Profile of and control measures for paediatric discharges against medical advice.
BACKGROUND
Children are minors in health decision- making and discharges against medical advice (DAMA) may portend adverse health, social and psychological consequences . This study was aimed at ascertaining the prevalence rate and the determining clinical, sociodemographic factors as well as caregivers' perceptions associated with paediatric DAMA with the view of proferring possible control measures.


METHODS
Pre-tested administered questionnaires were used to collect relevant data prospectively (March 2000- March 2002) from consecutive patients undertaking DAMA.


RESULTS
Prevalence rate of DAMA was 1.2%, comprising 202 of 16,440 discharges, of which 95 (47.0%) were neonates. Neonatal jaundice, gross congenital anomalies and severe birth asphyxia among neonates, and bronchopneumonia, gastroenteritis, malaria and malignancies among infant and older children,were the commonest diagnoses. Twenty (9.9%) cases were critically ill and 53(26.2%) were partially improved at discharge. Perceived improvement of illness, preference for outpatient care, financial constraints, high cost of hospital services, dissatisfaction and disagreements with care, were the commonest reasons for DAMA.


CONCLUSIONS
DAMA is of multifactorial aetiology, involving clinically heterogeneous patients who may be critically ill or partially recovered. Socioeconomic, quality and cost of health care are implicated. This study recommends some control measures.
Okoromah
C N
CN
Department of Paediatrics and Child Health, Lagos University Teaching Hospital, Nigeria.
Egri-Qkwaji
M T C
MT
D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria; D010351:Patient Discharge; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000523:psychology