dsast/svs/ms:Informa sobre as principais demandas de vigilância em saúde de trabalhadoras e trabalhadores da pesca artesanal e recomenda ações. Brasília, DF: Ministério da Saúde; 2018.
-
31 Ramírez-Maestre C, Esteve R. The role of sex/gender in the experience of pain: resilience, fear, and acceptance as central variables in the adjustment of men and women with chronic pain. J Pain. 2014 Jun;15(6):608-618.e1. https://doi.org/10.1016/j.jpain.2014.02.006
» https://doi.org/10.1016/j.jpain.2014.02.006 -
32 Fernandes RC, Pataro SMS, Carvalho RB, Burdorf A. The concurrence of musculoskeletal pain and associated work-related factors: a cross sectional study. BMC Public Health. 2016;16(1):1-9. https://doi.org/10.1186/s12889-016-3306-4
» https://doi.org/10.1186/s12889-016-3306-4 -
33 Falcão IR, Rêgo RC, Couto MC, Pena PG, Andrade LL, Müller JD, et al. Fatores associados com os distúrbios musculoesqueléticos em pescadoras artesanais/marisqueiras em Saubara, Bahia, Brasil. Cien Saude Colet. 2019 Jul;24(7):2557-68. https://doi.org/10.1590/1413-81232018247.19712017
» https://doi.org/10.1590/1413-81232018247.19712017 -
34 Devereux JJ, Vlachonikolis IG, Buckle PW. Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb. Occup Environ Med. 2002 Apr;59(4):269-77. https://doi.org/10.1136/oem.59.4.269
» https://doi.org/10.1136/oem.59.4.269 -
35 Fernandes RC, Assunção AA, Silvany Neto AM, Carvalho FM. Musculoskeletal disorders among workers in plastic manufacturing plants. Rev Bras Epidemiol. 2010 Mar;13(1):11-20. https://doi.org/10.1590/S1415-790X2010000100002
» https://doi.org/10.1590/S1415-790X2010000100002 -
36 Vieira ER, Schneider P, Guidera C, Gadotti IC, Brunt D. Work-related musculoskeletal disorders among physical therapists: a systematic review. J Back Musculoskelet Rehabil. 2016 Aug;29(3):417-28. https://doi.org/10.3233/BMR-150649
» https://doi.org/10.3233/BMR-150649 -
37 Maneschy MC, Siqueira MC, Miranda LM. Pescadoras: subordinação de gênero e empoderamento. Rev Estudos Femin. 2012;20(3):713-37. https://doi.org/10.1590/S0104-026X2012000300007
» https://doi.org/10.1590/S0104-026X2012000300007 -
38 Almeida CG. Fernandes RCP. Distúrbios musculoesqueléticos em extremidades superiores distais entre homens e mulheres: resultados de estudo na indústria. Rev Bras Saude Ocup. 2017;42(0):1-10. https://doi.org/10.1590/2317-6369000125515
» https://doi.org/10.1590/2317-6369000125515 -
39 Bernard BP, Putz-Anderson V. Musculoskeletal disorders and workplace factors. A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. National Institute for Occupational Safety and Health. Washinton, DC: U. S. Department of Health and Human Services; 1997 [citado 4 fev 2018]. Disponível em: https://stacks.cdc.gov/view/cdc/21745
» https://stacks.cdc.gov/view/cdc/21745 -
40 Marras WS, Cutlip RG, Burt SE, Waters TR. National occupational research agenda (NORA) future directions in occupational musculoskeletal disorder health research. Appl Ergon. 2009 Jan;40(1):15-22. https://doi.org/10.1016/j.apergo.2008.01.018
» https://doi.org/10.1016/j.apergo.2008.01.018
-
Information about academic work:
Work based on Juliana dos Santos Muller’s doctoral thesis, entitled “Prevalência de distúrbios musculoesqueléticos e fatores associados e perfil dos pescadores artesanais de comunidade tradicional da Baía de Todos-os-Santos, Bahia, Brasil” (Prevalence of musculoskeletal disorders and associated factors and profile of artisanal fishing workers from a traditional community in Baía de Todos-os-Santos, Bahia, Brazil), presented in 2021 at the Postgraduate Program in Interactive Processes of Organs and Systems at the Federal University of Bahia.
-
Data availability:
The data supporting the study cannot be made publicly available for ethical and legal reasons.
-
Presentation at a scientific event:
The authors declare that the study has not been presented at a scientific event.
-
f
In this study, the standardized CBO term “multipurpose fishermen” (Code 6310 in the 2002 CBO) was adopted, which includes shellfish gatherers (Code 6310-10), called “mariscador” or “marisqueiro”, and fish and shrimp fishermen (Code 6310-20). In Brazilian publications, multipurpose fishermen are recognized as artisanal fishing workers.
-
Funding:
The authors declare that the study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico. Chamada CNPQ/ICMBIO/FAPS nº 18/2017.
Edited by
-
Editor-in-Chief:
Eduardo Algranti
Data availability
The data supporting the study cannot be made publicly available for ethical and legal reasons.
Publication Dates
-
Publication in this collection
06 Oct 2025 -
Date of issue
2025
History
-
Received
20 May 2024 -
Reviewed
26 Mar 2025 -
Accepted
25 Apr 2025
Source: Prepared by the authors.
Source: Prepared by the authors.