Prevalence and Factors Associated with Burnout Syndrome among Resident Doctors at Tertiary Teaching Hospitals in Dar es Salaam, Tanzania

Introduction: Burnout syndrome is prevalent to a great extent among medical residents, and this can interfere with their training and patient management. However, the extent of the problem is still unknown in our setting. This study therefore aimed at determining prevalence and factors associated with burnout syndrome among resident doctors at tertiary teaching hospitals in Dar es Salaam, Tanzania. Method: A cross-sectional study of resident doctors was carried out in four teaching hospitals of Muhimbili University of Health and Allied Sciences between January 2021 and March 2021. Participants were interviewed using a structured questionnaire and Maslach Burnout Inventory. Results: The study had 398 participants with a mean age of 35 ± 3.5 years. Overall burnout prevalence was 33.7%, as for the burnout dimensions, 205 (51.5%) respondents reported burnout in the dimension of emotional exhaustion (EE), 177 (44.5%) in the dimension of depersonalization (D), and 144 (36.2%) in the dimension of reduced personal accomplishment (RPA). Independent factors associated with burnout syndrome were: inadequate support from residency program supervisors (Odds Ratio (OR) 1.97, 95% CI: 1.23 3.14, p = 0.005), work-related family conflicts (Odds Ratio (OR) 3.2, 95% CI: 1.35 7.71, p = 0.008), stressful call perception (Odds Ratio (OR) 3.31, 95% CI: 1.90 5.76, p = 0.001) and each added year of study (Odds Ratio (OR) 3.46, 95% CI: 1.08 6.73, p = 0.009). Conclusion: Burnout is a problem among resident doctors in Tanzania. This could be addressed by directing preventive and intervention measures in the residency training proHow to cite this paper: Lugazia, E.R., Sway, H.C., Boniface, R.L. and Abdullah, A. (2022) Prevalence and Factors Associated with Burnout Syndrome among Resident Doctors at Tertiary Teaching Hospitals in Dar es Salaam, Tanzania. International Journal of Clinical Medicine, 13, 36-49. https://doi.org/10.4236/ijcm.2022.131003 Received: December 6, 2021 Accepted: January 11, 2022 Published: January 14, 2022 Copyright © 2022 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access E. R. Lugazia et al. DOI: 10.4236/ijcm.2022.131003 37 International Journal of Clinical Medicine gram. Periodic assessment is also needed to mitigate factors associated with burnout among resident doctors.


Introduction
Burnout is a state of physical, mental, and emotional exhaustion arising from a continued response to chronic interpersonal stressors while at work, which in turn affects the working efficiency of a person [1]. The term was first introduced by Freudeberger and Maslach who independently studied the social issues faced by underprivileged citizens in 1970, and in 1974 it was described among health care professionals [2]. Burnout syndrome among health care professionals has become a serious health problem and the mental health of doctors is an issue of growing concern all over the world as it frequently interferes with their professional training and responsibilities [3]. Among practicing physicians, it has reached epidemic levels with a prevalence that approximates 50% [4]. The condition is also well associated with negative physiological, cognitive, psychological, and behavioral manifestations which create severe pressure on the whole health care system threatening patients' care and safety. It is not a sign of weakness, mental illness, or inability to cope with life and it can be treated, and prevented [5].
Burnout appears to be quite prevalent in both developing and developed countries and probably represents considerable economic, social and psychological costs to employees and employers in these countries. The problem of residents' burnout is widely recognized with diverse solutions implemented across developed countries. However, there is a lack of clarity about the global prevalence of burnout among medical residents due to limited evidence on residents' burnout in low-income and middle-income countries (LMIC). This affects interventions to prevent and reduce residents' burnout as most of the studies of sufficient quality have only been done in high-income countries [6].
Although the factors that contribute to residents' burnout are unclear, several studies have explored possible reasons for burnout in residency training. In these studies, residents report that time demands, workload, practice setting, lack of control over time management, work planning, work organization, specialty choice, inherently difficult job situations, sleep deprivation, problems with work-life balance and interpersonal relationships are stressors that may contribute to burnout [7] [8].
Other factors cited in the literature include age, gender, marital status and parenting responsibilities. Concerning gender, the previous speculation had led to  the hypothesis that women residents are more prone to stress and be at a greater   risk of burnout as a result of conflicts between traditional gender roles and   professional practice and because of the climate of medical education which is competitive and oriented towards masculine tradition [9]. These stressors have resulted in reported incidence of psychological symptoms with feelings of becoming less humanistic, more cynical and ''burning out'' during residency training [10]. While previous studies done elsewhere have focused on identifying stress factors as perceived by resident doctors [11], there is insufficient information on burnout among doctors in residency training in our country. This study was therefore conducted to help us understand the prevalence and factors associated with burnout syndrome among resident doctors at Tertiary Teaching Hospitals in Dar es Salaam, Tanzania.

