Discharge of children against medical advice at CHU of Brazzaville (Congo)

Abstract

In a prospective study conducted from January to December 2010 in the Teaching Hospital of Brazzaville (Congo), we compared the discharge of hospitalized children against medical advice at the parents' request (group 1 - cases) with those admitted during same period with routine discharge (group 2 - controls). Two hundred and seven (7.7%) hospitalized children, 117 boys and 90 girls, were discharged at the parents request. The mean age was 18.0 ± 13.5 months (range: 1 month-5 years). Among these patients, 150 (72.5%) children were from biparental families, and 30.9% of children were the first and/or only child of the household. Among the parents of Congolese nationality, 147 (71%) had a secondary school level education, including 66.7% of mothers and 58% of the fathers 59.9% of children were admitted between 15 and 7 hours, and 75.4% were hospitalized during working days. The duration of hospitalization did not exceed 3 days in 147 cases (71%). The main reasons for hospitalization were digestive disorders (27%), fever (16.4%), convulsions (11.1%) and anaemia (11.1%). Among patients discharged against medical advice, 34.8% left on the first day of hospitalization (72 cases), 36.7% before the start of treatment (76 cases of which 36 during check-up) and 63.3% during treatment (131 cases). The main reasons for discharge request were improvement in the clinical condition improvement (30.9% of cases), lack of money (28% of cases), supposed insufficient medical care (7.7% of cases), unsatisfactory hospitalization conditions (6.3% of cases), care of other children at home (6.3% of cases), traditional and/or religious beliefs (5.8% of cases) and disagreements with nurses (5.3%). Patients discharge against medical advice was correlated strongly with the educational level of parents, age of the child, delay of consultation, time of admission, rank of the child in family and nationality of parents. Discharge against medical advice is associated to the distrust between the patients and nurses. Improvement of hospitalization conditions in our hospitals, improvement of the socioeconomic status of Congolese and establishment of national social security seem to be the main determinants of reduction of discharge against medical advice.

Discharge against medical advice in paediatric patients

“…While one study has shown that the children of parents who were satisfied with their jobs spend more time in the hospital receiving treatment, 27 our investigation concluded that a parent's occupation did not play a role in the level of the completion of their child's medical treatment. Aliyu et al 26 . showed that patients who experienced long periods of treatment and hospitalisation had a greater tendency to insist on DAMA, which was confirmed by the present study.…”

“…Economic factors are the most important factors in early clearance with personal satisfaction. While Aliyu et al 26 . showed that economic issues were the most important factors for DAMA, we did not find this in our research; although, this may be because our population displayed values of promoting health and a high rate of insurance coverage 23 .…”

“…showed that some of the factors that had a high correlation with DAMA included dissatisfaction with hospital services as well as a host of personal reasons such as: addiction or drug abuse (by the patient or the parents), high hospital costs, psychiatric problems, family problems (such as the presence of other small children at home), no significant improvement, belief in traditional medicine, long hospital stays, a feeling of recovery, and place of residence (urban or rural). The major findings of this study which correlated with the types of discharge and risk-factors outlined in the studies mentioned above were as follows: the child's feelings of recovery with regard to parental perception, having other children at home, challenging economic situations, and residing a long distance from the hospital 23, 24, 25, 26, 27, 28, 29…”

“…Some researchers believe that, in curded families, parents are more likely to insist on DAMA because of the economic impacts, 28 but we did not find a significant relationship between the number of children in a family and paediatric DAMA. The type of employment of the patient's parent was another factor which had high impact on paediatric DAMA 26 ; this factor is related to economic status. While one study has shown that the children of parents who were satisfied with their jobs spend more time in the hospital receiving treatment, 27 our investigation concluded that a parent's occupation did not play a role in the level of the completion of their child's medical treatment.…”

Factors associated with hospitalization outcomes for cases of anemia in pregnancy at a regional level in Burkina Faso

“…In studies conducted in African hospitals, most authors have found high proportions of discharges without or against medical advice. The main reasons for these discharges were the lack of improvement in health, nancial di culties, poor hospital conditions and disagreements with caregivers (14).…”