Table 3. Study characteristics, meta-analysis of burnout in primary health-care professionals in low- and middle-income countries up to 2022.
| Study and year | Country | Type of participant | Burnout measurement tool | No. of participants | Mean age of participants, years | Proportion of female participants, % | Overall burnout prevalence, % | Prevalence of burnout by MBI subscale score category, (%)a |
||
|---|---|---|---|---|---|---|---|---|---|---|
| Emotional exhaustion | Depersonalization | Personal accomplishment | ||||||||
| Putnik 201171 | Serbia | Family physicians | MBI–General Survey | 373 | 47 | 84 | ND | High (48.3); moderate (34.0) | High (12.9); moderate (32.7) | High (5.1); moderate (16.9) |
| Mandengue 201759 | Cameroon | Family physicians | MBI–Human Services Survey | 85 | ND | 48.2 | 42.4 | High (11.8); moderate (18.8) | High (10.6); moderate (31.8) | High (30.6); moderate (29.4) |
| López-León 200756 | Mexico | Family physicians | MBI | 131 | 46.4 (SD: 6.3) | 42 | 39.7 | High (26.0); moderate (22.1) | High (19.8); moderate (12.3) | High (8.4); moderate (14.5) |
| Lesić 200972 | Serbia | Family physicians | MBI | 38 | 42.2 (SD: 10.7) | 79.0 | ND | High (29.0); moderate (45.2) | High (11.1); moderate (27.8) | High (24.2); moderate (27.3) |
| Kotb 201460 | Egypt | Family physicians | MBI | 31 | ND | 80 | 41.94 | ND | ND | ND |
| Kosan 201973 | Turkey | Family physicians | MBI | 385 (139 in 2008 and 246 in 2012) | 2008: 30 (SD: 5.13); 2012: 34.05 (SD: 5.78) | 64.2 (48.9 in 2008 and 72.8 in 2012) | ND | 2008: high (0.7) and moderate (24.5); 2012: high (9.3) and moderate (21.5) | 2008: high (4.3) and moderate (18.0); 2012: high (4.5) and moderate (19.9) | 2008: high (76.3) and moderate (21.6); 2012: high (79.3) and moderate (17.4) |
| Gan 201945 | China | Family physicians | MBI–Human Services Survey | 1015 | ND | ND | 35.0 (high on one MBI subscale); 21.0 (high on two subscales); 2.5 (high on three subscales) | High (24.83); moderate (23.25) | High (6.21); moderate (12.0) | High (33.99); moderate (20.0) |
| Charoentanyarak 202074 | Thailand | Family physician residents | MBI–Human Services Survey | 149 | 28.29 (SD: 2.59) | 67.1 | 10.7 | High (33.56); moderate (30.87) | High (14.09); moderate (27.52) | High (1.34); moderate (2.68) |
| Cetina-Tabares 200655 | Mexico | Family physicians | MBI | 93 | 44 | 46.2 | 20.5 (high on three subscales); 29.0 (moderate on three MBI subscales) | ND | ND | ND |
| Stanetić 201375 | Bosnia and Herzegovina | Family physicians | MBI–Human Services Survey | 239 | ND | 83.3 | ND | High (46.0); moderate (28.9) | High (21.3); moderate (31.8) | High (22.2); moderate (34.7) |
| Soler 200824 | Bulgaria and Turkey | Family physicians | MBI–Human Services Survey | 69 in Bulgaria and 112 in Turkey | ND | ND | ND | Bulgaria: high (62.3); Turkey: high (15.2) | Bulgaria: high (30.4); Turkey: high (15.2) | Bulgaria: high (18.8); Turkey: high (69.4) |
| Aranda 200453 | Mexico | Family physicians | MBI–Human Services Survey | 163 | 47 | 36.2 | 42.3 | High (16.0); moderate (16.0) | High (1.8); moderate (5.5) | High (6.7); moderate (8.6) |
