Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study

BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Déterminants des coûts directs de la maladie en soins ambulatoires dans les ménages à Kinshasa analyse comptable et économétrique / Determinants of the direct costs of the disease in outpatient care in households in Kinshasa: accounting and econometric analysis

Contexte et objectif. Avec une grande majorité d'habitants sans couverture-maladie, l'inaccessibilité aux soins pour manque d'argent est un problème réel parmi les habitants de Kinshasa en raison des paiements directs. La présente étude a évalué le coût direct de la maladie du point de vue des ménages et identifié les facteurs déterminants dudit coût. Méthodes. Une enquête a été menée dans la commune de Limete auprès de 150 ménages choisis de manière aléatoire dans huit quartiers. Les données collectées ont été soumises d'abord à un traitement comptable, puis à l'analyse statistique et à l'analyse économétrique. Résultats. Le coût total direct moyen était de 145.258,88 CDF (environ 88 US $) par épisode-patient en ambulatoires. Dominés largement par les médicaments, les frais médicaux représentent 86,57 % du total (76 US $) contre 13,43 % de frais non médicaux (12 US $). Excepté la consultation, les autres frais médicaux influent positivement sur le total des frais médicaux. De même, tous les frais non médicaux, sauf les frais d'appel téléphonique, influent sur le total des frais non médicaux. Conclusion. Le coût médical en ambulatoire par patient-épisode est dominé à 65 % par les frais de médicaments mais dont l'impact sur le coût médical de la maladie reste plus faible.

Burnout and associated factors in undergraduate medical students at a South African university

Background. Medical students are at risk of burnout owing to various challenges.Objectives. To investigate burnout and associated factors among undergraduate students at a South African medical school.Methods. In this cross-sectional study, findings of the Copenhagen Burnout Inventory (CBI), demographic data and information related to resilience were collected by means of an anonymous self-administered questionnaire. Associations between burnout subscales and various factors were determined.Results. Five-hundred students (preclinical, n=270; clinical, n=230) completed the questionnaire. CBI mean scores for preclinical and clinical students were 17.9 and 17.4 (personal), 22.3 and 21.9 (work related) and 24.8 (patient related; clinical students only), respectively. High scores on the subscale reflect low levels of burnout in related areas. Male students and students with high self-reported resilience and low stress had significantly lower burnout levels. White preclinical students had lower levels of personal and work-related burnout, and black clinical students had less patient-related burnout.High mean scores in all three burnout subscales indicated low burnout levels among students. Academic and personal stress, as well as perceived poor support from institutional structures, were associated with significantly higher personal and work-related burnout, but not patient-related burnout in clinical students

A cross-sectional self-assessment of burnout amongst a sample of doctors in Ghana

Background: The occurrence of burnout amongst African health professionals has been widely anticipated, but there is a dearth of published data, especially amongst doctors. Burnout has been reported to be as high as 53% amongst doctors in the United States. If not detected, it can result in prescription errors, work-related accidents, substance abuse and depression. Aim: The aim of this study was to determine the prevalence of burnout and its associated factors amongst a sample of physicians in Ghana. Setting: This study was conducted in Kumasi amongst physicians attending a conference organised by the West African College of Physicians, Ghana Chapter. Method: A cross-sectional study. Of the 90 physicians who registered for the conference, 60 responded to a self-administered Maslach Burnout Inventory questionnaire. Data were analysed descriptively and inferentially using STATA® version 14. Results: Approximately 52% of respondents had been in medical practice for 10­19 years (mean 15.4 years). All the major medical specialties were represented. Internal Medicine had the highest number of participants (48.3%). With respect to the components of burnout, 5.5% of respondents experienced depersonalisation, 7.8% had a lack of personal achievement and 10.8% experienced emotional exhaustion. The association between burnout and age, sex, years of practice and clinical specialty was not found to be statistically significant. Conclusion: This pilot study has shown burnout to be common amongst physicians in Ghana. It is recommended that further studies are conducted, involving a larger cross-section of doctors in various parts of Africa

Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa

Background: Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. Objectives: The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa.Method: A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study.Results: Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes.Conclusion: The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs

The prevalence of burnout among registrars in the school of clinical medicine at the University of the Witwatersrand, Johannesburg, South Africa

