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BACKGROUND: The health implication of backpack carriage among school-aged children is a topic of growing research and public health interest. Low weighing backpacks may decrease the risk of musculoskeletal discomforts (MSDs). OBJECTIVE: To investigate MSDs and their association with backpack carriage practices among secondary school students in eastern Nigeria. METHOD: Across-sectional study of 404 (243 females and 161 males) secondary school students aged thirteen to seventeen who were residents of Enugu State, Nigeria was conducted. The Modified Standard Nordic Musculoskeletal Questionnaire was adapted and used to collect information onstudents' demographics, musculoskeletal painand backpack carriage. Descriptive statistics (frequencies and percentages) were utilized to summarize results. Chi-square test was used to explore the association between MSD prevalence and backpack carriage practices. Data were analysed using SPSS version 20.0. Alpha level was kept at 0.05. RESULTS: The average backpack weight carried by the students in this study was 2.49 kg. Shoulder (185, 45.8%), neck (121, 30.0%), upper back (91, 22.6%) and lower back (22, 5.5%) in that order were the body regions most affected by MSDs within the last 12 months. More females than males reported MSDs (60.5% vs 45.2%; x2 = 8.09, p = 0.04). Other students'characteristics and backpack carriage related factors were not associated with MSDs. CONCLUSION: There is a high prevalence of MSDs among secondary school students in this study but it is not related to backpack carriage. Further research is required to identify the factors responsible for the MSDs, as well as suitable interventions to reduce its impact in this population. [ABSTRACT FROM AUTHOR]