SUMMARYDischarge against medical advice (DAMA) presents healthcare providers with clinical, ethical and legal challenges. Patient factors – demographic, social and clinical – may determine the possibility of a hospitalisation ending against medical advice. All cases of DAMA from St Agnes Hospital, Baltimore, were identified from the computerised medical system. Patient factors including demographic, social and clinical variables relating to these discharges were analysed. Readmission data and cost of hospitalisation were also assessed. DAMA represented 1% of all discharges. The average length of stay was 2.3 days, at a cost of $3716.00. The average length of stay of 30‐day readmission was 4.7 days, making the cumulative cost of hospitalisation $10,761.56, 56% higher than expected. African Americans, males, lack of medical insurance and substance abuse were strongly associated with DAMA (p<0.01). Careful and proactive management strategies could mitigate the potential clinical, legal and economic implications of DAMA.

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We sought to determine the magnitude and spatio-temporal pattern of maternal morbidity in Kano State, Nigeria. Analysis was on deliveries within the period 1990-1999. We counted 59772 maternal complications among 171621 deliveries, yielding an overall maternal morbidity ratio of 34.8%. We observed yearly variations and increment in the number of complications among mothers (p=0.04). A total of 4154 maternal deaths were registered within the period. The level of maternal deaths correlated significantly with burden of morbidity (r=0.44; p=0.0008). Case fatality rate was 6.9% with temporal fluctuations, and wide variations among the various health institutions. Our study revealed an extremely high morbidity ratio, which indicates that a high proportion of pregnant mothers are in need of essential obstetric care in this population.