A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria

Onankpa, BO; Ali, Tariq; Abolodje, E

doi:10.5958/j.2319-5886.3.2.063

Cited by 6 publications

(23 citation statements)

References 11 publications

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“…Most of the studies reported financial constraints as one of prominent reasons for requesting LAMA which is quite different in present study as treatment in SNCU is free of cost. 4,12,14 Self-discharge to take the neonate to a better equipped facility was the commonest reasons cited in the present study. This may be because of the impending fear of deterioration of the neonate and lack of a nearby referral centre with difficult roads and unavailability of vehicles at odd times which may impede timely referral as and when required.…”

Section: Discussionmentioning

confidence: 80%

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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: 80%

“…This is similar to findings of other studies. 12,13 Term babies are usually more active especially when not suffering from serious conditions which falsely assures the parents that the neonate is well.…”

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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“…Discharged against medical advice occurs when an in-patient decides to leave the hospital before discharge is recommended by the treating clinicians or physicians. DAMA poses serious clinical, ethical, and legal challenges to the individual physician as well as to the hospital (1,(6)(7)(8)(9). The DAMA prevalence has been shown to vary depending on geographical areas and the study population.…”

Section: Background and Rationalementioning

confidence: 99%

Effectiveness of Faith-Based Interventions on the Rate of Discharged Against Medical Advice in Tertiary Newborn Units in Nigeria: A Protocol for an Open Label Randomized Control Trial

Alao

Ibrahim

Ogunbosi

et al. 2022

Front. Public Health

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BackgroundDischarged against medical advice (DAMA) is a risk factor that often leads to adverse outcomes and hospital readmissions in neonatal units. A few studies have shown that spiritual/faith-based interventions (FBIs) tend to have a lower incidence of DAMA compared with public hospitals. Perhaps, a holistic approach to patient care that addresses the spiritual needs, the soul and the body component of a being in this setting may account for the observed lower incidence of DAMA. Limited randomized control trials (RCTs) exist on FBIs with regard to DAMA in the published literature. This study seeks to compare the effectiveness of FBI, social support, religiosity, and types of FBI on neonatal DAMA against standard of care in tertiary hospitals in Nigeria.MethodsThis RCT will be conducted in two public tertiary teaching hospitals in two of the six geopolitical zones in Nigeria. The sociodemographic and clinical details of all patients admitted to the neonatal wards during the study period will be documented. Study participants will be selected through a multistage sampling technique. Subjects will be randomized and allocated to treatment and control arms having the established baseline measure of social support and religiosity. Ethical approval was obtained from the State Research Ethics Review Committee. A written informed consent will be obtained from the parents/caregivers prior to patient enrolment. The study will be conducted in line with the Declaration of Hesinki 2000. Appropriate statistical tools will be used for data collection and analysis.DiscussionThe outcome of this analysis will give insights into the effectiveness of FBI on DAMA. It will also predict the effect of the mediators of parents/caregivers' religiosity, spirituality, forms of FBI, the religious sect of parents/caregivers, and social support on the rate of DAMA on neonatal admission in tertiary hospitals in Nigeria. This could help Public Health Institutions and Governments make decisions about the determinants of neonatal DAMA and how to mitigate such outcomes. It is hoped that the evidence from this study may guide policy formulation and guidelines on enhancing hospital retention of sick neonates until they are fit for discharge.Trial RegistrationThis study was registered at the Pan Africa Clinical Trial Registry (PACTR202102670906630).

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“…DAMA poses serious clinical, ethical, and legal challenges to the individual physician as well as the hospital. (2,(7)(8)(9)(10) The DAMA prevalence has been shown to vary depending on geographical areas and study population. The rate of DAMA compares inversely with the socioeconomic status: a relatively lower rate was observed at a hospital serving primarily middle and upper-class populations, whereas a higher rate was observed at a hospital serving disadvantaged urban areas.…”

Section: Background and Rationalementioning

confidence: 99%

“…The rate of DAMA compares inversely with the socioeconomic status: a relatively lower rate was observed at a hospital serving primarily middle and upper-class populations, whereas a higher rate was observed at a hospital serving disadvantaged urban areas. (10)(11)(12)(13)(14) The paediatric age group, and especially the newborns are at a greatest risk for DAMA in Nigeria from published literature (10)(11)(12).…”

Section: Background and Rationalementioning

confidence: 99%

Effectiveness of faith-based interventions on the rate of discharged against medical advice in the tertiary newborn units in Nigeria: A protocol for an open label randomized control trial, the FBI-DAMA Study

Alao

Ibrahim

Ogunbosi

et al. 2021

Preprint

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Background: Discharged against medical advice (DAMA) is a risk factor that often leads to adverse outcomes and hospital re-admissions in neonatal units. Few studies have shown that spiritual/faith-based institutions (FBI) tend to have lower incidence of DAMA compared with public hospitals. Perhaps the holistic approach to patient care that addresses the spiritual needs, the soul and the body component of a being in this setting may account for the observed lower incidence of DAMA. Limited randomized control trials (RCT) exist on faith-based interventions with regards to DAMA in published literature. This study seeks to compare the effectiveness of FBI, social support, religiosity and types of FBI on neonatal DAMA against standard of care in tertiary hospitals in Nigeria. Methods: This RCT will be carried out in 2 public tertiary teaching hospitals in 2 of 6 geopolitical zones in Nigeria. The socio-demographic and clinical details of all patients admitted to the neonatal wards during the study period will be documented. Study participants will be selected through a multistage sampling technique. Subjects will be randomized and allocated to treatment and control arms having established baseline measure of social support and religiosity. Ethical approval was obtained from the State Research Ethics Review Committee. Written informed consent will be obtained from the parents/caregivers prior to patient enrolment. The study will be conducted in line with Declaration of Hesinki 2013. Appropriate statistical tools will be used for data collection and analysis.Discussion:The outcome of this analysis will give insight into the effectiveness of FBI on DAMA. It will also predict the effect of the mediators of parents/caregivers’ religiosity, spirituality, forms of FBI, parents/caregivers’ religious sect and social support on rate of DAMA on neonatal admission in tertiary hospitals in Nigeria. This may help inform Public Health Institutions and Governments’ decisions on the determinants of neonatal DAMA and how to mitigate such outcomes. It is hoped that the evidence from this study may guide policy formulation and guidelines to enhance hospital retention of sick neonates until they are fit for discharge. Trial registration: This study was registered in the Pan Africa Clinical Trial Registry (PACTR202102670906630).

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A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria

Cited by 6 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

Effectiveness of Faith-Based Interventions on the Rate of Discharged Against Medical Advice in Tertiary Newborn Units in Nigeria: A Protocol for an Open Label Randomized Control Trial

Effectiveness of faith-based interventions on the rate of discharged against medical advice in the tertiary newborn units in Nigeria: A protocol for an open label randomized control trial, the FBI-DAMA Study

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