A systematic review protocol for burnout among Nurses in sub-Saharan Africa:

1. PROSPERO
International prospective register of systematic reviews
Prevalence of burnout among nurses in sub-Saharan Africa: a systematic review protocol
Rosebenter Owuor, Clifford Mwita, Ruth Anyango, Koki Mutungi
Citation
Rosebenter Owuor, Clifford Mwita, Ruth Anyango, Koki Mutungi. Prevalence of burnout among
nurses in sub-Saharan Africa: a systematic review protocol. PROSPERO 2018 CRD42018105450
Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018105450
Review question
What is the best available evidence on the burden of burnout among nurses working in sub Saharan Africa?
More specifically, what are the incidence and prevalence rates for burnout among nurses working in
countries within the sub Saharan Africa region?
Searches
The search strategy aims to find both published and unpublished studies. A three-step search strategy will
be utilized in this review. An initial limited search of MEDLINE and EMBASE will be undertaken followed by
analysis of the text words contained in the title and abstract, and of the index terms used to describe the
article. A second search using all identified keywords and index terms will then be undertaken across all
included databases. Thirdly, the reference list of all identified reports and articles will be searched for
additional studies.The primary databases to be searched include: MEDLINE (via PubMed), African Journals
Online (AJOL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and EMBASE will be
search from inception to July 2018. The search for unpublished studies and grey literature will include WHO
Library and Grey Literature Report. In addition, experts in the field will be contacted for any additional
information they may have had concerning the review question. The initial search analyzed the text words
contained in the title and abstract, and the index terms used to describe the articles. A second search using
all identified keywords and index terms will then be applied. Initial keywords to be used are: "burnout",
"nurses" and "africa". Databases will be searched from inception to the present date. Only English language
studies will be considered. Two independent reviewers will be involved in the process of screening identified
titles and abstracts and assessing studies for fulfillment of inclusion criteria. Discrepancies will be resolved
through discussion, or with a third review author.
Types of study to be included
This review will consider observational study designs including prospective and retrospective cohort studies,
case-control studies and cross sectional studies for inclusion.
Condition or domain being studied
Burnout is a response to chronic work-related stress that impacts negatively on the performance of an
individual. Its prevalence has been noted to increase in the recent past and it is becoming a significant
problem with potential effects on various sectors of a country’s economy including health care. While there
there is ample information on the prevalence and risk factors for burnout in high income countries (HICs),
there is a paucity of data from low and middle-income countries (LAMICs), particularly those in sub Saharan
Africa which have the largest share of the global burden of disease. The burden of burnout among health
care professionals working in such areas where healthcare systems remain underdeveloped and its impact
of burnout on the healthcare system is un-quantified. This systematic review seeks to close this informational
gap by attempting to synthesize the best available evidence on the prevalence of burnout among nurses in
sub Saharan Africa. The aim is to have baseline information on the burden of the condition and help guide
nurse practitioners, researchers and policy makers in devising ways to handle it and hopefully optimize nurse
well being and patient outcomes.
Participants/population
This review will consider studies that include nurses or nursing staff directly involved in patient care. Studies
that assess burnout in a combined cohort of healthcare workers (i.e. doctors, nurses and other allied health
practitioners) but that have separate data on nurses alone will also be considered for inclusion.
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2. PROSPERO
International prospective register of systematic reviews
Intervention(s), exposure(s)
N/A
Comparator(s)/control
N/A
Main outcome(s)
This review will consider studies that assess and report the incidence and/or prevalence of burnout among
nursing staff as determined by the Maslach Burnout Inventory (MBI). However, studies that utilize other
validated tools to determine the presence/absence of burnout will also considered. Studies that report only
the individual components of burnout (i.e. emotional exhaustion, depersonalization and personal
accomplishment) will also be considered for inclusion.
Additional outcome(s)
None
Data extraction (selection and coding)
Following the search, all identified citations will be collated and uploaded onto a citation management system
and duplicates removed. Titles and abstracts will be screened by two independent reviewers and those that
do not fit the inclusion criteria for the review will be excluded. Studies that seem to meet the inclusion criteria
will be retrieved for full text review and further evaluation by two independent reviewers. Among these
studies, those that do not meet the inclusion criteria will be excluded and reasons for exclusion noted. Data
will be extracted from included papers using a standardized data extraction tool for prevalence and incidence
data. Two independent reviewers will be involved in the process. The data extracted will include specific
details about the condition, populations, study methods and proportions of interest to the review question
and specific objectives. Any disagreements that arise between reviewers will be resolved through discussion.
Where necessary, study authors will be contacted to request for missing or additional data.
Risk of bias (quality) assessment
Selected studies will be assessed for methodological quality by two independent reviewers using
standardized critical appraisal instruments for studies reporting prevalence data. Any disagreements that
arise between reviewers will be resolved through discussion.
Strategy for data synthesis
Where possible studies will be pooled in statistical meta-analysis using the Joanna Briggs Institute's System
for the Unified Management, Assessment and Review of Information (JBI SUMARI) software. Effect sizes will
be expressed as a proportion with 95% confidence intervals around the summary estimate after logit
transformation so as to stabilize variance and avoid undue weighting of studies. A random effects model will
be used for statistical pooling. Heterogeneity will be assessed statistically using the standard ?², ?² and I²
tests. To determine the impact of study level co-variates (study setting, study design, participant age, data
collection techniques, population size,) on heterogeneity, meta-regression will be carried out. Additional
analysis will be done on STATA v.11 (Stata Corp LLC, Texas, USA). Where statistical pooling is not possible
the findings will be presented in narrative form including tables and figures to aid in data presentation where
appropriate.
Analysis of subgroups or subsets
Subgroup and sensitivity analyses will be conducted where there is sufficient data for analysis. The impact of
study level co-variates (study setting, study design, data collection techniques, population size etc.) on
prevalence/incidence will be determined.
Contact details for further information
Rosebenter Owuor
rosebenter1981@yahoo.com
Organisational affiliation of the review
Maseno University
Review team members and their organisational affiliations
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3. PROSPERO
International prospective register of systematic reviews
Ms Rosebenter Owuor. Maseno University
Dr Clifford Mwita. Afya Research Africa
Miss Ruth Anyango. Afya Research Africa
Miss Koki Mutungi. Afya Research Africa
Type and method of review
Epidemiologic
Anticipated or actual start date
01 June 2018
Anticipated completion date
01 June 2019
Funding sources/sponsors
None
Conflicts of interest
Language
English
Country
Kenya
Stage of review
Review Ongoing
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Africa South of the Sahara; Burnout, Professional; Humans; Prevalence
Date of registration in PROSPERO
14 August 2018
Date of first submission
27 July 2018
Stage of review at time of this submission
Stage Started Completed
Preliminary searches Yes Yes
Piloting of the study selection process Yes No
Formal screening of search results against eligibility criteria Yes No
Data extraction No No
Risk of bias (quality) assessment No No
Data analysis No No
The record owner confirms that the information they have supplied for this submission is accurate and
complete and they understand that deliberate provision of inaccurate information or omission of data may be
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4. PROSPERO
International prospective register of systematic reviews
construed as scientific misconduct.
The record owner confirms that they will update the status of the review when it is completed and will add
publication details in due course.
Versions
14 August 2018
PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission
is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any
associated files or external websites.
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