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Table 2 Characteristics of studies on burnout among nurses in sub-Saharan Africa (N = 26)

From: Systematic review of burnout among healthcare providers in sub-Saharan Africa

1st author, Year Country Study population Burnout assessment Reported burnout Main findings
Amoo, 2008 [68] Nigeria Psychiatric nurses (N = 50) and secondary school teachers (N = 50) Executive Burnout Scale Among nurses,
Total burnout (mean ± SD): 47.4 ± 12.2
General subscale: 21.3 ± 5.7
Somatic subscale: 16.4 ± 5.9
Interpersonal subscale: 9.9 ± 3.0
Teachers had significantly higher total job burnout, and burnout on the three subscales (general, somatic, and interpersonal) than nurses (p < 0.05). Burnout was not associated with sex, marital status, age and length of service. No significant difference in job satisfaction was observed between the two groups (p = 0.297).
Asiedu, 2018 [69] Ghana Nurses from public hospitals (N = 134) MBI-GS 1.7 ± 0.8 (mean ± SD) Sex, age, number of older dependents, weekend work, work-to-family conflict and family-to-work conflict were significantly associated with burnout (p < 0.05). Work-to-family conflict and family-to-work conflict accounted for 20% of variance in burnout.
Buitendach, 2011 [70] Namibia Nurses from two private hospitals (N = 191) MBI-GS Exhaustion (mean ± SD): 11.3 ± 8.6
Cynicism: 4.6 ± 4.8
Professional efficacy: 25.5 ± 10.5
Job satisfaction was associated with emotional exhaustion and cynicism. The interaction of problem-focused coping and job satisfaction were significant predictors of emotional exhaustion (p < 0.05)
Coetzee, 2013 [71] South Africa Nurses at private and public national referral hospitals (N = 1187) Emotional Exhaustion subscale of MBI 45.8% report high levels of burnout on emotional exhaustion subscale Nurses with more favorable practice environments were less likely to report high burnout (OR = 0.55; 95% CI: 0.41–0.75). Nurses who worked at public hospitals were more likely to have burnout compared to those at private hospitals (53.8% vs. 40.6%; p < 0.001).
Davhana-Maselesele, 2008 [72] South Africa Nurses caring for HIV-positive and AIDS patients (N = 174) MBI Mean for personal accomplishment, emotional exhaustion and depersonalization were 52, 33 and 29%, respectively High measures of depression, sadness, fatigue and low energy were found among nurses.
Engelbrecht, 2008 [73] South Africa Nurses at clinics and community health centers (N = 542) MBI-HSS Emotional exhaustion (mean ± SD): 31.3 ± 9.3
Depersonalization: 17.8 ± 4.9
Personal accomplishment: 20.3 ± 6.8
Availability of resources, time pressure of workload, and conflict and social relations predicted 21% of the variance in emotional exhaustion and 8% of the variance in depersonalization scores. Availability of resources and time pressure of workload predicted 14% of variance in personal accomplishment.
Ezenwaji, 2019 [74] Nigeria Nurses at hospitals (N = 393) Oldenburg Burnout
Inventory
Mean burnout score of male nurses was 3.2 ± 0.1 and female nurses was 3.2 ± 0.1 Sex, age, work experience, and work environment were not significantly associated with burnout scores.
Gandi, 2011 [75] Nigeria Nurses at hospitals (N = 373) MBI-GS Among men:
Emotional exhaustion (mean ± SD):2.3 ± 1.3
Depersonalization: 0.6 ± 0.7
Personal accomplishment: 5.1 ± 1.1
Among women:
Emotional exhaustion (mean ± SD): 2.5 ± 1.3
Depersonalization: 0.8 ± 0.9
Personal accomplishment: 5.2 ± 0.8
Sex was not significantly associated with burnout scores. The relationship between work characteristics and burnout was mediated by work-home interference and home-work interference.
Gorgens-Ekermans, 2012 [76] South Africa Nurses (N = 122) MBI Emotional exhaustion (mean ± SD): 13.6 ± 11.0
Depersonalization: 6.6 ± 5.3
Personal accomplishment: 34.1 ± 9.9
Emotional management and emotional control, as measured by the Swinburne University Emotional Intelligence test, were associated with self-reported stress and burnout subscales (p < 0.01). Workload was a significant predictor of emotional exhaustion (β = 0.547, p = < 0.001) and work/family interface as a source of stress was a significant predictor of depersonalization (β = 0.296, p = 0.004). Emotional intelligence was a moderator of the relationship between stress and burnout, explaining 59.5% of the variance in the emotional exhaustion and 23.9% of the variance in the depersonalization subscale of burnout.
