IndexAbstractStatement of the problemLiterature reviewDeterminants of occupational stress among workersSociodemographic factorsPsychosocial factorsAbstractContext: occupational stress is a negative physical and emotional response to the imbalance between job demand and the capabilities and needs of individuals employees. Work stress and related illnesses such as depression and anxiety are responsible for a large percentage of disabilities worldwide. However, there is no study on work stress among factory workers in Ethiopia. Occupational stress may increase due to high workload, high psychological and physical work demands, low support from colleagues and supervisors, substance use, and lack of physical exercise among workers. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get Original Essay Objective: To evaluate the prevalence of occupational stress and associated factors in Addis Pharmaceutical Factory in Adigrat, Tigray, Ethiopia, 2018. Methods: An institution cross-sectional study was conducted at Addis Pharmaceutical Plant from 15 to 30 May 2018. Using a simple random sampling technique, approximately 423 samples were included from the total 952 study populations. The data were collected through a structured self-administration questionnaire. The prevalence of work stress was assessed using the short version of the Siegrist Scale Effort-Reward Imbalance Questionnaires which had Cronbach's α 0.80 and had good reliability in the pre-test of this study. The collected data were entered into Epi-data version 3.1 and exported to the Statistical Package for Social Sciences version 20.0 for analysis. Descriptive statistics were used to summarize and present the results in paragraphs, tables and graphs. A logistic regression analysis was performed to identify variables that have an association with job stress and to control for confounding factors. Odds ratios and 95% confidence intervals were reported at P < 0.05 and considered significant. Results: The response rate of this study was 94.1%. The prevalence of occupational stress in the study population was 30.2% (confidence interval 25.6 -34.7). Female sex (adjusted odds ratio, 3.68; 95% confidence interval, 1.61-8.42), low ability to control work (adjusted odds ratio, 3.10; 95% confidence interval, 1.29 -7.46), work overload (adjusted odds ratio 3.60; (adjusted odds ratio 3.60; confidence interval, 1.59 - 8.18), current alcohol use (adjusted odds ratio 2.458; confidence interval, 95% confidence interval, 1.05 - 5.76) and lack of exercise habits (adjusted odds ratio, 3.12; 95% confidence interval, 1.28 - 7.57) were significantly associated with occupational stress. Conclusion and recommendation: - the prevalence of occupational stress was found to be high. Female sex, poor ability to control work, excessive workload and the habit of lack of physical exercise were found to be independent predictors of occupational stress. Stress requires due attention and corrective actions by policy makers, director of Addis pharmaceutical factory and other concerned bodies. Problem Statement Stress can be defined in vague terms as the feeling of pressure in everyday life. No one is exempt from stress: in a normal range it helps us motivate ourselves and be productive, but too much stress or a strong response to the stressor (stimuli) has dangerous consequences for health. Stress is “thenon-specific response of the body to any request" (1,2). Work stress is the harmful physical and emotional response that occurs when the demands of the job are not in balance with the worker's abilities, needs, knowledge and resources. dependent or negative responses due to extraordinary efforts expended with few recognized rewards, leading to poor health (3,4). It is characterized by physiological problems such as headache, loss of sexual desire, severe physical illness, increased heart rate and blood pressure, palpitations and chest discomfort, shortness of breath, muscle pain, sleep problems, etc. Behavioral problems such as impulsiveness, eating disorders, easy distractibility, speech problems, irritability or aggression, teeth grinding, increased smoking and drug and alcohol use, increased errors, absenteeism, etc. and psychological symptoms such as anxiety, fear and tension, memory problems, depression, dissatisfaction, only negative vision, poor judgment, worries and catastrophic thoughts, overestimation of danger (5, 6). Work stress has been studied interchangeably by giving different names such as work-related stress, occupational stress, work-related stress and occupational stress in many areas, but all commonly represent work-induced stress (7). Commonly, the cause of work stress includes internal situations such as the person's attitude, thinking and lifestyle and external situations such as harsh work environment, increasing job demands, relationship problems (with colleagues and supervisor) and communication problems (8 ) According to the WHO report, stress affects 25% of workers worldwide and is the second most commonly reported work-related problem, affecting 22% of employees in the European Union(9). Health costs related to work stress are estimated at approximately $5.4 billion each year worldwide(10) and represent the second leading cause of absenteeism for non-manual workers(11). 