Pediatric Discharges Against Medical Advice: A Review of Cases in Ado-Ekiti, Nigeria

Abstract

Background: Knowledge of the profile of pediatric discharge against medical advice (DAMA) may help design interventions to reduce its prevalence. Objectives: This study aimed to assess the profile of pediatric DAMA at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State, Nigeria. Methods: This retrospective cross-sectional descriptive study included all pediatric cases of DAMA from January 2012 to December 2018. Relevant information was extracted from the patients’ case notes. Data was analyzed using the statistical package for social sciences (SPSS) version 23. Results: The overall prevalence of pediatric DAMA was 3.8%. Of the 233 pediatric DAMA with complete information, 127 (54.5%) were males. Severe malaria (27.3%) was the most common diagnosis among DAMA cases at the children emergency ward (CEW), while severe perinatal asphyxia (25.0%) and neonatal sepsis (25.0%) were the most common at the special care baby unit (SCBU). Only 1 (0.4%) patient was enrolled in the National Health Insurance Scheme (NHIS). Moreover, 43 (18.5%) parents took DAMA due to financial constraints, and 55% of the patients had their DAMA form signed by their fathers. In addition, among the patients who referred for follow-up, 11 (4.7%) patients fully recovered, 2 (0.8%) recovered with disability, 1 (0.4%) was readmitted, and 1 (0.4%) died. The highest and lowest DAMA rates were in the months of May and December, respectively. Patients aged under five years old who took DAMA significantly had infectious diseases compared to older age groups (P

Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review

“…About 5% of patients seen in the years under review left against medical advice (LAMA). This finding is higher than less than 1% reported in a cross sectional study from Saudi Arabia [46] but comparable to 4.1% reported from Ogbomosho [47] and 4.9% from a previous study conducted in our hospital [48] . Perhaps the advancement in the health care indices in Saudi Arabia might be responsible for the low prevalence in that country compared to the current study and the one from Ogbomosho.…”

Households Health Care Financing Methods: Social Status Differences, Economic Implications and Clinical Outcomes Among Patients Admitted in a Pediatric Emergency Unit of a Tertiary Hospital in South West Nigeria

“…Also, while on treatment, users who pay directly from pocket often run out of fund and become exhausted, at which point, they request for discharge from the hospital even when still critically ill or still in need of in-patient care. [15][16][17] The health system in general is weak if it solely relies on the payment of care directly from pocket at the point of purchase. 2 The patronage is poor, ability to procure good up-to-date facilities is hampered and the care providers are rarely adequately incentivized.…”

“…Also, while on treatment, users who pay directly from pocket often run out of fund and become exhausted, at which point, they request for discharge from the hospital even when still critically ill or still in need of in- patient care. 15-17…”