Heyns, 2003 [77] South Africa Nurses caring for patients with Alzheimer’s disease (N = 226) MBI Emotional exhaustion (mean ± SD): 14.3 ± 10.3
Depersonalization: 4.5 ± 5.6
Personal accomplishment: 36.3 ± 8.2
26% reported high emotional exhaustion, 21% high depersonalization, and 66% low personal accomplishment.
Sense of Coherence Scale, Fortitude Questionnaire scores, age, years of experience, hours of work, hours of direct attention to patients, qualifications and institution predicted scores on the burnout subscales (p < 0.01).
Ifeagwazi, 2005 [78] Nigeria Nurses from a teaching hospital (N = 91) MBI Total burnout (mean ± SD):
widowed nurses: 3.1 ± 0.3 married nurses: 2.6 ± 0.5
Widowed nurses reported significantly higher burnout than married nurses (p < 0.001). There were significant differences between hospital units on mean burnout symptoms reported (p < 0.01), with nurses on the operating theater unit having higher mean burnout scores than nurses on the postnatal, casualty, labor, surgical and out-patient units. Nurses on intensive care unit had higher mean burnout than on the postnatal unit.
Khamisa, 2015 [79] South Africa Nurses from two private and two public hospitals (N = 895) MBI-HSS Not reported Staffing issues explain the highest variance in emotional exhaustion (16%), depersonalization (13%) and personal accomplishment (10%) subscales. Emotional exhaustion and personal accomplishment are associated with somatic symptoms explaining 21% of the variance in general health. In a follow-up survey, lack of support is associated with burnout (OR = 4.37, 95% CI: 2.89–6.62), and patient care is associated with job satisfaction (OR = 2.63, 95% CI: 1.35–5.16) [84].
Lasebikan, 2012 [81] Nigeria Hospital nurses (N = 270) MBI 39.1% had high burnout on the emotional exhaustion subscale, 29.2% in depersonalization and 40.0% on reduced personal accomplishment. Doctor/nurse conflict (OR = 3.1, 95% CI: 1.9–6.3), inadequate nursing personnel (OR = 2.6, 95% CI: 1.5–5.1), and frequent night duties (OR = 3.1, 95% CI: 1.7–5.6) were predictors of burnout on the emotional exhaustion subscale. Doctor/nurse conflict (OR = 3.4, 95% CI: 2.2–7.6) and frequent night duties (OR = 2.4, 95% CI: 1.5–4.8) were predictors of burnout on the depersonalization subscale. High nursing hierarchy (OR = 2.7, 95% CI: 1.5–4.8), poor wages (OR = 2.9, 95% CI: 1.6–5.6), and frequent night duties (OR = 2.3, 95% CI: 2.3–4.5) were predictors of burnout on the reduced personal accomplishment subscale.
Levert, 2000 [82] South Africa Nurses at psychiatric hospitals (N = 94) MBI Emotional exhaustion (mean ± SD): 29.9 ± 12.9
Depersonalization: 9.6 ± 4.6
Personal accomplishment: 19.2 ± 8.3
Emotional exhaustion was associated with nurses’ workload, lack of support from colleagues, role conflict and role ambiguity (p < 0.05). Personal accomplishment was associated with role conflict (p = 0.015). Depersonalization was associated with work load, lack of support from colleagues, role conflict and role ambiguity (p < 0.05).
Mashego, 2016 [83] South Africa Hospital nurses (N = 83) ProQOL, burnout subscale 30.7 ± 5.3 (mean ± SD) 92% had moderate burnout. Burnout score was not associated with age, marital status, education level, or years of working in the maternity ward.
Mbambo, 2003 [84] South Africa Nurses in a District Health System (N = 60) Observer coded according to Exhaustion-Disengagement Model Not reported Hospital nurses have higher job demands and lower job resources compared to primary healthcare nurses. Hospital nurses run a greater risk of exhaustion and disengagement.
Mbanga, 2018 [85] Cameroon Nurses at state-owned and private hospitals (N = 143) Oldenburg Burnout Inventory 38.4 ± 5.7 (mean ± SD) In univariable regression analyses, being in a relationship was significantly protective, predicting 3.8% of variation in burnout syndrome (p = 0.029).
