Work-Related Stress Among Neglected Work Forces in Tertiary Hospitals, Eastern Ethiopia: A Cross-Sectional Study

Hospital cleaners are an often-neglected workforce routinely exposed to hazardous working conditions that increase their risk of work-related stress (WRS). However, evidence on WRS among hospital cleaners in low- and middle-income countries, including Ethiopia is limited. This study aimed to determine the prevalence of WRS and identify associated factors among hospital cleaners working in eight tertiary hospitals in eastern Ethiopia.

A hospital-based cross-sectional study was conducted among 741 cleaners from May to August 2023. Work-related stress (WRS) was assessed using modified items from the Copenhagen Psychosocial Questionnaire II (COPSOQ-II) and the National Health Survey. Severe and low WRS were classified using the mean cut-off score derived from the summed components of physical indicators of WRS. Data quality was ensured through training, pretesting, expert evaluation of the assessment tools, and internal consistency testing using Cronbach's alpha. Data were entered into EpiData version 3.1 and analyzed using Stata 17MP. Descriptive statistics summarized participant characteristics. Binary and multivariable logistic regression analyses identified factors associated with WRS. Variables with p < 0.20 were included in the multivariable model, and AORs with 95% CIs were reported.

Of 741 hospital cleaners, 679 participated (response rate: 91.63%). The prevalence of severe WRS was 29.16% (95% CI: 25.77%-32.74%). Multivariable analysis identified significant factors. Workload (AOR = 10.23, 95% CI: 6.16-16.98; p < 0.001), smoking (AOR = 6.64, 95% CI: 3.53-12.51; p < 0.001), khat chewing (AOR = 4.07, 95% CI: 2.34-7.09; p < 0.001), job dissatisfaction (AOR = 2.67, 95% CI: 1.24-5.76; p = 0.012), less-than-monthly supervision (AOR = 1.63, 95% CI: 1.01-3.06; p = 0.030), lack of social recognition (AOR = 3.11, 95% CI: 1.63-5.92; p < 0.001), sleeping difficulties (AOR = 2.18, 95% CI: 1.27-3.71; p = 0.004), and inadequate OHS services (AOR = 1.64, 95% CI: 1.16-2.83; p = 0.043) increased WRS. Experience > 6.72 years reduced stress (AOR = 0.44, 95% CI: 0.26-0.75; p = 0.003).

The study concludes that almost one-third of cleaners in tertiary hospitals had severe WRS. Higher levels of stress were substantially associated with smoking, chewing khat, job dissatisfaction, infrequent supervision, lack of social recognition, trouble sleeping, and inadequate workplace health and safety services, with workload being the most significant predictor. Conversely, higher levels of education and more work experience were protective factors. These findings highlight the necessity of comprehensive workplace interventions that reduce excessive workloads, support occupational health and safety services, improve supervision and recognition, promote healthy lives, and support cleaners' professional growth.