Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 May 9;25(1):669.
doi: 10.1186/s12913-025-12699-5.

Indicators associated with job morale of physicians in low- and middle-income countries during the COVID- 19 pandemic: a systematic review and meta-analysis

Alina Kuandyk  1 , Nazerke Toleukhanova  2 , Mariya Dmitriyeva  3 , Timur Suleimenov  4 , Dauren Sarssenov  3 , Raimzhan Mamytkhan  3 , Madiyar Sakhayev  3 , Arman Tleubergenov  3 , Medet Toleubayev  3
Affiliations
Meta-Analysis

Indicators associated with job morale of physicians in low- and middle-income countries during the COVID- 19 pandemic: a systematic review and meta-analysis

Alina Kuandyk et al. BMC Health Serv Res. .

Abstract

Background: The COVID- 19 pandemic has placed immense strain on healthcare systems around the globe, with low- and middle-income countries facing unique challenges due to limited resources and fragile healthcare infrastructures. This systematic review and meta-analysis aims to define the levels of four indicators of job morale (job motivation, job satisfaction, burnout, and depression symptoms) among physicians working in public healthcare settings in low- and middle-income countries.

Methods: A comprehensive search of Scopus, PubMed, Embase, Web of Science, the Cochrane Library, and grey literature was performed. Studies were eligible if at least one job morale indicator (job motivation, job satisfaction, burnout, or depression symptoms) was assessed using quantitative methods, and at least 50% of the sample were qualified physicians working in low- and middle-income countries during the COVID- 19 pandemic. Random effects meta-analyses, planned sub-group analyses, and meta-regression were performed.

Results: Overall, 82 studies involving 65,431 participants across 26 middle-income countries met the inclusion criteria for the review. The pooled random effect estimates of the prevalence of burnout suggest that 49% of physicians working in middle-income countries during the COVID- 19 pandemic suffered from professional burnout. The overall estimate of the mean was 24.64, which also indicated a high level of burnout. The pooled random effect estimates of the prevalence of depression symptoms varied from 41 to 58%, depending on the adopted scale. Sufficient data were not available for meta-analyses of job motivation and job satisfaction.

Conclusions: The findings suggest that job morale among physicians working in middle-income countries was generally low during the COVID- 19 pandemic. However, due to substantial variation and limited methodological quality among the studies included, any conclusions offered should be approached with caution. Future research should focus on assessing job morale in low-income regions and identifying effective resilience strategies to support interventions aimed at improving job morale.

Keywords: Burnout; COVID-19 pandemic; Job morale; Low- and middle-income countries; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Meta-analysis of the prevalence of ‘high’ emotional exhaustion among physicians in LMICs during the COVID-19 pandemic (based on results provided as dichotomous data). NB: ES = Proportion
Fig. 3
Fig. 3
Meta-analysis of the prevalence ‘high’ depersonalization among physicians in LMICs during the COVID-19 pandemic (based on results provided as dichotomous data). NB: ES = Proportion
Fig. 4
Fig. 4
Meta-analysis of the prevalence of ‘low’ personal accomplishment among physicians in LMICs during the COVID-19 pandemic (based on results provided as dichotomous data) NB: ES = Proportion
Fig. 5
Fig. 5
Meta-analysis of the mean score for emotional exhaustion among physicians and dentists in LMICs during the COVID-19 pandemic (based on results provided as continuous data). NB: ES = Mean score
Fig. 6
Fig. 6
Meta-analysis of the mean score for depersonalization among physicians in LMICs during the COVID-19 pandemic (based on results provided as continuous data).NB: ES = Mean score
Fig. 7
Fig. 7
Meta-analysis of the mean score for personal accomplishment among physicians in LMICs during the COVID-19 pandemic (the mean score for personal accomplishment is based on results provided as continuous data). NB: ES = Mean score
Fig. 8
Fig. 8
Meta-analysis of depression symptoms among physicians in LMICs during the COVID-19 pandemic (based on results provided as dichotomous data measured by the PHQ- 9). NB: ES = Proportion
Fig. 9
Fig. 9
Meta-analysis of depression among physicians in LMICs during the COVID-19 pandemic (based on results provided as dichotomous data measured by the DASS- 21). NB: ES = Proportion
Fig. 10
Fig. 10
Meta-analysis of depression among physicians in LMICs during the COVID-19 pandemic (based on results provided as dichotomous data measured by the HADS). NB: ES = Proportion
Fig. 11
Fig. 11
Meta-analysis of depression symptoms among physicians in LMICs during the COVID-19 pandemic (based on results provided as continuous data measured by the PHQ- 9). NB: Effect = Mean
Fig. 12
Fig. 12
Meta-analysis of depression symptoms among physicians in LMICs during the COVID-19 pandemic (based on results provided as continuous data measured by the DASS- 21). NB: Effect = Mean
Fig. 13
Fig. 13
Meta-analysis of depression symptoms among physicians in LMICs during the COVID-19 pandemic (based on results provided as continuous data measured by the HADS- 14). NB: Effect = Mean
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Sabitova A, Hickling LM, Priebe S. Job morale: a scoping review of how the concept developed and is used in healthcare research. BMC Public Health. 2020;20(1):1166. - PMC - PubMed
    1. Warr P. AQThe measurement of Well-Being and other aspects of mental health. J Occup Organ Psychol. 1990;63(3):193–210.
    1. Warr P. Work, happiness and unhappiness. NJ: Lawrence Erlbaum Associates; 2011. p. 1–548.
    1. Bakker AB, Demerouti E. The job Demands-Resources model: state of the Art. J Managerial Psychol. 2007;22(3):309–28.
    1. Dewa CS, et al. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open. 2017;7(6):e015141. - PMC - PubMed

LinkOut - more resources