Indonesian Journal of Medicine (2026), 11(03): 151-163 Masters Program in Public Health, Universitas Sebelas Maret
Analysis of Risk Factors for Spinal Postural Disorders among Primary School Children
Zulfa Nadia1), Annang Giri Moelyo2), Revi Gama Hatta Novika1), Okid Parama Astirin3), Dhoni Akbar Ghozali4)
1)Master's Program in Public Health, Maternal and Child Health, Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
2)Child Health Department, Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
3)Biology Department, Faculty of Mathematics and Natural Sciences, Universitas Sebelas Maret Surakarta, Indonesia
4)Anatomy Department, Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
ABSTRACT
Background: Spinal postural disorders (kyphosis and lordosis) are increasingly prevalent among primary school children during the pre-pubertal phase when the spine remains structurally plastic. Evidence on screen time, physical activity, ergonomics, and nutritional status as simultaneous risk factors remains limited. This study examined their associations and identified the dominant determinant.
Subjects and Method: A cross-sectional study was conducted at an Integrated Islamic Primary School in Bekasi, Indonesia. A total of 240 students aged 9–12 years were enrolled by total sampling. The dependent variable was spinal postural disorder (kyphosis and/or lordosis), assessed by Occiput Wall Distance and Lumbar Wall Distance. Independent variables were screen time, physical activity, learning ergonomics, and nutritional status (BMI-for-age z-score, WHO AnthroPlus). Data were analysed by chi-square, Spearman correlation, multivariable logistic regression, and path analysis (SEM-ML).
Results: Prevalence of spinal postural disorders was 77.5% (kyphosis 55.8%; lordosis 63.3%; both simultaneously 44.2%). High screen time (>2 h/day) was found in 87.5% (mean 4.90±2.10 h/day), 61.7% were physically inactive, and 67.5% had abnormal nutritional status. Multivariable analysis identified BMI (aOR=1.12; 95% CI=1.04 to 1.21; p=0.002), high screen time (aOR=2.18; 95% CI=1.03 to 4.61; p=0.041), and physical inactivity (aOR=2.61; 95% CI=1.27 to 5.35; p=0.009) as independent predictors. Obesity showed the strongest bivariate association (OR=3.80; 95% CI=1.80 to 8.10; p<0.001). Path analysis confirmed BMI as the dominant determinant (total effect=0.38; CFI=1.00;
RMSEA=0.00) and physical activity as a partial mediator of the BMI (Sobel z=2.34; p=0.019) and screen time (Sobel z=2.50; p=0.012) pathways.
Conclusion: Obesity, high screen time, and physical inactivity pose a high risk of spinal postural
disorders. Weight management, screen time restriction, and increased physical activity are essential.
Keywords: Spinal posture, kyphosis, lordosis, school children, sedentary behavior
Correspondence: Annang Giri Moelyo. Child Health Department, Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, Surakarta 57126, Central Java, Indonesia. Email: annanggiri@staff.uns.ac.id.