Healthcare worker burnout: exploring the experiences of doctors working in a maternity unit in Namibia.

BACKGROUND: Globally, healthcare workers (HCWs) in maternity units are at high risk of developing burnout. Burnout can lead to multiple harmful impacts on HCWs, their patients, and the broader healthcare system. Little is known about the burden of burnout among sub-Saharan African HCWs. Although evidence suggests that maternity unit doctors in a hospital complex in Namibia are at risk of developing burnout, no studies have been conducted on doctors in this department yet. METHODS: Through participant observation and a mixed-methods needs assessment, this study aimed to explore the drivers, experiences, and impact of burnout symptoms among doctors in this department, and current support mechanisms in place. Survey data was collected from 18 participants and seven in-depth interviews were conducted. Burnout risk was assessed using the Burnout Assessment Tool. RESULTS: Seven out of 18 participants were at very high risk for burnout and three were at risk, showing a high prevalence of burnout risk. Burnout risk remained similar between levels of staff, while gender qualitatively impacted burnout-related experiences. Drivers of burnout were identified at personal, occupational, and systemic levels. CONCLUSIONS: Over half of participants were at risk or at very high risk of burnout. Results highlighted a need for support and identified areas for intervention and further research. Such areas include blame culture, lack of trust between colleagues, and systemic drivers of burnout. This study contributes to the understanding of burnout among HCWs in sub-Saharan Africa.

Criteria-based audit of caesarean section in a referral hospital in rural Tanzania.

OBJECTIVE: WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity and mortality in a referral hospital in rural Tanzania. METHODS: Cross-sectional study was from November 2009 to November 2011. Women with severe maternal morbidity and mortality were identified and those with CS were included in this audit. Audit criteria were developed based on the literature review and (inter)national guidelines. Tanzanian and Dutch doctors reviewed hospital notes. The main outcome measured was prevalence of substandard quality of care leading to unnecessary CS and delay in performing interventions to prevent CS. RESULTS: A total of 216 maternal near misses and 32 pregnancy-related deaths were identified, of which 82 (33.1%) had a CS. Indication for CS was in accordance with audit criteria for 36 of 82 (44.0%) cases without delay. In 20 of 82 (24.4%) cases, the indication was correct; however, there was significant delay in providing standard obstetric care. In 16 of 82 (19.5%) cases, the indication for CS was not in accordance with audit criteria. During office hours, CS was more often correctly indicated than outside office hours (60.0% vs. 36.0%, P < 0.05). DISCUSSION: Caesarean section rate is not an useful indicator to monitor quality of EmOC as a high rate of unnecessary and potentially preventable CS was identified in this audit.

Mutations in LPL, APOC2, APOA5, GPIHBP1 and LMF1 in patients with severe hypertriglyceridaemia.

OBJECTIVES: The severe forms of hypertriglyceridaemia (HTG) are caused by mutations in genes that lead to the loss of function of lipoprotein lipase (LPL). In most patients with severe HTG (TG > 10 mmol L(-1) ), it is a challenge to define the underlying cause. We investigated the molecular basis of severe HTG in patients referred to the Lipid Clinic at the Academic Medical Center Amsterdam. METHODS: The coding regions of LPL, APOC2, APOA5 and two novel genes, lipase maturation factor 1 (LMF1) and GPI-anchored high-density lipoprotein (HDL)-binding protein 1 (GPIHBP1), were sequenced in 86 patients with type 1 and type 5 HTG and 327 controls. RESULTS: In 46 patients (54%), rare DNA sequence variants were identified, comprising variants in LPL (n = 19), APOC2 (n = 1), APOA5 (n = 2), GPIHBP1 (n = 3) and LMF1 (n = 8). In 22 patients (26%), only common variants in LPL (p.Asp36Asn, p.Asn318Ser and p.Ser474Ter) and APOA5 (p.Ser19Trp) could be identified, whereas no mutations were found in 18 patients (21%). In vitro validation revealed that the mutations in LMF1 were not associated with compromised LPL function. Consistent with this, five of the eight LMF1 variants were also found in controls and therefore cannot account for the observed phenotype. CONCLUSIONS: The prevalence of mutations in LPL was 34% and mostly restricted to patients with type 1 HTG. Mutations in GPIHBP1 (n = 3), APOC2 (n = 1) and APOA5 (n = 2) were rare but the associated clinical phenotype was severe. Routine sequencing of candidate genes in severe HTG has improved our understanding of the molecular basis of this phenotype associated with acute pancreatitis and may help to guide future individualized therapeutic strategies.