Discharge against medical advice amongst patients admitted into the Paediatric wards of the University of Port Harcourt Teaching Hospital

Abstract

Objectives: To identify the characteristics of patients and factors
contributing to DAMA in paediatric patients admitted into the University of Port Harcourt Teaching Hospital and to determine ways
to reduce its prevalence.
Method: This was a retrospective study of children admitted into the
paediatric wards of the Hospital. Case files of affected patients over a
two year period were reviewed and relevant information obtained and
analyzed.
Results: There were 150 of 3981 patients admitted over the period
giving a prevalence rate of 3.8%. There were 86 (57.3%) males and
64 females (42.7%) with a male: female ratio of 1.3:1. Neonatal sepsis,
birth asphyxia and prematurity were the commonest diagnosis in
neonates whilst severe malaria, meningitis and bronchopneumonia
were the commonest in other children. Most discharges (54%) occurred
within the first week of admission. Majority of patients were from low (35.3%) and middle (41.3%) income classes. The commonest
reasons for DAMA were lack of funds (26.6%) and no improvement
(26.6%), necessitating need to seek alternative therapy. The discharge document was signed by the father in 61.3% of cases.
Conclusion: Children who were DAMA suffered from common
causes of childhood mortality. Lack of funds, no improvement and lack/
low decision making power of mothers were contributory factors.
There is need for more universal implementation of the National
Health Insurance Scheme; effective communication between medical
team and parents and female empowerment to reduce rates of
DAMA in our environment.