An Assessment of Factors influencing Hospital Discharges Against Medical Advice of Paediatric Patients in Enugu: A Review of 67 Cases

Abstract

A study was carried out with the aim of determining the prevalence of discharges against medical advice (DAMA) at the University of Nigeria Teaching Hospital, Enugu as well as identifying the reasons for such requests. Data in respect of 67 patients who fulfilled the criteria for DAMA were analysed. A prevalence rate of 1.8 per cent was obtained for DAMA out of 4443 admissions over the study period. Poor financial support was the commonest reason for discharge against medical advice. Septicaemia was the commonest cause of admission accounting for 17 (25.4 per cent) followed by HIV/pulmonary tuberculosis in 15 (22.4 per cent) cases. Fifty-three (79.1 per cent) children were admitted without a formal referral letter and 51 (76.2 per cent) children were discharged within two weeks of admission while 45 (67.2 per cent) children belonged to the lower social classes. It is concluded that parental low social class, poor financial support and unpreparedness for hospital admission are risk factors for DAMA. A case is made for the implementation of the National Health Insurance Scheme as well as a review of the methods of counseling parents who ask for DAMA for their children or wards. This is important since the children are not directly involved in their parents'/guardians' decision to seek their discharges.

Nigerian Journal of Paediatrics, 2002; 29:1-4.