Tuyishime Eugene, Bould Chilombo, MacIsaac Daniel I, Nkurunziza Charles, Mpirimbanyi Christophe, Nduhuye Felix, Pereira Matthew, O'Reilly Heather, Bould M Dylan
From the Department of Anesthesia, Critical Care, and Emergency Medicine, University of Rwanda, Kigali, Rwanda.
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Anesth Analg. 2025 Aug 4. doi: 10.1213/ANE.0000000000007672.
Many studies address health care provider burnout in high-income countries; however, there is little data on burnout in low-income countries. Our objectives were (1) to estimate the prevalence of burnout among perioperative health care providers and (2) to explore factors associated with burnout among perioperative health care providers in Rwandan public hospitals.
A cross-sectional study using a survey was conducted among perioperative health care providers working in 22 public hospitals across Rwanda. We used a purposive sampling method to represent all regions (4 provinces and the capital Kigali) and types of public hospitals in Rwanda conducting surgery, excluding major teaching centers. We used the Maslach Burnout Inventory Human Services Survey (MBI_HSS), a validated 22-item survey including 3 dimensions of burnout: (1) emotional exhaustion (EE), (2) depersonalization (DP), and (3) personal achievement (PA). We estimated the prevalence of burnout using Wilson's method and we identified factors associated with burnout using a multivariate analysis.
There were 221 responses from 402 surveys sent with a response rate of 53.7% including nurses 106 (47.9%), general practitioners 36 (16.3%), nonphysician anesthetists 33 (14.9%), midwives 25 (11.3%), and specialist surgeons and anesthesiologists 4 (1.8%). Forty-7 (21.3, 95% CI 16.1-27.3)% participants had burnout, 95 (42.9, 95 CI 36.6-49.6)% had high emotional exhaustion, 57 (25.8, 95 CI 20.5-31.9)% had low personal accomplishment, 15 (6.8, 95 CI 4.2-10.9)% had high depersonalization). Three major burnout profiles were identified among participants, including the overextended group 84 (38%), the engaged group 83 (37.6%), and the ineffective group 39 (17.6%). Among postulated predictors of burnout, only a lack of having the right equipment was strongly associated with burnout (adj-OR, 3.21; 95 CI, 1.18-8.73, P = .02).
One in 5 perioperative health care providers in Rwanda report having burnout, which is consistent with previous data. This suggests that burnout is widespread across the Rwandan health care system, across different perioperative professions. The only factor that was associated with burnout was lack of access to essential equipment; however, other factors that have been identified in the literature, which are not statistically significant in this study, should not be overlooked. Addressing equipment shortages may reduce the risk of burnout among perioperative health care providers in low-resource settings, in addition to directly impacting the quality of care.
许多研究关注高收入国家医疗保健人员的职业倦怠；然而，关于低收入国家职业倦怠的数据很少。我们的目标是：（1）估计围手术期医疗保健人员职业倦怠的患病率；（2）探讨卢旺达公立医院围手术期医疗保健人员职业倦怠的相关因素。
对卢旺达22家公立医院的围手术期医疗保健人员进行了一项横断面调查研究。我们采用目的抽样方法，以代表卢旺达所有地区（4个省和首都基加利）以及进行手术的各类公立医院，但不包括主要教学中心。我们使用了马氏职业倦怠量表-人类服务调查（MBI_HSS），这是一个经过验证的包含22个条目的调查，包括职业倦怠的3个维度：（1）情感耗竭（EE），（2）去个性化（DP），以及（3）个人成就感（PA）。我们使用威尔逊方法估计职业倦怠的患病率，并通过多变量分析确定与职业倦怠相关的因素。
在发出的402份调查问卷中，有221份得到回复，回复率为53.7%，其中护士106人（47.9%），全科医生3人（16.3%），非医师麻醉师33人（14.9%），助产士25人（11.3%），专科外科医生和麻醉师4人（1.8%）。47人（21.3%，95%置信区间16.1 - 27.3%）的参与者存在职业倦怠，95人（42.9%，95%置信区间36.6 - 49.6%）有高度情感耗竭，57人（25.8%，95%置信区间20.5 - 31.9%）个人成就感较低，15人（6.8%，95%置信区间4.2 - 10.9%）有高度去个性化。在参与者中确定了三种主要的职业倦怠类型，包括过度劳累组84人（38%），投入组83人（37.6%），以及低效组39人（17.6%）。在假定的职业倦怠预测因素中，只有缺乏合适的设备与职业倦怠密切相关（调整后比值比，3.21；95%置信区间，1.18 - 8.73，P = 0.02）。
卢旺达五分之一的围手术期医疗保健人员报告存在职业倦怠，这与之前的数据一致。这表明职业倦怠在卢旺达医疗保健系统中普遍存在，涉及不同的围手术期职业。与职业倦怠相关的唯一因素是缺乏基本设备；然而，文献中确定的其他因素，在本研究中虽无统计学意义，但也不应被忽视。解决设备短缺问题除了直接影响护理质量外，还可能降低资源匮乏地区围手术期医疗保健人员职业倦怠的风险。
