Discharge against medical advice from a Mission tertiary hospital, South-West, Nigeria

Niger J Clin Pract. 2020 Oct;23(10):1333-1338. doi: 10.4103/njcp.njcp_118_20.

Abstract

Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital.

Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23.

Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS).

Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.

Keywords: Discharge against medical advice; Mission hospital; pediatrics; tertiary.

MeSH terms

  • Caregivers / psychology
  • Caregivers / statistics & numerical data*
  • Child
  • Child, Preschool
  • Counseling
  • Female
  • Hospitals, Private
  • Hospitals, Religious / statistics & numerical data*
  • Humans
  • Inpatients
  • Male
  • Nigeria / epidemiology
  • Parents / psychology*
  • Patient Discharge / statistics & numerical data*
  • Pediatrics*
  • Prevalence
  • Prospective Studies
  • Socioeconomic Factors
  • Treatment Refusal / statistics & numerical data*