Research Article: Systematic review on the prevalence of illness and stress and their associated risk factors among educators in Malaysia

Date Published: May 28, 2019

Publisher: Public Library of Science

Author(s): Kwee Ling Tai, Yee Guan Ng, Poh Ying Lim, Sıdıka Bulduk.


Despite evidence of physical (illness) and mental (stress) health problems, there appears to be a lack of studies or concern regarding occupational safety and health among educators in Malaysia.

To review the prevalence of illness, stress, and corresponding risk factors among educators in Malaysia.

Scopus, ProQuest, PubMed, ScienceDirect, CAB, and other computerized databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies published between January 2013 and April 2019 on the prevalence and associated risk factors of illness and stress among educators (S1 Checklist). The keywords used included educator, teacher, lecturer, academic staff, teaching profession, university staff, academician, faculty, illness, injury, disease, pain, WMSD, dysphonia, hoarseness, stress, mental health, strain, health problem, disorder, and/or Malaysia. Selected studies were evaluated by quality assessment.

Twenty-two articles fulfilled the eligibility criteria. The prevalence of illness and stress was determined for low back pain (33.3–72.9%); upper back pain (33.33–56.4%); neck/shoulder pain (40.4–80.1%); upper arm discomfort (91.3%); forearm pain (89.6%); wrist pain (16.7–93.2%); hip pain (13.2–40.9%); thigh discomfort (91.8%); lower leg discomfort (90.5%); knee pain (23.7–88.0%); ankle/feet pain (19.3–87.7%); elbow pain (3.5–13.0%); voice disorder (10.4–13.0%) and stress (5.5–25.9%). Sex, education level, teaching experience, quality of life, anxiety, depression, coping styles, and others were reported as associated risk factors across the studies.

There appears to be a cause for concern regarding musculoskeletal disorders, voice disorder, and stress reported among educators in Malaysia. While most risk factors matched those reported in studies elsewhere, others such as school characteristics (school level, government or private school, and location [rural/urban]) have not been investigated.

Partial Text

Occupational health (OH) has attracted increasing attention in Malaysia in recent years, including that in the academic sector. The International Labour Organization (ILO/WHO) (1950) defines OH as “the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs” [1]. In the academic sector, educators play a pivotal role in ensuring that their learners achieve the expected learning outcomes corresponding to the level of education and educational policy. However, the quality of teaching and learning activities may be affected where educators become ill or injured due to occupational hazards in the workplace.

A systematic review was carried out to identify observational studies reporting on the prevalence and associated risk factors of illness and stress among educators in Malaysia that were published between January 2013 and April 2019. This systematic review was conducted using five electronic databases, including Scopus, ProQuest, PubMed, ScienceDirect, and CAB Direct.

In the 22 articles reviewed, the studied population (educators) were from different levels of school in Malaysia. Three articles studied primary school teachers, six included secondary school teachers, 11 assessed lecturers or academicians at higher learning institutions, and two articles did not clearly specify the level of schools from which the educators were recruited (Table 3).

Similar to most education tier systems worldwide, teachers or educators in Malaysia can be generally classified as pre-school, primary school, secondary/high school, and university and college (which usually uses the term academician to reflect the research components in the higher learning institutions) educators. The results of this review illustrate the apparent lack of study on a homogenous group of educators regarding a particular health effect outcome or associated risk factors in Malaysia except for stress.

In conclusion, despite the lack of study among educators in Malaysia, there is cause for concern as the studies included in this review reported a high prevalence of musculoskeletal disorders, voice disorders, and stress. Besides the commonly reported socio-demographic risk factors (sex, age, education level, body mass index, ethnicity, and religious practice), occupational risk factors (teaching experience, ergonomic issues, workload, and salary), and other risk factors such as personal lifestyle (smoking and alcohol consuming) and psychosocial factors, there were potentially other unexplored contributors to illnesses and stress among educators. By understanding the health status and risk factors of this population, future studies are warranted to explore proper mechanisms and for policy planning to ensure the most appropriate and effective preventive measures.