Background. Burnout is a response to prolonged stress and consists of three elements: emotional exhaustion (EE), depersonalisation (DP), and feelings of personal accomplishment (PA). The existence of burnout in doctors is often not acknowledged but has major consequences for personal and professional life. Only limited research has been done on the prevalence of burnout among registrars in South Africa (SA).Objectives. To describe the prevalence of burnout in a cohort of SA registrars, and assess relationships between burnout and sociodemographic factors.Methods. A cross-sectional descriptive internet survey was conducted. Respondents were registrars in departments of the School of Clinical Medicine at the University of the Witwatersrand, Johannesburg, SA. The Maslach Burnout Inventory (MBI) was used to measure burnout. Relationships were assessed by the independent-samples t-test and analysis of variance.Results. A total of 585 emails were delivered to registrars, of whom 201 started the survey (response rate 34%); 170 questionnaires were analysed. The mean age of the respondents was 33 years, and the male/female ratio was 1:1.8. The mean (standard deviation) score for EE was 3.5 (1.2), for DP 2.7 (1.1) and for PA 4.1 (1.1). The overall level of burnout was 84%. None of the respondents scored low over all categories. No significant association between sociodemographics (age, sex, discipline, year in the programme and experience) and MBI dimensions wasfound.Conclusions. The prevalence of burnout in this study was higher than that reported in the national and international literature. Levels of DP were extremely high and are worrying, as DP affects professionalism and engagement of doctors. In keeping with the literature, no associations were found between sociodemographic factors and burnout, suggesting that the cause of burnout should be sought in the work environment. Efforts to improve autonomy in the workplace, development opportunities and promoting peer collaboration are needed to prevent burnout

Burnout among Nigerian doctors: a systematic review

Burnout among physicians is a global phenomenon which has been under-reported in middle and low-income economies. The importance of burn-out on the physicians' well-being, patient care and overall health care system cannot be overemphasized. In Nigeria, few studies are specific to burnout, with most of the available studies exploring psychosocial issues at physicians' workplace stress and job dissatisfaction. This present review of literature is assessing burnout among Nigerian Physicians. This review is designed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The review identified observational, review, longitudinal and experimental studies on Nigerian physicians between 1970- 2017, which have the full text in the English language. The articles were searched from online databases such as PUBMED, Directory of Open Access Journals (DOAJ), African Journals Online (AJOL) and Google Scholar by researchers. The keywords used include "Physician", "Nigeria", "burn-out" syndrome. The prevalence of 23.6% to 51.7% burnout was reported among physicians in the selected studies, with young age being a strong predictor for burnout. High burden of emotional exhaustion, depersonalization and personal accomplishment were reported in the study carried out among resident doctors who are early career doctors. The prevalence of burnout reported from these studies in Nigeria is very high, although they are within the globally reported range of physician burnout. Nevertheless, there is a dearth of information on the subject matter among Nigerian Physicians. There is a need to carry out more studies on burnout among Nigerian Physicians

Experiences of Nurses Caring for Mental Health Care Users in an Acute Admission Unit at a Psychiatric Hospital in the Western Cape Province

Background: Caring for mental health care users (MHCUs) with mental illnesses is a major task that confronts nurses globally. It has been argued that caring for this group of patients is accompanied by unique challenges. Despite the available abundance of data about nursing patients suffering from mental illnesses; little is known about the lived experiences of nurses who care for MHCUs in acute admission units in the Western Cape province.Objectives: This study's aim is to explore and describe the lived experiences of nurses who care for MHCUs in an acute admission unit at a psychiatric hospital in the Western Cape province.Methods: A qualitative; descriptive; phenomenological study was conducted. A purposive sampling procedure was applied which resulted in a sample that comprised eight nurses. Indepth; individual; semi-structured interviews were conducted with these eight participants. Interviews were audio-recorded and transcribed verbatim and the researcher utilised Collaizzi's method to analyse collected data.Results: Both positive and negative experiences were reported. Positive experiences werethe recovery of patients; teamwork; and passion for caring. Negative experiences were the feelings of being unappreciated and unsupported by authorities. Physical assault by MHCUs;shortage of staff; increased workload and burnout was also reported.Conclusions: In-service training about management of aggression needs to be provided; debriefing sessions to deal with burnout needs to be arranged; and research to quantify levelsof burnout should be conducted

Burnout amongst hospital nurses in Kimberley; South Africa

Aim: The aim of this study was to quantify the extent of burnout and identify demographic and employment characteristics associated with burnout in Kimberley hospital nurses. Methods: During staff meetings; 194 of a population of 200 nurses completed a questionnaire; which consisted of socio-demographic details; the Maslach Burnout Inventory and an open-ended question. Results: Most of the respondents were female (94.3) and the median number of years worked was 15 years. More than half (55.2) the nurses suffered from emotional exhaustion; 33.7 from a feeling of depersonalisation and 27.5 from a sense of a lack of personal accomplishment. Only 7.3 suffered from all of the above; i.e. burnout. Nurses in the 31-40 and 41-50 year age groups were more likely to suffer from emotional exhaustion. No significant associations could be found between age; gender or marital status; and a feeling of depersonalisation or a sense of a lack of personal accomplishment. Nurses who had been in the profession longer were more likely to suffer from emotional exhaustion. The significant association between years to stay in the profession and a feeling of depersonalisation was less consistent. Conclusion: This study found that more than half the nurses were emotionally exhausted. Since a mentally and physically sound caregiver is able to render more efficient services than one who is emotionally drained and physically exhausted; the signs of burnout should be detected and addressed as early as possible