Burnout among primary health-care professionals in low- and middle-income countries: systematic review and meta-analysis Épuisement chez les professionnels des soins de santé primaires dans les pays à revenu faible ou intermédiaire: revue systématique et méta-analyse El desgaste entre los profesionales de la atención primaria de salud en los países de ingresos bajos y medios: revisión sistemática y metanálisis الإرهاق بين أخصائيي الرعاية الصحية الأولية في الدول ذات الدخل المنخفض والدخل المتوسط: مراجعة منهجية وتحليل تلوي 低收入和中等收入国家初级医疗护理工作者的职业倦怠情况：系统回顾和元分析 Профессиональное выгорание среди специалистов первичной медико-санитарной помощи в странах с низким и средним уровнем дохода: систематический обзор и метаанализ

ABSTRACT

Objective To estimate the prevalence of burnout among primary health-care professionals in low- and middle-income countries and to identify factors associated with burnout. Methods We systematically searched nine databases up to February 2022 to identify studies investigating burnout in primary health-care professionals in low- and middle-income countries. There were no language limitations and we included observational studies. Two independent reviewers completed screening, study selection, data extraction and quality appraisal. Random-effects meta-analysis was used to estimate overall burnout prevalence as assessed using the Maslach Burnout Inventory subscales of emotional exhaustion, depersonalization and personal accomplishment. We narratively report factors associated with burnout. Findings The search returned 1568 articles. After selection, 60 studies from 20 countries were included in the narrative review and 31 were included in the meta-analysis. Three studies collected data during the coronavirus disease 2019 pandemic but provided limited evidence on the impact of the disease on burnout. The overall single-point prevalence of burnout ranged from 2.5% to 87.9% (43 studies). In the meta-analysis (31 studies), the pooled prevalence of a high level of emotional exhaustion was 28.1% (95% confidence interval, CI 21.5–33.5), a high level of depersonalization was 16.4% (95% CI 10.1–22.9) and a high level of reduced personal accomplishment was 31.9% (95% CI 21.7–39.1). Conclusion The substantial prevalence of burnout among primary health-care professionals in low- and middle-income countries has implications for patient safety, care quality and workforce planning. Further cross-sectional studies are needed to help identify evidence-based solutions, particularly in Africa and South-East Asia.