title: Hospitalized Pregnant Women Who Leave Against Medical Advice: Attributes and Reasons.
abstract: OBJECTIVE
  To identify the contributing factors for discharge against medical advice (DAMA) among pregnant women in Sistan and Balouchestan Province, southeastern Iran.
  
  
  METHODS
  This hospital-based case-control study included a total of 168 DAMA pregnant women and 191 pregnant women who left hospital with medical approval. The participants were recruited between August 2012 and August 2013. Logistic regression models were used for data analysis.
  
  
  RESULTS
  Factors that increased the chance of DAMA in pregnant women included older age, younger spouse age, low level of education, low income level and having a health insurance. History of DAMA in previous hospitalizations, referral from other clinics, emergency admission and admission advice from non-physician individuals for hospitalization, and giving birth at home during previous pregnancies, were associated with an increase in the risk of DAMA. The most common hospital-related reason for DAMA was the teaching environment of the hospital (26.2%) followed by hospital staff misconduct (23.8%) and overcrowding in the hospital wards (23.2%). The most frequent patient-related factors for DAMA were willingness of the patients to continue treatment at home (58.9%) and feeling relative improvement (58.3%).
  
  
  CONCLUSIONS
  We found that both hospital and patient related factors contribute to DAMA among pregnant women. Early identification of women at risk of DAMA and improvement of medical staff communication skills may decrease the occurrence of DAMA and improve health outcomes of pregnant women.
authors.affiliation: Pregnancy Health Research Center, Zahedan University of Medical Sciences, Mashahir Square, Zahedan, Islamic Republic of Iran.
authors.forename: Seyed Mehdi
authors.initials: SM
authors.lastname: Tabatabaei
authors.affiliation: Sistan and Balouchestan Provincial Health Center, Zahedan University of Medical Sciences, Zahedan, Islamic Republic of Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sargazi Moakhar
authors.affiliation: Pregnancy Health Research Center, Zahedan University of Medical Sciences, Mashahir Square, Zahedan, Islamic Republic of Iran. bp.darya@yahoo.com.
authors.forename: Fateme
authors.initials: F
authors.lastname: Behmanesh Pour
authors.affiliation: Sistan and Balouchestan Provincial Health Center, Zahedan University of Medical Sciences, Zahedan, Islamic Republic of Iran.
authors.forename: Sedighe
authors.initials: S
authors.lastname: Shaare Mollashahi
authors.affiliation: Sistan and Balouchestan Provincial Health Center, Zahedan University of Medical Sciences, Zahedan, Islamic Republic of Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Zaboli
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007492:Iran; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000639:trends*; D011247:Pregnancy; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Case–control; Discharge against medical advice; Iran; Maternal health; Self-discharge