Discharge of hospitalized under-fives against medical advice in Benin City, Nigeria

Abstract

Objective: To determine the incidence of discharge against medical advice (DAMA) among under-fives in Benin City, document reasons for these discharges and suggest ways of reducing its occurrence.

Methods: The admissions and discharges registers as well as the case-notes of all children aged between one and fifty-nine months admitted over a two-year period were retrospectively examined. The data obtained included sex, age, main diagnosis, signatories to the discharge documents and reasons/circumstances for DAMA.

Results: Of the 1017 under-fives admitted, 58 (5.7%) were DAMA with a higher prevalence in girls (7.4%) than in boys (4.2%) p>0.05. The incidence of DAMA (9.7%) was highest among children aged 24-35 months. About half (51.7%) of the parents of children DAMA either did not have formal education or failed to complete primary education. Thirty seven (63.8%) of parents of children DAMA belonged to social classes IV and V. The fathers were the signatories to the discharge documents in 65.5% and the mothers in only 5.2% of cases. Within 24-48 hours after DAMA, 20.7% of cases were re-admitted. Parental fear of accumulation of hospital bills was the commonest reason for DAMA. Mean duration of hospital stay was 3.1 days.

Conclusion: Discharge of hospitalised under-fives against medical advice is a common social paediatric problem with gender differentials in its incidence. We believe that with improvement in the socio-economic status of our parents the incidence of DAMA will be greatly reduced.