192 Is burnout among community midwives just a problem of high-income countries? Cross-sectional study from Sri Lanka

Background Burnout is a state of physical and psychological fatigue and exhaustion, which is attributed to personal, work and client related spheres in a person’s life. It has major behavioural and heath implications. Being a grass root level health care worker, Community Midwives (Public Health Midwives) are at risk of burnout due to their responsibilities with community and their commitment to services. This study was carried out to establish whether community midwives (Public Health Midwives) in Sri Lanka suffer from the problem of occupational burnout described in high-income countries. Methods A cross sectional descriptive study was conducted in a sample of 556 PHMs in Western Province of Sri Lanka selected by stratified random sampling. A self administered questionnaire was used including validated Sinhala version of Copenhagen Burnout Inventory (CBI-S). Results Burnout was a much bigger problem in younger than older midwives. In those with 5–9 years service, 26.1% (95% CI: 14.3 to 41.1%) scored >50 (the threshold which have suggested indicates a significant problem). Personal burnout (mean score in all age groups 44.5, 95% CI: 43.0 to 46.1) was a significantly bigger problem than client or work related burnout (mean scores 21.2 and 26.4 respectively). As in Europe, high workload was a risk factor but lack of a supportive work environment was equally important. The most important personal factor was housework burden. Conclusions Burnout among community midwives, particularly junior midwives, is not a problem restricted to high-income countries. It undermines care quality and threatens the sustainability of the service. Despite country-specific cultural differences, the underlying causes and solutions are almost certainly the same. Resource constraints make it difficult to reduce workload but providing better recognition and professional support for younger midwives working in isolated community settings is not resource-intensive and likely to impact substantially on sustainability and future service quality.