title: Prospective evaluation of cases of discharge against medical advice in Abuja, Nigeria.
abstract: BACKGROUND
  Discharge against medical advice (DAMA) is a global clinical phenomenon contributing significantly to adverse patients' outcome. Literatures abound on self-discharges in specific medical subpopulations. However, multidisciplinary studies on this subject in our region are few.
  
  
  OBJECTIVE
  To prospectively evaluate cases of DAMA in a wholesale multidisciplinary perspective at Federal Staff Medical Centre, Abuja, and suggest strategies to reduce it.
  
  
  METHODS
  All consecutive patients who DAMA from our medical centre between June 2013 and May 2014 were included in the study. Data harvested from the standard proforma were analyzed using IBM SPSS version 19.0.
  
  
  RESULTS
  We recorded an overall DAMA rate of 2.1%. The majority of the patients were paediatric cases (n = 63, 44.6%) while closed long bone fractures represented the leading diagnosis (n = 35, 24.8%). The most commonly cited reasons for leaving the hospital were financial constraints (n = 46, 32.6%) and seeking alternative therapy (n = 25, 17.7%).
  
  
  CONCLUSIONS
  The DAMA rate in our study is comparable to some urban hospitals elsewhere. However, the leading reasons for this phenomenon are unacceptable in the current medical best practice. Thus, strengthening the Health Insurance Scheme, strict control of traditional medical practices, and focused health education are recommended strategies to reduce DAMA.
authors.affiliation: Department of Surgery, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Bioku Muftau
authors.identifier: 0000-0002-4478-3495
authors.initials: BM
authors.lastname: Jimoh
authors.affiliation: Department of Obstetrics and Gynecology, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Obalim-Chris
authors.initials: OC
authors.lastname: Anthonia
authors.affiliation: Department of Obstetrics and Gynecology, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Igwilo
authors.initials: I
authors.lastname: Chinwe
authors.affiliation: Department of Obstetrics and Gynecology, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Adewumi
authors.initials: A
authors.lastname: Oluwafemi
authors.affiliation: Department of Surgery, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Aremu
authors.initials: A
authors.lastname: Ganiyu
authors.affiliation: Department of Internal Medicine, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Adamu
authors.initials: A
authors.lastname: Haroun
authors.affiliation: Department of Pediatrics, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Eziechila
authors.initials: E
authors.lastname: Chinwe
authors.affiliation: Department of Radiology, Federal Staff Medical Centre, Abuja, Nigeria.
authors.forename: Aiyekomogbon
authors.initials: A
authors.lastname: Joshua
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010351:Patient Discharge / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011446:Prospective Studies; D016312:Treatment Refusal / Q000706:statistics & numerical data; D055815:Young Adult
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