Mefoh, 2019 [86] Nigeria Nurses at a tertiary healthcare hospital (N = 283) MBI-HSS Not reported Emotion-focused coping was positively associated with burnout subscales of emotional exhaustion (β = 0.32, p = 0.01), and depersonalization (β = 0.18, p = 0.01). Emotion focused coping was not significantly associated with burnout subscale of reduced personal accomplishment (β = − 0.10, p = 0.45). However, the interaction effect of age and emotion-focused coping on reduced personal accomplishment was significant (β = 0.03, p = 0.04).
Okwaraji, 2014 [87] Nigeria Nurses at a tertiary health institution (N = 210) MBI 42.9% high emotional exhaustion, 47.6% depersonalization, and 53.8% reduced personal accomplishment. Burnout was significantly higher among nurses who were women, older than 35 years old, not married, and those with nursing certificates compared to those with nursing degrees or nursing officers (p < 0.01).
Pienaar, 2011 [88] South Africa Nurses from 225 clinics (N = 542) MBI Emotional exhaustion (mean ± SD): 31.3 ± 9.3
Depersonalization: 17.8 ± 4.9
Personal accomplishment: 20.3 ± 6.8
Burnout subscale scores were associated with intention to quit nursing jobs (p < 0.001)
Roomaney, 2017 [89] South Africa Nurses at a large tertiary hospital (N = 110) MBI Not reported Workload, job status, and interpersonal conflict at work significantly explained more than one-third of the variance on the emotional exhaustion subscale of burnout (R2 = 0.39, p = 0.001). Interpersonal conflict, workload, organizational constraints and HIV stigma significantly explained the depersonalization subscale (R2 = 0.33, p = 0.001). Job status and organizational constraints significantly predicted personal accomplishment subscale (R2 = 0.18, p = 0.001).
van der Colff, 2014 [90] South Africa Nurses in private, public, hospital, community, psychiatric and management sectors (N = 818) MBI Emotional exhaustion (mean ± SD): 22.2 ± 11.3
Depersonalization: 7.2 ± 5.9
Personal accomplishment: 34.5 ± 7.6
Exploratory factor analysis resulted in a three-factor structure of burnout. Statistically significant differences were found in burnout levels with regard to language, age, rank, job satisfaction, reciprocity, full-time employment and specialized training (p < 0.01).
van der Doef, 2012 [91] Kenya, Tanzania, and Uganda Nurses in private and public hospitals (N = 309) MBI 32.1% reported burnout In comparison with a reference Dutch population, the East African nurses have higher emotional exhaustion (t = 13.2, p < 0.001) and depersonalization (t = 3.60, p < 0.001). East African nurses had lower scores on personal accomplishment than the reference population (t = 11.34, p < 0.001). Job conditions explain 17% of the variance on the emotional exhaustion subscale. A higher workload (β = −0.21, p < 0.01), lower social support from colleagues (β = − 0.15, p < 0.05) and problems concerning information provision (β = − 0.20, p < 0.001) are associated with higher emotional exhaustion. 7.4% of the variance in personal accomplishment is explained by job conditions. Higher decision latitude (β = − 0.15, p < 0.05) and better interdepartmental cooperation (β = − 0.17, p < 0.05) are associated with higher personal accomplishment. Job conditions fail to explain a significant proportion of the variance on depersonalization.
van Doorn, 2016 [92] Nigeria Nurses at an international health organization (N = 214) Emotional exhaustion subscale of the MBI 4.8 ± 1.6 (mean ± SD) Emotional exhaustion was significantly associated with gender, age, job demands, and lack of supervisor support (p < 0.01).
van Wijk, 1997 [93] South Africa Nurses at military institutions (N = 46) Not specified 34% reported a ‘burnout experience’ within the past 3 months Burnout was more common among registered nurses (46%) compared to enrolled (35%) or assistant nurses (21.4%). Nurses in isolated areas had higher burnout compared to nurses in more populated areas (44 vs. 26%, respectively). Burnout was higher among younger nurses.
Wilson, 1989 [94] Zimbabwe Nurses (N = 83) MBI Not reported Internal-External externality score was significantly related to personal accomplishment subscale (r = −0.24, p < 0.05), depersonalization subscale (r = 0.03, p < 0.05), and total burnout (r = 0.20, p < 0.05) but unrelated to the emotional exhaustion subscale (r = 0.03).
  1. Abbreviations: MBI Maslach Burnout Inventory, MBI-HSS Maslach Burnout Inventory - Human Services Survey, MBI-GS Maslach Burnout Inventory – General Survey