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Badru OA, Alabi TA, Okerinde SS, Kabir MA, Abdulrazaq A, Adeagbo OA, Badru FA. Investigating the emigration intention of health care workers: A cross-sectional study. Nurs Open 2024; 11:e2170. [PMID: 38773757 PMCID: PMC11109476 DOI: 10.1002/nop2.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/03/2024] [Accepted: 04/24/2024] [Indexed: 05/24/2024] Open
Abstract
AIMS To (1) explore the intramigration experience of HCWs within Nigeria, (2) explore the migration intention of health care workers (HCWs) in Nigeria and (3) identify the predictors of migration intention among HCWs in Nigeria. DESIGN Cross-sectional study. METHODS The online survey was used to collect data from 513 HCWs in Nigeria between May and June 2023. Crude and adjusted logistic regression were used to identify factors associated with emigration intention. Analyses were performed on SPSS version 26 at a 95% confidence interval. RESULTS The study found that 34.4% had intramigration experience, and the rate of intention to emigrate to work in another country was 80.1%. The United Kingdom was the most preferred destination (109 HCWs), followed by Canada (92 HCWs) and the United States (82 HCWs). At the multivariate level, emigration intention was associated with the experience of burnout and duration of practice as a HCW. Nurses had higher emigration intentions than medical doctors. CONCLUSIONS Many HCWs in Nigeria appear to have emigration intent, and nurses are more likely to be willing to migrate than doctors. The Nigerian government may want to explore strategies to reverse the emigration intent of the HCWs in Nigeria.
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Affiliation(s)
- Oluwaseun Abdulganiyu Badru
- Department of Community and Behavioral HealthUniversity of IowaIowa CityIowaUSA
- Usmanu Danfodiyo University Teaching HospitalSokotoNigeria
| | - Tunde Adeyemo Alabi
- Department of SociologyUniversity of LagosLagosNigeria
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
| | | | | | | | - Oluwafemi Atanda Adeagbo
- Department of Community and Behavioral HealthUniversity of IowaIowa CityIowaUSA
- Department of SociologyUniversity of JohannesburgJohannesburgSouth Africa
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Wright T, Mughal F, Babatunde OO, Dikomitis L, Mallen CD, Helliwell T. Burnout among primary health-care professionals in low- and middle-income countries: systematic review and meta-analysis. Bull World Health Organ 2022; 100:385-401A. [PMID: 35694622 PMCID: PMC9178426 DOI: 10.2471/blt.22.288300] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/27/2022] Open
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.
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Affiliation(s)
- Tanya Wright
- School of Medicine, David Weatherall Building, Keele University, University Road, Keele, Staffordshire, ST5 5BG, England
| | - Faraz Mughal
- School of Medicine, David Weatherall Building, Keele University, University Road, Keele, Staffordshire, ST5 5BG, England
| | - Opeyemi O Babatunde
- School of Medicine, David Weatherall Building, Keele University, University Road, Keele, Staffordshire, ST5 5BG, England
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, England
| | - Christian D Mallen
- School of Medicine, David Weatherall Building, Keele University, University Road, Keele, Staffordshire, ST5 5BG, England
| | - Toby Helliwell
- School of Medicine, David Weatherall Building, Keele University, University Road, Keele, Staffordshire, ST5 5BG, England
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Miranda-Pacheco JA, De Santis-Tamara SA, Parra-Pinzón SL, González-Monterroza JJ, Lozada-Martínez ID. Medical interest groups and work policies as emerging determinants of a successful career: A student perspective - Correspondence. Int J Surg 2021; 92:106020. [PMID: 34252595 DOI: 10.1016/j.ijsu.2021.106020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Ivan David Lozada-Martínez
- Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cra. 50 #24120, Cartagena, Colombia.
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Díaz-Caballero MH, Evaristo-Chyong TA. Burnout syndrome and associated factors among dentists working in hospitals of the Ministry of Health in the Lima Metropolitan Area, Peru. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n1.86761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Worldwide, burnout syndrome is becoming increasingly frequent among dentists, so it is necessary to identify its possible causes.
Objective: To describe the prevalence of burnout syndrome and the factors associated with its development among dentists working in hospitals of the Ministry of Health (MINSA) in the Lima Metropolitan Area, Peru.
Materials and methods: Analytical cross-sectional study carried out between December 2019 and January 2020 in 105 dentists working in the 11 MINSA hospitals in the Lima Metropolitan Area. The Maslach Burnout Inventory instrument was used to measure burnout. Factors such as sex, age, marital status, type of shift, years of experience as a dentist, whether they performed any other dentistry-related work activity, and hours of physical activity and leisure per day were evaluated. Crude and adjusted prevalence ratios (PR) were obtained to analyze the association between the presence of the syndrome and the factors.
Results: The prevalence of burnout syndrome was 28.57%. Emotional exhaustion, depersonalization and personal accomplishment levels were high in 90.47%, 98.09% and 35.23% of the participants, respectively. The presence of the syndrome was 47% lower in women (aPR=0.53, p=0.044) compared to men, and 70% lower in those who reported having worked as dentists between 11 and 20 years (aPR=0.30, p=0.017), compared to those with less than 11 years of work experience as dentists.
Conclusions: Almost one third of the participants had burnout syndrome. In addition, the majority of dentists showed high levels of emotional exhaustion and depersonalization. Being a woman and having 11 to 20 years of work experience as dentists were protective factors for burnout syndrome.