| Aranda-Beltrán 200554 | Mexico | Family physicians | MBI | 197 | ND | 37.1 | 41.8 | High (13.3); moderate (17.9) | High (2.0); moderate (6.6) | High (6.6); moderate (7.7) |
| Al Dabbagh 201976 | Iraq | Family physicians | MBI | 134 | ND | 64.8 | 30.6 (high); 50.0 (moderate) | High (68.7); moderate (11.9) | High (26.1); moderate (28.4) | High (41.1); moderate (26.1) |
| Ahmadpanah 201577 | Iran (Islamic Republic of) | Family physicians | MBI | 100 | 32.90 (SD: 5.06) | 29 | ND | High (15.4) | High (14.5) | High (10.2) |
| Aguilera 201057 | Mexico | Family physicians | MBI–Human Services Survey | 233 | 44.4 (SD: 7.18) | 40.3 | 41.6 | High (31.7) | High (15.0) | High (15.9) |
| Račić 201967 | Bosnia and Herzegovina | Family physicians | Compassion fatigue questionnaire | 120 | ND | 80 | 75 (moderate) | ND | ND | ND |
| Rossouw 201378 | South Africa | Family physicians | MBI | 132 | ND | ND | ND | High (53) | High (64) | High (43) |
| Çevik 202168b | Turkey | Family medicine residents | Burnout Measure (short version) | 477 | Median: 28 (range: 24–54) | 61.2 | 25.8 (moderate); 24.1 (severe); 23.3 (very severe) | ND | ND | ND |
| Zhang 202152 | China | Family physicians | MBI–General Survey (Chinese version) | 2 693 | 44.64 (SD: 7.25) | 35.6 | 65.2 | High (30.1); moderate (24.2) | High (22.2); moderate (11.7) | High (48.3); moderate (13.3) |
| Engelbrecht 200879 | South Africa | Community nurses | MBI | 542 | ND | ND | ND | High (68.7); moderate (30.9) | High (85.1); moderate (12.9) | High (8.3); moderate (91.0) |
| Hu 201544 | China | Community nurses | MBI | 420 | ND | 100 | 86.2 | ND | ND | ND |
| Alshawish 202062 | West Bank and Gaza Strip | Community nurses and midwives | MBI | 207 | ND | 91.3 | 10.6 | High (36.7); moderate (17.9) | High (14.0); moderate (20.8) | High (17.9); moderate (19.3) |
| Merces 201732 | Brazil | Community nurses | MBI–Human Services Survey | 60 | 39.55 (SD: 10.38) | 95 | 58.3 (high on at least one MBI subscale); 16.7 (high on all three subscales) | High (18.3); moderate (43.3) | High (48.3); moderate (41.7) | High (56.6); moderate (41.7) |
| Merces 201630 | Brazil | Community nurses | MBI | 28 | 39.1 (SD: 9.6) | 100 | 7.1 | High (28.6); moderate (39.3) | High (21.5); moderate (32.1) | High (46.4); moderate (50.0) |
| Barbosa Ramos 201937 | Brazil | Community nurses | MBI | 52 | ND | 100 | ND | High (15.4); moderate (34.6) | High (13.5); moderate (34.6) | High (23.1); moderate (21.2) |
| Merces 201631 | Brazil | Community nurses | MBI | 189 | ND | 96.8 | 10.6 | High (20.6); moderate (40.7) | High (31.7); moderate (39.2) | High (48.1); moderate (49.2) |
| Lorenz 201834 | Brazil | Community nurses | MBI | 168 | ND | 88.4 | ND | High (28.0); moderate (37.5) | High (32.1); moderate (33.9) | High (38.7); moderate (33.3) |
| Holmes 201426 | Brazil | Community nurses | MBI | 45 | ND | 100 | 11.1 | High (53.3); moderate (20.0) | High (11.1); moderate (28.9) | High (11.1); moderate (48.9) |
