No abstract

Objectives: To identify the characteristics of patients and factors contributing to DAMA in paediatric patients admitted into the University of Port Harcourt Teaching Hospital and to determine ways to reduce its prevalence. Method: This was a retrospective study of children admitted into the paediatric wards of the Hospital. Case files of affected patients over a two year period were reviewed and relevant information obtained and analyzed. Results: There were 150 of 3981 patients admitted over the period giving a prevalence rate of 3.8%. There were 86 (57.3%) males and 64 females (42.7%) with a male: female ratio of 1.3:1. Neonatal sepsis, birth asphyxia and prematurity were the commonest diagnosis in neonates whilst severe malaria, meningitis and bronchopneumonia were the commonest in other children. Most discharges (54%) occurred within the first week of ad-mission. Majority of patients were from low (35.3%) and middle (41.3%) income classes. The commonest reasons for DAMA were lack of funds (26.6%) and no improvement (26.6%), necessitating need to seek alternative therapy. The discharge document was signed by the father in 61.3% of cases. Conclusion:Children who were DAMA suffered from common causes of childhood mortality. Lack of funds, no improvement and lack/ low decision making power of mothers were contributory factors. There is need for more universal implementation of the National Health Insurance Scheme; effective communication between medical team and parents and female empowerment to reduce rates of DAMA in our environment.

Background: The greatest risk of childhood death occurs during the neonatal period. The World Health Organization estimates that approximately 4 million newborns die each year with most deaths occurring in developing countries. Any discharge against medical advice (DAMA) amongst this vulnerable group can adversely affect morbidity and mortality.Aim: To identify the causes of DAMA and try to find ways to reduce its incidence in neonates in Port Harcourt, Nigeria. Method: This was a retrospective study done amongst neonates admitted into the Special Care Baby Unit of the University of Port Harcourt Teaching Hospital. Case files of all affected neonates over a 2 year period were reviewed and relevant information obtained and analysed.Results: There were 63 cases of DAMA out of 1481 admissions during the period, giving a prevalence rate of 4.3%. 58 case files were retrieved and analysed. There were 37 males and 21 females with a male: female ratio of 1.7: 1. Preterm babies constituted 25.9% of the cases. The commonest diagnoses were neonatal sepsis and birth asphyxia. Most discharges occurred within the first week of admission (mean =5.9± 4.5days). Common reasons for DAMA were lack of funds and falsely perceived improvement. The discharge document was signed by the father in 77.6% of cases.Conclusion: Poverty, mis-conceived ideas, and other social issues contributed to DAMA in this study. Some babies had life threatening conditions and discharges occurred more within the first few days of life. DAMA in neonates will retard progress in achieving millennium development goal 4.

No abstract