Caregivers’ reasons and health professionals’ perceptions of pediatric discharge against medical advice in Eastern Ethiopia: a mixed-methods study

Abstract

Background: Discharge against medical advice among children remains a critical challenge in healthcare, as it interrupts essential treatment, increases complications, and may result in death. Objective: This study assessed the caregivers’ reasons and health professionals’ perceptions of pediatric discharge against medical advice in eastern Ethiopia. Methods: A mixed-methods design was employed, combining a cross-sectional survey of caregivers whose children were discharged against medical advice with in-depth interviews of health professionals. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed. Results: Among 82 pediatric DAMA cases, the most frequent caregiver-reported reasons for DAMA were perceived clinical improvement (59.8%), prolonged hospitalization (25.6%), dissatisfaction with care (14.6%), and financial constraints (7.3%). Health professionals highlighted additional contributing factors, including knowledge gaps, cultural and religious beliefs, and lack of family support. DAMA was perceived as common, emotionally distressing, and ethically challenging for providers, who often faced repeated cases without clear institutional guidance. Conclusion: Pediatric DAMA is shaped by an interplay of caregiver, socioeconomic, and systemic factors. Addressing it requires strengthening caregiver education, improving provider–caregiver communication, expanding financial and psychosocial support, and establishing institutional guidelines that empower health professionals to act in the best interest of children.