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

Abstract

Introduction: Paediatric discharges against medical advice (DAMA) are common hospital experiences which limit appropriate and comprehensive treatment as a result of abrupt termination of physician care. The fact remains that the children who are the major culprits of this practice are not legally able to participate in this decision making process which may negatively affect their health.
Objectives: This present study was carried out with the aim of identifying the DAMA prevalence, the socio-cultural characteristics and reason(s) for DAMA among the paediatric patients admitted into the Niger Delta University Teaching Hospital, Bayelsa.
Methods: Case notes of all children who had been discharged against medical advice over a 2 year period(1st of June 2011 to 31st of May 2013) were retrospectively reviewed and analysed.
Results: One hundred and fortyone children out of a total of 1872 children admitted into the paediatric wards had been discharged against medical advice, giving a DAMA prevalence rate of 7.5%. Out of 120 children whose case notes were retrieved and analysed, there were69(57.5%) males and 51 (42.5%) females with a male: female ratio of 1.4:1. Neonatal septicaemia (32.6%), birth asphyxia (27.9%) and prematurity (14.0%) were the major diagnosis in neonates while respiratory tract infections (18.2%), severe malaria (15.6%) and septicaemia (14.3%) were the commonest diagnosis in older children who were DAMA. Discharges against medical advice occurred commonly in the first week of admission (69.0%) and among infants (58.0%). Majority of the patients were from low and middle social classes (85.8%) with 30% of the children belonging to families with 4 or more children. The commonest reasons for DAMA were financial constraints (36.7%), lack of clinical improvement (7.5%) and inconvenience of child’s admission (7.5%). Only 27% of the children’s clinical condition had been noted to have improved before DAMA and fathers were the signatories to the discharge documents in 68% of cases.
Conclusions: Discharges against medical advice remain a serious public health problem with infants being the most vulnerable. Government provision of free child health services, improving access to health facilities through creation of better road network, better patient- physician relationship, child advocacy and female empowerment would help to ameliorate this problem.

Keywords: Discharges against medical advice, child care, advocacy, Nigeria.