60% of worker absenteeism is attributable to stress-related disorders(12). In the United States, stress is considered a health epidemic of the 21st century because 300 billion dollars per year lost due to stress and has increased from 10 to 30% among all demographic groups with over 50% of individuals having perceive a negative impact on work productivity(13). A recent report from Great Britain also shows that more than five hundred thousand different workers suffered and twelve million working days were lost due to work-related stress, depression and anxiety in 2016/17(14). Work-related stress, depression and anxiety accounted for 40% of work-related illnesses and 49% of working days lost in 2016/2017(15). Work stress strongly affects education, agriculture, healthcare institutions and industries ( 16). Work stress and related comorbidities, such as depression and anxiety, are responsible for a large percentage of disabilities worldwide as it impacts the psychological or physical well-being of individuals, such as increased medical and insurance costs with a reduction in income, and on the financial and organizational implications. worsening of productivity, increase in absenteeism and employee turnover (8,17). Occupational stress is linked to low quality of life, job burnout, increased risk of accidents and injuries at work and causes job changes and early retirement of employees (18). Occupational stress is associated with middle age, working for long periods, high workload, low organizational social support, being female, separated or divorced marital status, lowincome and alcohol consumption or cigarette smoking (7,19–23). Some studies have been conducted on work stress in areas of human and socio-economic activity. -professional categories in Europe, but there is a paucity of studies in Africa that also include factories owned by these European countries(24). There are also some studies on work stress in Africa, but there are no studies on work stress in factory workers in Ethiopia. So this research aims to evaluate the prevalence of occupational stress and associated factors in Addis pharmaceutical factory in Adigrat. Literature Review Occupational stress occurs when employees perceive the work environment to be harsh to their reaction resulting in feelings of inability to cope with real pressures or deadlines within the work environment (25). As reported by the WHO, 25% of the entire population experiences symptoms of stress at least once in their life (17). A research conducted in Thailand among workers in a rubber glove factory showed that 27.5% of them were subjected to work stress. The study was conducted on 200 workers using a questionnaire on job content(26). A cross-sectional study conducted among workers at a palm oil mill in Malaysia shows that 21% of employees suffered from work stress based on the O'Donnell Personal Stress Inventory(27). . Another cross-sectional study conducted among polymer manufacturing workers in Malaysia found that job stress was 25.3% (28). Furthermore, another cross-sectional study conducted on male workers in automotive assembly plants found occupational stress in 31.1% of them (29). A study was conducted among female ready-made garment (RMG) industry workers in Bangladesh which showed that 22.9% of them had high stress according to the ERI –Q scale (30). As many studies conducted in Iran have pointed out, in different factories such as industries and companies, the prevalence of work stress was varied. For example, in a case-control study conducted among workers in the automotive sector it emerged that the assessed work stress was equal to 21.3% among the control group and 35.1% among workers in the case group with injuries that presented professional stress(31). A cross-sectional study conducted among employees in the spinning industry revealed that 29.2% of them were subjected to high stress(32). Another cross-sectional study conducted in a similar area among 400 male employees of a steel company shows that 53% of them suffered from work stress(33). Another cross-sectional survey among white-collar workers at the Esfahan Steel Company conducted in Iran using a validated standardized questionnaire on work stress was also extended to the scholars was 50% (34). In assessing work stress among garment factory workers in India which was a cross-sectional study reported the prevalence to be 26% (23). Another descriptive cross-sectional study conducted among thermal energy workers in India to assess work and non-work stress reported that the prevalence of work stress was 9.5% (35). As per the INRS (National Institute for Scientific Research) Occupational Health Research Conference in 2012 revealed that workplace stress in South Africa affected 23% of miners, of which they were found in high-pressure jobs. stress(36). A cross-sectional survey conducted among garment workers in the Democratic Republic of the Congo showed that 28% of workers suffered from job stress according to Karasek's labor demand control model and 22% according to the effort-reward imbalance model on Siegrist scale(22). In Ethiopia,(35,38,45,46).