Discharge against medical advice amongst patients admitted into the Paediatric wards of the University of Port Harcourt Teaching Hospital

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.

Paediatric discharges against medical advice at a tertiary health centre in Bayelsa State, Nigeria

“…This may further reduce the prevalence of DAMA. As reported in many other studies 5,6,10 fathers signed the discharge documents in majority of the cases of DAMA. This emphasizes the role of fathers as the principal and often sole decision makers in the family.…”

“…8 Financial constraints and Low socio-economic class also featured prominently as reasons for DAMA in other studies inNigeria. [4][5][6][7][8][9] Gloydet al 14 in their study on DAMA in the paediatric ward of a central hospital in Bouake, Cote D'Ivoire noted a 5 fold increase in DAMA rates occurring simultaneously with an increase in hospital fees. Roodpegma et al 13 in Iran gave financial reasons as the fourth reason for DAMA in their study however most of the patients had health insurance unlike the present study where health care is funded by the parents/guardians.…”

“…It has been demonstrated by the present study that DAMA prevalence is higher among the lower socio-economic class. Most of the parents in the Port Harcourt study 6 may be better able to afford hospital fees and therefore be less likely to discharge their children against medical advice.…”

“…These findings are similar to findings from other Nigerian studies though in different orders of frequency. 5,6,10,19 Neonates are a high risk group 19 and these conditions are also the major reasons for neonatal admissions in our environment. 21 In the older children beyond the neonatal age group, infections such as bronchopneumonia, severe malaria and septicaemia were the commonest reasons for admission in these children who were DAMA.…”

“…It has also been noted that subsequent treatment after DAMA may be more difficult and costly 3 . Discharge against medical advice has commonly been reported in many paediatric centres in Nigeria, [4][5][6][7][8][9][10][11][12] other African countries 14,16 and Asia 13,15 with DAMA prevalence rates ranging from 0.96% 10 to 7.4% 4 . Various reasons for DAMA given have included financial constraints, dissatisfaction with medical care and treatment, parent's impression that child's clinical condition had improved, resort to alternative medicine, lack of trust in orthodox medicine, lack of clinical improvement and inconvenience of child's hospitalisation [4][5][6][7][8][9][10][11][12][13][14][15][16][17] .…”