Volume 25, Issue 4 (12-2011)                   Med J Islam Repub Iran 2011 | Back to browse issues page


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Onyiriuka A N. Pediatric discharge against medical advice: experience from a Nigerian secondary healthcare institution. Med J Islam Repub Iran. 2011; 25 (4) :194-199
URL: http://mjiri.iums.ac.ir/article-1-457-en.html

Department Of Child Health, University of Benin Teaching Hospital, Pmb 1111, Benin City,Nigeria. , didiruka@gmail.com
Abstract:   (2982 Views)

 Abstract

 Background and Objective: Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice (DAMA) among hospitalized children and examine the reasons given by parents/guardians for such discharges.

 Methods: A retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility.

 Results: The overall prevalence of DAMA was 6.3% while the prevalence among neonates was 7.5%, p>0.05. Sixty-two (56.4%) of all cases were less than 12 months old with neonates accounting for 40 (64.5%) of the 62. The prevalence of DAMA was 2.8 times higher in male neonates compared to female neonates. Thirty two (9.9%) of 322 male neonates compared to 8 (3.7%) of female neonates were DAMA Odd ratio, OR=2.8 95% Confidence Interval, CI= 1.26, 6.20). Majority (65.4%) of the signatories to the discharge documents were the child’s fathers. In only 5.5% of cases were the child’s mothers the signatories. Rate of re-admission was 13.6%. The commonest reason for DAMA in both neonates and older children was financial constraints. Parental disagreement with planned treatment and/or investigations ranked second in the case of neonates.

 Conclusions: DAMA is a common social pediatric health problem, especially among infants and has multifactorial etiology. Socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence.

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Type of Study: Original Research | Subject: Pediatric

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