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Leave Against Medical Advice amongst Pediatric Patients Admitted in a Tertiary Teaching Hospital in Nepal: A
Sahisnuta Basnet1, Ganesh B K1, Aslam Ansari1
1Department of Pediatrics, Manipal College of Medical Sciences, Phulbari, Pokhara, Nepal.
Insights
Leave against medical advice (AMA) in pediatric patients occurred at 4.2% in a Nepal hospital. This preventable health issue requires better physician-parent communication and health insurance awareness.
Area of Science:
- Pediatric Health
- Public Health
- Medical Ethics
Background:
- Leave against medical advice (AMA) poses significant risks to child health, especially for pediatric patients who depend on parental decisions.
- Understanding the prevalence of AMA in pediatric admissions is crucial for developing targeted interventions.
Purpose of the Study:
- To determine the prevalence of pediatric patients leaving against medical advice (AMA) at a tertiary teaching hospital in Nepal.
- To identify demographic factors associated with AMA in pediatric care.
Main Methods:
- A descriptive cross-sectional study was conducted over 12 months (August 2019-July 2020) in the Department of Pediatrics.
- Data from 1608 pediatric admissions were analyzed using SPSS version 23, calculating point estimates with 95% Confidence Intervals.
Main Results:
- The prevalence of pediatric leave against medical advice (AMA) was 4.2% (95% CI: 3.22-5.18), with 67 cases out of 1608 admissions.
- The highest proportion of AMA cases (33%) were neonates (birth to 7 days), while older children (>10 years) represented 9%.
- Males constituted 54% of AMA cases, and females 46%.
Conclusions:
- The prevalence of pediatric AMA in this Nepali hospital is comparable to findings in other regions.
- AMA is a significant social health problem that can be mitigated through increased health awareness and accessible health insurance.
- Enhanced communication strategies between healthcare providers and parents are essential to reduce detrimental AMA practices.
Introduction:
Leave against medical advice has a potentially deleterious effect on the health of a child. This is particularly alarming in case of pediatric patients as they are unable to understand the implications of it and rely on parents to make decisions regarding their health. This study was undertaken to find out the prevalence of leave against medical advice among pediatric patients admitted in a tertiary teaching hospital in Nepal.
Methods:
A descriptive cross-sectional study was conducted in the Department of Pediatrics, Manipal Teaching Hospital between August 2019 and July 2020. Ethical clearance was obtained from the Institutional Review Committee (Ref: 256). Convenient sampling method was used. Data entry and analysis was done on Statistical Package for Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
Results:
Out of 1608 pediatric admissions taken in our study, the prevalence of leave against medical advice was found to be 67 (4.2%) at 95% Confidence Interval (3.22-5.18). Maximum 22 (33%) and minimum 6 (9%) patients respectively belonged to the age group from birth to 7 days and more than 10 years. Out of 67 cases, there were 36 (54%) males and 31 (46%) females.
Conclusions:
The prevalence of leave against medical advice among admitted pediatric patients in our study was similar to that of other studies. It is a social health problem which can be prevented by increasing the awareness and facilitating the use of health insurance schemes. More effective communication is required between the treating physicians and the parents to prevent this detrimental practice.
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