Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution
Background and Objective: Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice (DAMA) among hospitalized children and examine the reasons given by parents/guardians for such dischar...
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| Format: | Article |
| Language: | English |
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Iran University of Medical Sciences
2011-12-01
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| Series: | Medical Journal of The Islamic Republic of Iran |
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| Online Access: | http://mjiri.tums.ac.ir/browse.php?a_code=A-10-1-282&slc_lang=en&sid=1 |
| _version_ | 1818250663622082560 |
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| author | Alphonsus N. Onyiriuka |
| author_facet | Alphonsus N. Onyiriuka |
| author_sort | Alphonsus N. Onyiriuka |
| collection | DOAJ |
| description | Background and Objective: Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice (DAMA) among hospitalized children and examine the reasons given by parents/guardians for such discharges. Methods: A retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility. Results: The overall prevalence of DAMA was 6.3% while the prevalence among neonates was 7.5%, p>0.05. Sixty-two (56.4%) of all cases were less than 12 months old with neonates accounting for 40 (64.5%) of the 62. The prevalence of DAMA was 2.8 times higher in male neonates compared to female neonates. Thirty two (9.9%) of 322 male neonates compared to 8 (3.7%) of female neonates were DAMA; Odd ratio, OR=2.8; 95% Confidence Interval, CI= 1.26, 6.20). Majority (65.4%) of the signatories to the discharge documents were the child’s fathers. In only 5.5% of cases were the child’s mothers the signatories. Rate of re-admission was 13.6%. The commonest reason for DAMA in both neonates and older children was financial constraints. Parental disagreement with planned treatment and/or investigations ranked second in the case of neonates. Conclusions: DAMA is a common social pediatric health problem, especially among infants and has multifactorial etiology. Socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence. |
| first_indexed | 2024-12-12T15:55:58Z |
| format | Article |
| id | doaj.art-8f5be14b57f44b8280f2a82ef6f6417d |
| institution | Directory Open Access Journal |
| issn | 1016-1430 2251-6840 |
| language | English |
| last_indexed | 2024-12-12T15:55:58Z |
| publishDate | 2011-12-01 |
| publisher | Iran University of Medical Sciences |
| record_format | Article |
| series | Medical Journal of The Islamic Republic of Iran |
| spelling | doaj.art-8f5be14b57f44b8280f2a82ef6f6417d2022-12-22T00:19:29ZengIran University of Medical SciencesMedical Journal of The Islamic Republic of Iran1016-14302251-68402011-12-01254194199Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare InstitutionAlphonsus N. OnyiriukaBackground and Objective: Often, discharge of children against medical advice has a negative effect on the well-being of the patient. To determine the prevalence of discharge against medical advice (DAMA) among hospitalized children and examine the reasons given by parents/guardians for such discharges. Methods: A retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility. Results: The overall prevalence of DAMA was 6.3% while the prevalence among neonates was 7.5%, p>0.05. Sixty-two (56.4%) of all cases were less than 12 months old with neonates accounting for 40 (64.5%) of the 62. The prevalence of DAMA was 2.8 times higher in male neonates compared to female neonates. Thirty two (9.9%) of 322 male neonates compared to 8 (3.7%) of female neonates were DAMA; Odd ratio, OR=2.8; 95% Confidence Interval, CI= 1.26, 6.20). Majority (65.4%) of the signatories to the discharge documents were the child’s fathers. In only 5.5% of cases were the child’s mothers the signatories. Rate of re-admission was 13.6%. The commonest reason for DAMA in both neonates and older children was financial constraints. Parental disagreement with planned treatment and/or investigations ranked second in the case of neonates. Conclusions: DAMA is a common social pediatric health problem, especially among infants and has multifactorial etiology. Socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence.http://mjiri.tums.ac.ir/browse.php?a_code=A-10-1-282&slc_lang=en&sid=1ChildrenDischarge Against Medical Aadvice (DAMA)Hospital Fees |
| spellingShingle | Alphonsus N. Onyiriuka Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution Medical Journal of The Islamic Republic of Iran Children Discharge Against Medical Aadvice (DAMA) Hospital Fees |
| title | Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution |
| title_full | Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution |
| title_fullStr | Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution |
| title_full_unstemmed | Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution |
| title_short | Pediatric Discharge Against Medical Advice: Experience from a Nigerian Secondary Healthcare Institution |
| title_sort | pediatric discharge against medical advice experience from a nigerian secondary healthcare institution |
| topic | Children Discharge Against Medical Aadvice (DAMA) Hospital Fees |
| url | http://mjiri.tums.ac.ir/browse.php?a_code=A-10-1-282&slc_lang=en&sid=1 |
| work_keys_str_mv | AT alphonsusnonyiriuka pediatricdischargeagainstmedicaladviceexperiencefromanigeriansecondaryhealthcareinstitution |