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

Duru, Chika O.; Peterside, O; Ududua, AO

doi:10.4314/njp.v41i2.2

Cited by 11 publications

(25 citation statements)

References 11 publications

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“…This study showed that sepsis and birth asphyxia were the common causes, this is corroborated by other studies. 4,8,11 Hatim in his study found transient tachypnea of neonates and suspected sepsis to be the common morbidities in neonates being taken LAMA.…”

Section: Discussionmentioning

confidence: 96%

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Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Kumar

2018

Int J Contemp Pediatr

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Background: Patients who leave against medical advice (LAMA) is a universal problem. Neonates being unable to decide for their own, are dependent on parents for all decisions for their treatment. LAMA is a sensitive issue in neonatology practice with ethical and medico legal ramifications. This study was done to evaluate the factors associated with the decision of LAMA by care givers in our special newborn care unit (SNCU).Methods: This is a retrospective hospital based observational study and was conducted in SNCU of HNB Base Teaching Hospital, Srinagar, Garhwal. Data pertaining to LAMA between 1st August 2017 and 31st July 2018 was retrieved. Information obtained included place of birth, gestational age, weight, diagnoses, duration of hospital stay and reasons for LAMA. Data were entered into a Microsoft Excel Spread Sheet and analyzed using software. Graph Pad Prism v 7.04. Chi-Square test was used to test for significant difference among various groups.Results: Out of 689 neonates admitted in SNCU during the study period, 167 (24.24%) took LAMA. Male to female ratio of 1:1.1. 102 (61%) were inborn and 65 (39%) were out born. Term babies constituted 62.87%. 78.44% neonates were discharged within 7 days of admission. 58 (34.73%) neonates had sepsis and 30 (17.96%) had birth asphyxia. The commonest reason in 25.15% for taking LAMA was to take the neonate to better equipped facility followed by false perception that the baby is well enough to be discharged.Conclusions: Multiple factors contribute for getting a neonate discharged against medical advice. Improvement of infrastructure, training of health care staff for proper counselling, sensitivity and empathy towards neonate and the care givers can decrease the rate of LAMA.

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Section: Discussionmentioning

confidence: 96%

“…7 But the LAMA rate remains high in neonates 35.8 % as reported by Duru, and infants 40.4% by Gafri respectively. 8,9 Kumar R. Int J Contemp Pediatr. 2019 Jan;6(1):176-180…”

Section: Discussionmentioning

confidence: 99%

Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Kumar

2018

Int J Contemp Pediatr

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“…of DAMA among the pediatric population to range from 1.2% to 7.5% (1,4,5,(9)(10)(11). Some of the factors identified as contributors to DAMA included financial constraints, dissatisfaction with care, perceived improvement of clinical condition, high cost of hospital services, inconvenience of hospitalization, desire to seek alternative/complementary medicine, and lack of noticeable improvement in clinical condition (1,4,5,(9)(10)(11). When DAMA occurs, it often leads to prolonged morbidity and increased risk of mortality (1,3,4,(6)(7)(8).…”

Section: Years Have Reported Prevalencementioning

confidence: 99%

Pediatric Discharges Against Medical Advice: A Review of Cases in Ado-Ekiti, Nigeria

et al. 2021

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Background: Knowledge of the profile of pediatric discharge against medical advice (DAMA) may help design interventions to reduce its prevalence. Objectives: This study aimed to assess the profile of pediatric DAMA at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State, Nigeria. Methods: This retrospective cross-sectional descriptive study included all pediatric cases of DAMA from January 2012 to December 2018. Relevant information was extracted from the patients’ case notes. Data was analyzed using the statistical package for social sciences (SPSS) version 23. Results: The overall prevalence of pediatric DAMA was 3.8%. Of the 233 pediatric DAMA with complete information, 127 (54.5%) were males. Severe malaria (27.3%) was the most common diagnosis among DAMA cases at the children emergency ward (CEW), while severe perinatal asphyxia (25.0%) and neonatal sepsis (25.0%) were the most common at the special care baby unit (SCBU). Only 1 (0.4%) patient was enrolled in the National Health Insurance Scheme (NHIS). Moreover, 43 (18.5%) parents took DAMA due to financial constraints, and 55% of the patients had their DAMA form signed by their fathers. In addition, among the patients who referred for follow-up, 11 (4.7%) patients fully recovered, 2 (0.8%) recovered with disability, 1 (0.4%) was readmitted, and 1 (0.4%) died. The highest and lowest DAMA rates were in the months of May and December, respectively. Patients aged under five years old who took DAMA significantly had infectious diseases compared to older age groups (P

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“…55 The 5% prevalence of discharge against medical advice in our patient cohort is similar to the overall rates reported in other Nigerian studies (3.1 to 7.5%) . [56][57][58] The reasons for discharge against medical advice for pediatric patients in Nigerian hospitals include financial constraints (27 to 42%), lack of perceived clinical improvement (10 to 26%), perceived clinical improvement (22 to 27%), the inconvenience that admission causes the parents or caregiver (7 to 8%) and dissatisfaction with the medical care (5 to 8%). [56][57][58] When health care costs are paid out of pocket, as is the case in Nigeria, it leads to catastrophic expenditures and adverse outcomes, creating barriers to receiving and providing health care.…”

Section: Original Articlementioning

confidence: 99%

“…[56][57][58] The reasons for discharge against medical advice for pediatric patients in Nigerian hospitals include financial constraints (27 to 42%), lack of perceived clinical improvement (10 to 26%), perceived clinical improvement (22 to 27%), the inconvenience that admission causes the parents or caregiver (7 to 8%) and dissatisfaction with the medical care (5 to 8%). [56][57][58] When health care costs are paid out of pocket, as is the case in Nigeria, it leads to catastrophic expenditures and adverse outcomes, creating barriers to receiving and providing health care. It is not surprising that financial constraint is the major reason parents prematurely remove their children from the hospital; without a system to take over the continued cost of providing for the child's needs, health care workers can only play an advisory role in such cases.…”

Section: Original Articlementioning

confidence: 99%

Factors Predicting Heart Failure in Children Admitted to a Pediatric Emergency Ward in a Developing Country

Onubogu

2020

International Journal of Cardiovascular Sciences

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

Cited by 11 publications

References 11 publications

Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Pediatric Discharges Against Medical Advice: A Review of Cases in Ado-Ekiti, Nigeria

Factors Predicting Heart Failure in Children Admitted to a Pediatric Emergency Ward in a Developing Country

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