Results
A total of 420 residents were enrolled in our study, from which 406 (96.6%) responded. Eight (2%) were excluded due to incomplete data. Data from 398 residents were analyzed (Figure 1).

Socio-Demographic and Work-Related Characteristics of the Participants
The participants' age ranged between 24 and 50 years with a mean age of 35 ±

Prevalence of Burnout
Out of 398 residents involved in this study, burnout syndrome accounted for 134/398 (33.7%) of participants ( Figure 2).

Prevalence of Burnout across Dimensions among Participants
Analyzing each sub-scale separately according to Maslach's categorization, 205/398

Factors Associated with Burnout Syndrome
The following factors were significantly associated with burnout syndrome after

Discussion
This study examined the prevalence and factors associated with burnout syndrome among resident doctors at tertiary teaching hospitals in Dar es Salaam, Tanzania. It revealed the prevalence of 33.7%, which is within the range of burnout syndrome among health care workers reported globally 25% -75% [14]. It is also within the range reported in a systematic review done in Nigeria 23.6% -51.7% [15]. Our findings are also similar to a meta-analysis study results done in Brazil in which they reported overall prevalence of 35.7% [16].
Although the prevalence reported in this study is almost similar to what has been reported in other studies done elsewhere, the implication on health services delivery in Tanzania may be more serious taking into account that, resident doctors form the major part of health care delivery across tertiary hospitals in the country due to low doctor to patient ratio situation facing the country. So, there is a risk of negative impact of burnout on patient care including medical errors, patient safety risks, and potential compromise of quality of care. For   [22], in which they revealed work place social support was a major characteristic related to good performance. This is an important modifiable finding and has a greater implication in policy change.
The current study also found that senior residents in their third year of study were more likely to develop burnout, similar findings were reported by Dhusia et al. [21]. The increased experience usually accounts for higher working hours, increased workload and it is a time when they are working on their dissertations in our settings, combining all those, puts much pressure on them and may exacerbate the syndrome. Residents who perceived call duty as stressful in this study were more likely to develop burnout compared to those who perceived it as not stressful. Our results are in line with a systematic review done in Nigeria by Ogunsuji et al. [15], which reported perception of call duty as stressful to be positive predictors of burnout among resident doctors. This can be due to the fact that night calls are associated with heavy workload especially handling emergencies, sleep deprivation and few staffs normally present during night shifts in our hospitals.
There are some key limitations in this study: firstly, the study was conducted at tertiary teaching hospitals in Dar es Salaam region. Therefore, it may be diffi-

Conclusions
The study has shown that burnout is prevalent among resident doctors in our setting and it has illuminated some factors that influenced burnout among resident doctors in residency training. There is therefore a need for directing preventive and intervention measures in the residency training program. Periodic assessment is also needed to mitigate factors associated with burnout among resident doctors.
What Is Known about This Topic?  Burnout among medical doctors is a global phenomenon.
 Burnout can hinder optimal healthcare delivery.
 Healthcare providers are in prolonged exposure to job stressors.

What This Study Adds
 This study provides valuable insight into the burden of burnout syndrome among resident doctors in Tanzania hospitals.  It also points out the need for support services to resident doctors in Tanzania.

Authors' Contributions
Edwin Rwebugisa Lugazia, Happiness Charles Sway, Respicious Lwezimula Boniface and Asha Abdullah conceived and designed the study. Happiness Charles Sway undertook the data collection and statistical analysis and wrote the first draft of the manuscript. All authors contributed to the intellectual content and approved the final manuscript.