Ergonomic challenges and health implications for long-distance bus passengers in Tanzania

This cross-sectional, multi-route study quantified ergonomic burdens among passengers on Tanzania's long-distance intercity buses. Standardized tools (Nordic Musculoskeletal Questionnaire; Borg CR-10; context items on seat/space, breaks, and perceived vibration aligned to ISO 2631) captured trip-specific symptoms and exposures. To evaluate ergonomic risks and symptoms among adults riding long-distance intercity buses in Tanzania, a cross-sectional, multi-route passenger survey was conducted on 12 main intercity routes that were specifically chosen to represent high passenger numbers and lengthy journey times. Discomfort increased with route distance at both the route and cluster levels. Lower-limb symptoms, low-back pain, and neck/shoulder stiffness predominated. Marked subgroup patterns were observed: leg swelling (CR-10 ≥ 4) was higher in females than males (38% vs 22), neck/shoulder stiffness higher in males than females (35% vs 25%), and severe low-back pain peaked in mid-life (18–30 y: 20%; 31–50 y: 42%; 51+ y: 38%). On routes >1200 km, 85% reported the single ∼10-min stop as inadequate for meaningful movement. In multivariable analysis, severe discomfort (CR-10 ≥ 4) was independently associated with greater distance, pre-existing conditions, luggage >15 kg, reduced seat pitch, and higher perceived vibration (Nagelkerke R 2 ≈ 0.48). These findings support an exposure triad, distance-driven immobility, seat/space constraints, and whole-body vibration as the principal drivers of passenger discomfort. Pragmatic actions include instituting ≥2 movement-oriented stops (≥15 min) on ≥12-h itineraries, specifying minimum seat-pitch/lumbar-support standards, enforcing legroom-protective luggage policies, and integrating basic vibration monitoring into maintenance. This calls for randomized or quasi-experimental evaluations of revised stop architecture, seat/layout trials using local anthropometry, expanded vibration logging across corridors, and longitudinal tracking of higher-risk travelers. • Neck/shoulder stiffness higher in males than females (35% vs 25). • On routes >1200 km, 85% reported the single ∼10-min stop as inadequate for meaningful movement. • Implement luggage policies and seating strategies to preserve legroom on long journeys. • Movement friendly stop architecture, duty cycles for breaks, and legroom/luggage policies for high-duration routes. • Integrate basic WBV monitoring into operator reporting for select corridors.