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Profile of and control measures for paediatric discharges against medical advice

C N Okoromah1, M T C Egri-Qkwaji

  • 1Department of Paediatrics and Child Health, Lagos University Teaching Hospital, Nigeria.

The Nigerian Postgraduate Medical Journal
|July 16, 2004
PubMed

Insights

Discharges against medical advice (DAMA) in children occur in 1.2% of cases, driven by factors like perceived improvement, cost, and dissatisfaction. Addressing these issues is crucial for improving pediatric care outcomes.

Area of Science:

  • Pediatric Health Outcomes
  • Healthcare Management
  • Patient Discharge Studies

Background:

  • Discharges against medical advice (DAMA) in children can lead to adverse health, social, and psychological consequences.
  • Understanding the factors contributing to pediatric DAMA is essential for developing effective interventions.

Purpose of the Study:

  • To determine the prevalence of pediatric DAMA.
  • To identify clinical, sociodemographic factors, and caregiver perceptions associated with DAMA.
  • To propose control measures for reducing pediatric DAMA.

Main Methods:

  • Prospective data collection using pre-tested questionnaires.
  • Study conducted over two years (March 2000 - March 2002) with consecutive patients undergoing DAMA.
  • Inclusion of clinical diagnoses, patient condition at discharge, and reasons for DAMA.

Main Results:

  • The prevalence rate of DAMA was 1.2% (202 out of 16,440 discharges), with neonates comprising 47.0% of these cases.
  • Common diagnoses included neonatal jaundice, congenital anomalies, birth asphyxia, bronchopneumonia, gastroenteritis, malaria, and malignancies.
  • Key reasons for DAMA were perceived illness improvement, preference for outpatient care, financial constraints, high healthcare costs, and dissatisfaction with care.

Conclusions:

  • Pediatric DAMA is multifactorial, involving critically ill or partially recovered patients.
  • Socioeconomic factors, quality of care, and healthcare costs significantly contribute to DAMA.
  • The study recommends specific control measures to mitigate pediatric DAMA.
Abstract

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