Table 1.

Characteristics of studies on burnout among physicians in sub-Saharan Africa (N = 12)

1st author, Year	Country	Study population	Burnout assessment	Reported burnout	Main findings
Coker, 2010 [55]	Nigeria	Physicians at a psychiatric hospital (N = 24)	MBI	12.5% reported burnout on emotional exhaustion, 33.3% on depersonalization, and 25% on low personal accomplishment. 23.6% reported high overall burnout.	8.3% of physicians also reported high scores on the Psycho-Physiological Symptoms Checklist.
Liebenberg, 2018 [56]	South Africa	Physicians at rural district hospitals (N = 36)	MBI-HSS	Emotional exhaustion (mean ± SD): 30.5 ± 11.0 Depersonalization: 14.6 ± 6.0 Personal accomplishment: 34.1 ± 6.0 81% reported burnout, with 31% reporting high burnout on all subscales.	Mean scores on the emotional exhaustion and depersonalization subscales were significantly greater than normative scores. Mean personal accomplishment scores did not differ from normative values.
Lrago, 2018 [57]	Ethiopia	Physicians at public hospitals (N = 491)	MBI-HSS	Emotional exhaustion (mean ± SD): 27.2 ± 8.0 Depersonalization: 12.9 ± 5.3 Personal accomplishment: 25.1 ± 6.6 65.2% reported high emotional exhaustion, 85.1% high depersonalization, and 91% low personal accomplishment.	Age, recognition from hospital managers, monthly salary, and number of patients observed per week were associated with emotional exhaustion (p < 0.05). Monthly salary and working in a primary hospital were associated with personal accomplishment (p < 0.05). Age, working in primary hospital, support from family and organization, monthly salary and professional training were associated with depersonalization (p < 0.05).
Ogundipe, 2014 [58]	Nigeria	Physicians undergoing residency training in a tertiary hospital (N = 204)	MBI	45.6% reported burnout on emotional exhaustion, 57.8% on depersonalization, 61.8% on personal accomplishment.	Participants who reported emotional distress were more likely to report burnout (OR = 6.97; 95% CI:3.28–14.81). Those who did not report doctor/doctor conflict were less likely to have depersonalization (OR = 0.36; 95% CI:0.17–0.76). Advanced age (OR = 0.66; 95% CI:0.47–0.95) and adequate support from management (OR = 0.45; 95% CI:0.22–0.90) were protective of burnout subscale of reduced personal accomplishment.
Opoku, 2014 [59]	Ghana	Physicians from web-based survey (N = 200)	Abbreviated MBI	Emotional exhaustion (mean ± SD): 9.1 ± 2.6 Depersonalization: 5.2 ± 2.1 Personal accomplishment: 5.8 ± 1.6 Total burnout: 20.0 ± 4.5	Overall career satisfaction (measured using physician work life survey) was negatively associated with emotional exhaustion (β = − 0.178, p < 0.001), low personal accomplishment (β = − 0.126, p < 0.01), and depersonalization (β = − 0.733, p < 0.05).
Peltzer, 2003 [60]	South Africa	Physicians (N = 402)	MBI	Emotional exhaustion (mean ± SD) 24.2 ± 10.8 Depersonalization: 11.4 ± 6.7 Personal accomplishment: 17.4 ± 6.8	The job stress index was found to be a predictor for emotional exhaustion (p < 0.001) and depersonalization (p < 0.001) but not personal accomplishment. Sex, age, race, length of service, and marital status were significantly associated with burnout subscales (p < 0.05).
Rajan, 2018 [61]	South Africa	Physicians working in public sector emergency centers (N = 93)	MBI-HSS	Emotional exhaustion (mean ± SD): 31.7 ± 10.3 Depersonalization: 13.4 ± 6.2 Personal accomplishment: 34.9 ± 6.5	Sex and relationship status were not significantly associated with burnout scores. There were significantly higher depersonalization scores among physicians in the moderate to high risk group who were less than 40 years of age, compared to those who were 40 years old and above (87% vs 61%, p < 0.05). Those with two or less years of experience had a significantly higher probability of leaving in the next five years compared to those with more experience (62% vs. 39%, p < 0.05).
Schweitzer, 1994 [62]	South Africa	Junior physicians (N = 126)	One question worded: “Do you ever feel so emotionally exhausted that you feel negative about yourself and about your job and lose the feeling of concern for your patients?”	77.8% had experienced burnout, 52.4% were experiencing burnout at current job, and 61% experienced burnout at a previous job.	Physician Stress Inventory (PSI) score was significantly higher among participants with burnout (p < 0.001). Doctors who were able to communicate with the majority of patients had lower burnout than those who could not (p = 0.04) and a lower mean PSI score (p = 0.04).
Stassen, 2013 [63]	South Africa	Advanced life support paramedics (N = 40)	CBI	Work related burnout (mean ± SD): 44.3 ± 16.8 Personal burnout: 48.0 ± 16.7 Patient care related burnout: 35.6 ± 16.2 Overall burnout: 42.9 ± 14.0 38% reported work related burnout, 53% reported personal burnout, 23% reported patient care related burnout, and 30% reported overall burnout .	Burnout was not significantly associated with gender, employment sector, years of experience, or qualifications.
Stodel, 2011 [64]	South Africa	Junior physicians at a children’s hospital (N = 22)	MBI	Emotional exhaustion (mean ± SD): 37.7 ± 8.9 Depersonalization: 12.6 ± 5.6 Personal accomplishment: 32.1 ± 5.8	The mean scores on the emotional exhaustion (p = 3.29 × 10− 13) and depersonalization (p = 2.35 × 10− 7) subscales were significantly higher compared to a normative sample. Among surveyed participants, 95% reported an intention to leave the hospital.
Ugwu, 2019 [65]	Nigeria	Physicians at intensive care units of hospitals (N = 183)	Items that had the highest factor loading on emotional exhaustion (‘I feel burned out from my work’) and depersonalization (‘I have become more callous toward people since I took this job’)	5.5 ± 1.9 (mean ± SD)	Job burnout was significantly related to recovery from job stressors (p < 0.001), and perceived family cohesion (p < 0.01).
van der Walt, 2015 [66]	South Africa	Anesthetists at a university hospital (N = 124) and in private practice (N = 86)	MBI-HSS	Among hospital anesthetists, 45.2% reported high emotional exhaustion, 50% reported high depersonalization, and 46% reported low personal accomplishment. Among private practice anesthetists, 20.9% reported high emotional exhaustion, 26.7% reported high depersonalization, and 37.2% reported low personal accomplishment. High burnout was identified in 21% of hospital anesthetists and 8.1% of anesthetists in private practice.	Among anesthetists, burnout was not significantly associated with age, gender, or years of experience.

Abbreviations: CBI Copenhagen Burnout Inventory, MBI Maslach Burnout Inventory, MBI-HSS Maslach Burnout Inventory - Human Services Survey