Burnout Syndrome Among Anesthesia Providers Working in Public Hospitals in Rwanda: A Cross-Sectional Survey.

BACKGROUND: Many studies address anesthesia provider burnout in high-income countries; however, there is a paucity of data on burnout for anesthesia providers in low-income countries (LICs). Our objectives were (1) to evaluate the prevalence of burnout among anesthesia providers in Rwandan hospitals and (2) to determine factors associated with burnout among anesthesia providers in Rwandan hospitals. METHODS: A questionnaire was sent to selected Rwandan anesthesia providers working in public hospitals. The questionnaire assessed burnout using the Maslach Burnout Inventory Human Services Survey, a validated 22-item survey used to measure burnout among health professionals. Sociodemographic and work-related factors found to be associated with burnout were also assessed using logistic regression in a Bayesian framework to estimate odds ratios (OR) and associated credible intervals (CrIs). RESULTS: Surveys were distributed to 137 Rwandan anesthesia providers; 99 (72.3%) were returned. Sixty-six (67%) respondents were nonphysician anesthesia providers. Burnout was present in 26 of 99 (26.3%) participants (95% confidence interval [CI], 17.9-36.1). When considering weakly informative priors, we found a 99% probability that not having the right team (OR, 5.36%; 95 CrI, 1.34-23.53) and the frequency of seeing patients with negative outcomes such as death or permanent disability (OR, 9.62; 95% CrI, 2.48-42.84) were associated with burnout. CONCLUSIONS: In a cross-sectional survey of anesthesia providers in Rwanda, more than a quarter of respondents met the criteria for burnout. Lacking the right team and seeing negative outcomes were associated with higher burnout rate. These identified factors should be addressed to prevent the negative consequences of burnout, such as poor patient outcomes.

Not a "first world problem"-Care of the anesthetist in East and Southern Africa.

Burnout and related concepts such as resilience, wellness, and taking care of healthcare professionals have become increasingly prevalent in the medical literature. Most of the work in this area comes from high-income countries, with the remainder from upper-middle-income countries, and very little from lower-middle-income or low-income countries. Sub-Saharan Africa is particularly poorly represented in this body of literature. Anglo-American concepts are often applied to different jurisdictions without consideration of cultural and societal differences. However, anesthesia providers in this region have unique challenges, with both the highest burden of "surgical" disease in the world and the least resources, both in terms of human resources for health and in terms of essential drugs and equipment. The effect of burnout on healthcare systems is also likely to be very different with the current human resources for the health crisis in East and Central Africa. According to the Joint Learning Initiative Managing for Performance framework, the three essential factors for building a workforce to effectively support a healthcare system are coverage, competence, and motivation. Current efforts to build capacity in anesthesia in East and Southern Africa focus largely on coverage and competence, but neglect motivation at the risk of failing to support a sustainable workforce. In this paper, we include a review of the relevant literature, as well as draw from personal experience living and working in East and Southern Africa, to describe the unique issues surrounding burnout, resilience, and wellness in this region.

A Cross-Sectional Survey to Determine the Prevalence of Burnout Syndrome Among Anesthesia Providers in Zambian Hospitals.

BACKGROUND: Burnout is a psychological syndrome that results from chronic exposure to job stress. It is defined by a triad of emotional exhaustion, depersonalization, and reduced personal accomplishment. In research, mostly from high-income countries, burnout is common in health care professionals, especially in anesthesiologists. Burnout can negatively impact patient safety, the physical and mental health of the anesthetist, and institutional efficiency. However, data on burnout for anesthesia providers in low- and middle-income countries are poorly described. This study sought to determine the prevalence of burnout syndrome among all anesthesia providers (physician and nonphysician) working in Zambian hospitals and to determine which sociodemographic and occupational factors were associated with burnout. METHODS: A questionnaire was sent to all Zambian anesthesia providers working in private and public hospitals. The questionnaire assessed burnout using the Maslach Burnout Inventory Human Services Survey, a validated 22-item survey widely used to measure burnout among health professionals. Sociodemographic and occupational factors postulated to be associated with burnout were also assessed. RESULTS: Surveys were distributed to all 184 anesthesia providers in Zambia; 160 were returned. This resulted in a response rate representing 87% of all anesthesia providers in the country. Eighty-six percentage of respondents were nonphysician anesthesia providers. Burnout was present in 51.3% (95% confidence interval [CI], 43.2-59.2) of participants. Logistic regression analysis revealed that "not having the right team to carry out work to an appropriate standard" (odds ratio, 2.91, 95% CI, 1.33-6.39; P = .008), and "being a nonphysician" (odds ratio, 3.4, 95% CI, 1.25-12.34; P = .019) were significantly associated with burnout in this population. CONCLUSIONS: In a cross-sectional survey of anesthesia providers in Zambia, >50% of the respondents met the criteria for burnout. The risk was particularly high among nonphysician providers who typically work in isolated rural practice. Efforts to decrease burnout rates through policy and educational initiatives to increase the quantity and quality of training for anesthesia providers should be considered.