| Merces 202038 | Brazil | Community nurses | MBI–Human Services Survey | 1125 | 37.1 (SD: 9.6) | 87.9 | 18.3 | High (28.1); moderate (41.1) | High (44.5); moderate (35.9) | High (60.2); moderate (36.2) |
| Garcia 202142 | Brazil | Community nurses | Burnout characterization scale | 122 | 45.2 (SD: 9.8) | 94.3 | ND | High (27.9); moderate (37.7) | High (25.4); moderate (41.8)c | High (25.4); moderate (47.5)d |
| Seluch 202170b | Russian Federation | Community nurses | Emotional Burnout Diagnostics by Boyko V.V. | 60 | 40.86 | 100 | 50 | ND | ND | ND |
| Silveira 201429 | Brazil | Mixed primary health-care professionals | CESQT | 217 | ND | 88.9 | 18 (profile 1); 11 (profile 2) | ND | ND | ND |
| da Silva 200825 | Brazil | Mixed primary health-care professionals | MBI | 141 | 38.9 (SD: 11.4) | 92.2 | 24.1 | Moderate or high (70.9) | Moderate or high (34.0) | Moderate or high (47.5) |
| Selamu 201964 | Ethiopia | Mixed primary health-care professionals | MBI–Human Services Survey | 136 | ND | 61 | 3.8 (at baseline); 4.6 (at 6-month follow-up) | High (7.7 at baseline; 7.5 at 6-month follow-up) | ND | High (43.7 at baseline; 48.5 at 6-month follow-up) |
| Hernández 200366 | Cuba | Mixed primary health-care professionals | Short questionnaire of burnout | 144 | ND | 77.1 | 43.8 (doctors); 27.3 (nurses) | ND | ND | ND |
| Ran 202047 | China | Mixed primary health-care professionals | MBI–General Survey | 1 279 | ND | 66.5 | 18.69 | ND | ND | ND |
| Pinheiro 202039 | Brazil | Mixed primary health-care professionals | CESQT | 344 | 40 (SD: 9.7) | 88.7 | 14.4 (profile 1); 44.5 (profile 2) | ND | ND | ND |
| Mao 202048 | China | Mixed primary health-care professionals | MBI | 663 | ND | 44.5 | ND | High (24.1); moderate (14.6) | High (15.7); moderate (7.4) | High (34.7); moderate (15.8) |
| Lima 201833 | Brazil | Mixed primary health-care professionals | MBI–Human Services Survey | 153 | 45 (SD: 9.78) | 82.4 | 51 | ND | ND | ND |
| Li 201946 | China | Mixed primary health-care professionals | MBI–Human Services Survey | 951 | ND | 65.1 | ND | High (33.1); moderate (32.9) | High (8.8); moderate (19.8) | High (41.43); moderate (20.5) |
| Kruse 200961 | Zambia | Mixed primary health-care professionals | Single-item scale | 483 | 37 (IQR: 31–45) | 87 | 51.2 | ND | ND | ND |
| Hernández-Vargas 200958 | Mexico | Mixed primary health-care professionals | MBI | 276 | ND | ND | ND | High (34.8); moderate (30.1) | High (35.1); moderate (19.6) | High (36.2) Moderate (30.4) |
| Xu 202049 | China | Mixed primary health-care professionals | MBI | 15 627 | ND | 66.2 | 3.3 (high); 47.6 (moderate) | ND | ND | ND |
| Wang 202043 | China | Mixed primary health-care professionals | MBI | 1 148 | ND | 64.72 | ND | High (27.66) | High (6.06) | High (38.74) |
| Tomaz 202040 | Brazil | Mixed primary health-care professionals | Oldenburg Burnout Inventory | 94 | 40.9 (SD: 9.6) | 84 | 38.3 | High (21.3) | ND | ND |
| de Souza Filho 201936 | Brazil | Mixed primary health-care professionals | CESQT | 248 | 40.75 (SD: 9.66) | 91.1 | 24.2 (profile 1); 8.5 (profile 2) | ND | ND | ND |
