Prevalence, Reasons, and Determinants of Discharge Against Medical Advice Among Hospitalized Pediatric Patients at the University of Gondar Comprehensive Specialized Hospital: A Prospective Observational Study

Discharge against medical advice (DAMA) is a major challenge in pediatric care, leading to poor treatment outcomes, increased readmissions, and preventable mortality. Evidence on the prevalence and determinants of pediatric DAMA in Ethiopia is limited. This study aimed to assess the prevalence, reasons, and factors associated with DAMA among pediatric patients admitted to the University of Gondar Comprehensive Specialized Hospital (UGCSH), Northwest Ethiopia.

A hospital-based prospective observational study was conducted from December 1, 2024, to September 30, 2025. A total of 422 participants were selected using systematic random sampling. Data were collected through caregiver interviews and medical record review using a structured questionnaire, with participants enrolled at admission and discharge outcomes were assessed at hospital discharge. Descriptive statistics were used. Variables with p < 0.25 in bivariable analyses were included in multivariable logistic regression, and p < 0.05 was considered statistically significant.

Of 422 pediatric patients, 42 (9.7%; 95% CI: 7.1-12.8%) were discharged against medical advice. DAMA was more common among males (63.4%) and children aged ≥ 5 years (15.4%). DAMA was most frequent in the pediatric inpatient ward (36.5%). Financial constraints, lack of clinical improvement, and perceived recovery were the main reasons. In multivariable analysis, maternal education was significantly associated with DAMA. Children whose mothers had secondary education had 68% lower odds of DAMA (AOR = 0.32; 95% CI: 0.11-0.99; p = 0.04), while children whose mothers had tertiary education had 81% lower odds (AOR = 0.19; 95% CI: 0.04-0.84; p = 0.03) compared with children of mothers with no formal education.

Nearly one in ten hospitalized children were discharged against medical advice. Maternal education was significantly associated with DAMA, suggesting that socioeconomic factors and caregiver knowledge may play an important role in hospital discharge decisions. Interventions such as caregiver education and strengthening hospital services may help reduce DAMA and improve pediatric outcomes.