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

Abstract

AJOL Abstract: Objectives: To identify the characteristics of patients and factorscontributing to DAMA in paediatric patients admitted into the University of Port Harcourt Teaching Hospital and to determine waysto reduce its prevalence.Method: This was a retrospective study of children admitted into thepaediatric wards of the Hospital. Case files of affected patients over atwo year period were reviewed and relevant information obtained andanalyzed.Results: There were 150 of 3981 patients admitted over the periodgiving a prevalence rate of 3.8%. There were 86 (57.3%) males and64 females (42.7%) with a male: female ratio of 1.3:1. Neonatal sepsis,birth asphyxia and prematurity were the commonest diagnosis inneonates whilst severe malaria, meningitis and bronchopneumoniawere the commonest in other children. Most discharges (54%) occurredwithin the first week of admission. Majority of patients were from low (35.3%) and middle (41.3%) income classes. The commonestreasons 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 commoncauses 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 NationalHealth Insurance Scheme; effective communication between medicalteam and parents and female empowerment to reduce rates ofDAMA in our environment