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Leslie HH, Laos D, Cárcamo C, Pérez-Cuevas R, García PJ. Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study. BMC Health Serv Res 2021; 21:123. [PMID: 33549079 PMCID: PMC7865111 DOI: 10.1186/s12913-021-06117-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care. METHODS This cross-sectional continuous observation time motion study took place from July - September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection. RESULTS Two hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors. CONCLUSIONS The time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery.
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Affiliation(s)
- Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Denisse Laos
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Inter-American Development Bank, Lima, Peru
| | - Cesar Cárcamo
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Inter-American Development Bank, 6 Montrose Road, Kingston, Jamaica
| | - Patricia J García
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Commander SJ, Ellis D, Williamson H, Grabski D, Sallah AY, Derbew M, Fitzgerald TN. Predictors of Burnout and Depression in Surgeons Practicing in East, Central, and Southern Africa. J Surg Res 2020; 255:536-548. [PMID: 32640405 DOI: 10.1016/j.jss.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgeons are at risk of burnout and depression, which can lead to medical errors, inefficiency, exhaustion, conflicts, and suicide. Significant challenges exist in sub-Saharan Africa that may increase the prevalence of burnout and depression, but no formal evaluation has identified stressors specific to this environment. METHODS A survey was distributed to all members of the College of Surgeons of East, Central, and Southern Africa (COSECSA). Burnout, depression, and stressors were assessed with validated measures: Maslach Burnout Inventory for Medical Personnel, Patient Health Questionnaire (PHQ) 9, and Holmes-Rahe Life Stress Inventory. RESULTS There were 131 participants (98 African and 33 non-African surgeons). The incidence of moderate to severe depression was 48% (n = 63), and the incidence of burnout was as high as 38% (n = 48). There were no significant differences between African and non-African surgeons in marital status, number of children, partners in practice, or distribution of time. More African surgeons experienced birth of a child (18% versus 3%, P = 0.04) but had less workplace conflict (7.1% versus 10.7%, P = 0.045) than non-African surgeons. African surgeons more consistently felt they were positively influencing others (P = 0.008), enjoyed working with patients (P = 0.009), and were more satisfied (P = 0.04). For all surgeons, predictors of increased PHQ-9 depression were serious professional conflict (P = 0.02), difficulty accessing childcare (P = 0.04), and racial discrimination (P = 0.003). In the Maslach model, predictors of burnout were difficulty accessing childcare (P = 0.05) and denial of promotion based on gender (P = 0.006). CONCLUSIONS Burnout and depression in surgeons practicing in East, Central, and Southern Africa are substantial. Despite significant challenges, African surgeons tended to have a more positive outlook on their work. Improvements can be made to reduce burnout and depression by focusing on work conditions, equality of promotion opportunities, workplace conflict management, childcare support, and increasing the numbers of surgeons in practice.
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Affiliation(s)
| | - Danielle Ellis
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Hannah Williamson
- Duke Cancer Institute Biostatistics Shared Resource, Durham, North Carolina
| | - Dave Grabski
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Milliard Derbew
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina.
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Nwosu ADG, Ossai EN, Mba UC, Anikwe I, Ewah R, Obande BO, Achor JU. Physician burnout in Nigeria: a multicentre, cross-sectional study. BMC Health Serv Res 2020; 20:863. [PMID: 32928201 PMCID: PMC7489005 DOI: 10.1186/s12913-020-05710-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare workers are a burnout-prone occupational group and the prevalence is particularly high among physicians. With the prevailing low physician-patient ratio in Nigeria which has worsened with the recent wave of physician emigration, among other socio-economic constraints; a setting for high physician burnout may have been nurtured. Our survey set out to determine the prevalence of burnout among physicians practicing in Nigeria, ascertain the factors that were associated with the development of burnout and evaluate the respondents' perceived impact of physician burnout on patient safety. METHODS We used the Oldenburg burnout inventory as the measurement tool for burnout in the cross-sectional study conducted between November and December, 2019 among physicians in five tertiary health institutions in Nigeria. A 5- point Likert-type scale was used to evaluate the participants rating of their perceived impact of physician burnout on patient safety. Data entry and analysis were done using IBM Statistical package for social sciences software version 25 and the level of statistical significance was determined by a p value < 0.05. RESULTS The response rate was 61% (535/871), and burnout prevalence was 75.5% (404/535). Majority of the physicians (74.6%) perceive that physician burnout could impact patient safety. Physicians' professional grade, age and years in practice, but not specialty, gender or marital status were associated with the exhaustion domain, whereas only the physicians' age was associated with the disengagement domain of burnout. No socio-demographic or work-related characteristics determined overall burnout in our respondents. CONCLUSION Physician burnout in Nigeria is high and pervasive, and this should alert physicians to be wary of their general and mental health status. Public health policy should address this development which has implications for patient safety, physician safety and healthcare system performance.
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Affiliation(s)
- Arinze D G Nwosu
- Department of Anaesthesia, National Orthopaedic Hospital, Enugu, Nigeria.
| | - Edmund N Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Uwakwe C Mba
- Department of Plastic Surgery, College Of Medicine, ESUTH, Enugu, Nigeria
| | - Ifeanyi Anikwe
- Department of Orthopaedic Surgery, National Orthopaedic Hospital, Enugu, Nigeria
| | - Richard Ewah
- Department of Anaesthesia, FETHA, Abakaliki, Nigeria
| | - Bernard O Obande
- Department of Orthopaedic Surgery, Federal Medical Centre, Makurdi, Nigeria
| | - Justin U Achor
- Department of Psychiatry, Federal Neuropsychiatric Hospital, Enugu, Nigeria
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