Pattern of discharge against medical advice amongst paediatric in-patients at Federal Medical Centre, Azare, Nigeria

Abstract

Background: Discharge against medical advice (DAMA) is a common problem in health care delivery in developing countries, including Nigeria. Children are vulnerable in this situation as they may neither comprehend nor contribute to the decisions and it may be that DAMA is not in their best interest. We therefore sought to determine the prevalence rate of DAMA amongst paediatric in-patients at the Federal Medical Centre, Azare.
Methods: This was a retrospective study carried out over a 3 year period from January 2011 to December 2013. Hospital Numbers of  patients who were discharged against medical advice were identified from the ward admission and discharge registers for the Paediatric medical ward (PMW) and Special Care baby Unit (SCBU). Folders were retrieved; relevant clinical and socio-economic data were extracted as well as duration of hospital stay. Data was analyzed to generate rates and percentages.
Results: A prevalence rate of DAMA was 4.3% amongst the 3896 children admitted into the wards. PMW had a prevalence rate of 3.5% and SCBU had a prevalence of 6.8%. Acute infections accounted for the majority of admissions, the mean duration of hospital stay was less than one week and the most common documented reason for DAMA was financial constraints (15.5%) on the part of the caregivers.
Conclusion: DAMA is still frequent amongst paediatric patients and financial constraint is the most common reason given by caregivers for the request. Laws and policies enabling health insurance coverage of all children or provision of free health care should be made.