| da Silva 202141 | Brazil | Mixed primary health-care professionals | MBI | 2 940 | 36.7 (SD: 9.6) | 90.5 | 11.4 (severe) | High (39.7); moderate (24.9) | High (11.8); moderate (24.5) | High (18.3); moderate (27.2) |
| Lu 202050 | China | Mixed primary health-care professionals | MBI | 21 759 | 35 | 70.0 | 50.1 (total); 3.0 (severe); 47.1 (moderate) | ND | ND | ND |
| Yan 202151 | China | Mixed primary health-care professionals | MBI (Chinese version) | 1 214 | 40.26 (SD: 8.61) | 55 | 11.3 (severe); 37.6 (moderate) | ND | ND | ND |
| Malakouti 201180 | Iran, (Islamic Republic of) | CHWs | MBI | 212 | 35.1 (SD: 7.2) | 70.1 | 1.1 (high); 16.6 (moderate) | High (12.3); moderate (15.1) | High (5.3); moderate (8.0) | High (43.7); moderate (19.0) |
| Mota 201428 | Brazil | CHWs | MBI | 222 | ND | 87.8 | 29.3 | Moderate or high (57.7) | Moderate or high (51.8) | Moderate or high (59.0) |
| Martins 201427 | Brazil | CHWs | MBI | 107 | ND | ND | 41.6 | High (20.6); moderate (52.3) | High (21.1); moderate (50.0) | High (20.6); moderate (55.4) |
| Bijari 201681 | Iran (Islamic Republic of) | CHWs | MBI | 423 | 39 (SD: 8.4) | 57.9 | 5.7 (high on all three MBI subscales); 28.8 (high on either emotional exhaustion or depersonalization subscale) | High (17.7); moderate (13.7) | High (6.4); moderate (10.4) | High (53.0); moderate (18.2) |
| Amiri 201682 | Iran (Islamic Republic of) | CHWs | MBI | 548 | 35.8 (SD: 7.5) | 71 | 5.5 (high); 52.7 (moderate) | High (17.3); moderate (18.4) | High (8.8); moderate (10.0) | High (33.9); moderate (15.7) |
| Pulagam 202163 | India | CHWs | Copenhagen Burnout Inventory | 150 | ND | 100 | Personal burnout: 8.0 (high) and 30 (moderate); work burnout: 8.7 (high) and 24.7 (moderate); client burnout: 6.7 (high) and 23.3 (moderate) | ND | ND | ND |
| Muliira 201665 | Uganda | Midwives | Professional Quality of Life scale | 224 | 34 (SD: 6.3) | 79.5 | 10.3 (high); 87.9 (moderate) | ND | ND | ND |
| Maciel 201835 | Brazil | Community oral health team members | MBI–Human Services Survey | 50 | ND | 72 | ND | High (26); moderate (32) | High (16); moderate (26) | High (10); moderate (26) |
| Calgan 201183 | Turkey | Community pharmacists | MBI | 251 | 42.06 (SD: 11.19) | 58.6 | ND | High (1.2); moderate (27.1) | High (0.8); moderate (13.9) | High (71.3) Moderate (24.7) |
| Okuyan 202169b | Turkey | Community pharmacists | Burnout Measure (short version) | 1 098 | 41 | 64.8 | 31.5 | ND | ND | ND |
CESQT: Spanish Burnout Inventory (Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo); CHW: community health worker; IQR: interquartile range; MBI: Maslach Burnout Inventory; ND: not determined; SD: standard deviation.
a Definitions of low, moderate and high score categories for the Maslach Burnout Inventory subscales of emotional exhaustion, depersonalization and personal accomplishment are listed in Table 1.
b This study reported collecting data during the coronavirus 2019 pandemic.
c Dehumanization was assessed instead of depersonalization.
d Disappointment was assessed instead of personal accomplishment.