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07 18, 2019;17 (1): 58.

Burnout among primary healthcare workers during implementation of integrated mental healthcare in rural Ethiopia: a cohort study.

Medhin Selamu, Charlotte Hanlon, Girmay Medhin, Graham Thornicroft, Abebaw Fekadu
Author Information
  1. Medhin Selamu: College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia. medhins10@gmail.com. ORCID
  2. Charlotte Hanlon: College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
  3. Girmay Medhin: Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  4. Graham Thornicroft: Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
  5. Abebaw Fekadu: College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
PMID: 31319872 DOI: 10.1186/s12960-019-0383-3

Abstract

BACKGROUND: The short-term course of burnout in healthcare workers in low- and middle-income countries has undergone limited evaluation. The aim of this study was to assess the short-term outcome of burnout symptoms in the context of implementation of a new mental health programme in a rural African district.
METHODS: We followed up 145 primary healthcare workers (HCWs) working in 66 rural primary healthcare (PHC) facilities in Southern Ethiopia, where a new integrated mental health service was being implemented. Burnout was assessed at baseline, i.e. when the new service was being introduced, and after 6 months. Data were collected through self-administered questionnaires, including the Maslach Burnout Inventory (MBI) and instruments measuring professional satisfaction and psychosocial factors. Generalised estimating equations (GEE) were used to assess the association between change in the core dimension of burnout (emotional exhaustion) and relevant work-related and psychosocial factors.
RESULTS: A total of 136 (93.8%) of HCWs completed and returned their questionnaires at 6 months. There was a non-significant reduction in the burnout level between the two time points. In GEE regression models, high depression symptom scores (adjusted mean difference (aMD) 0.56, 95% CI 0.29, 0.83, p < 0.01), experiencing two or more stressful life events (aMD 1.37, 95% CI 0.06, 2.14, p < 0.01), being a community health extension worker vs. facility-based HCW (aMD 5.80, 95% CI 3.21, 8.38, p < 0.01), perceived job insecurity (aMD 0.73, 95% CI 0.08, 1.38, p = 0.03) and older age (aMD 0.36, 95% CI 0.09, 0.63, p = 0.01) were significantly associated with higher levels of emotional exhaustion longitudinally.
CONCLUSION: In the short-term, there was no significant change in the level of burnout in the context of adding mental healthcare to the workload of HCWs. However, longer term and larger scale studies are required to substantiate this. This evidence can serve as baseline information for an intervention development to enhance wellbeing and reduce burnout.

Keywords

Burnout Ethiopia Healthcare workers Job-related stress Primary healthcare Professional satisfaction Wellbeing

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Grants

  1. MR/M025470/1/Medical Research Council
  2. MR/R023697/1/Medical Research Council
  3. MR/S001255/1/Medical Research Council
  4. R01 MH100470/NIMH NIH HHS

MeSH Term

Adult
Burnout, Professional
Delivery of Health Care, Integrated
Ethiopia
Female
Humans
Male
Mental Disorders
Physicians
Primary Health Care
Rural Population
Surveys and Questionnaires
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 4

Word Cloud

Created with Highcharts 10.0.00healthcareburnoutaMD95%CIworkersmentalBurnout01short-termnewhealthruralprimaryHCWsp < 0studyassesscontextimplementationEthiopiaintegratedservicebaseline6 monthsquestionnairessatisfactionpsychosocialfactorsGEEchangeemotionalexhaustionleveltwo138p = 0BACKGROUND:courselow-middle-incomecountriesundergonelimitedevaluationaimoutcomesymptomsprogrammeAfricandistrictMETHODS:followed145working66PHCfacilitiesSouthernimplementedassessedieintroducedDatacollectedself-administeredincludingMaslachInventoryMBIinstrumentsmeasuringprofessionalGeneralisedestimatingequationsusedassociationcoredimensionrelevantwork-relatedRESULTS:total136938%completedreturnednon-significantreductiontimepointsregressionmodelshighdepressionsymptomscoresadjustedmeandifference562983experiencingstressfullifeevents3706214communityextensionworkervsfacility-basedHCW5803218perceivedjobinsecurity730803olderage360963significantlyassociatedhigherlevelslongitudinallyCONCLUSION:significantaddingworkloadHoweverlongertermlargerscalestudiesrequiredsubstantiateevidencecanserveinformationinterventiondevelopmentenhancewellbeingreduceamongEthiopia:cohortHealthcareJob-relatedstressPrimaryProfessionalWellbeing

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