Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 12:11:290.
doi: 10.25259/SNI_559_2020. eCollection 2020.

Determinants of discharge against medical advice from a rural neurosurgical service in a developing country: A prospective observational study

Toyin Ayofe Oyemolade  1 , Amos Olufemi Adeleye  2 , Oluwakemi C Ogunyileka  1 , Folawemimo M Arogundade  1 , Ayodele J Olusola  1 , Oluwadamilola O Aribisala  1
Affiliations

Determinants of discharge against medical advice from a rural neurosurgical service in a developing country: A prospective observational study

Toyin Ayofe Oyemolade et al. Surg Neurol Int. .

Abstract

Background: In low-resource regions of the world, discharge against medical advice (DAMA) is one empiric contributory factor to poor in-hospital outcome that is not often mentioned. This study aims to investigate the determinants of DAMA from a rural neurosurgical service in a developing country.

Methods: This was a prospective observational study of all patients who discharged against medical advice in our service between November 2018 and October 2019.

Results: There were 88 patients, 67 (76.1%) males, in the study, (M:F = 3.2:1), representing 17.4% of our patient population in the study period. The peak incidence was in the 20-29 years age group which accounted for 37.5% of the cases. About 55% of the patients presented directly to our center; 31.8% were referred from other hospitals, while 3.4% came from traditional caregivers and 1.1% from religious homes. Head injury was the most common indication for presentation (76.1% of the cases). The duration of hospital stay ranged from 2 h to 14 days. Majority of the patients (87.5%) left the hospital within 8 h of presentation. The reason for DAMA was financial constraints in 50% of cases, inadequate health literacy in 20.5%, financial constraints and poor health literacy together in 12.5%, religious misgivings in 4.5%, and traditional belief in 2.3%. Neurotrauma was predictive of early DAMA (P = 0.001).

Conclusion: The rate of DAMA was high in our study. Financial constraints with other socioeconomic limitations were the most common causes of DAMA in our environment.

Keywords: Determinants; Developing country; Discharge against medical advice; Rural neurosurgery.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Age distribution of the patients.
Figure 2:
Figure 2:
First point of care of the patients.
Figure 3:
Figure 3:
Pre (a) and post (b) reduction cervical spine X-rays of the patient with odontoid peg fracture.
Figure 4:
Figure 4:
Axial (a) and sagittal (b) postcontrast cranial computed tomography scan images of the patient with cerebellar abscess.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Adefemi SA, Adeleke IT, Gara P, Ghaney OO, Omokanye SA, Yusuf AM. The rate, reasons and predictors of hospital discharge against medical advice among inpatients of a tertiary health facility in North-Central Nigeria. Am J Health Res. 2015;3:11–6.
    1. Adeleye AO, Fasunla JA, Young PH. Skull base surgery in a large, resource-poor, developing country with few neurosurgeons: Prospects, challenges, and needs. World Neurosurg. 2012;78:35–43. - PubMed
    1. Adeleye AO, Jite IE, Smith OA. A tale of two acute extradural hematomas. Surg Neurol Int. 2016;7:54. - PMC - PubMed
    1. Adeleye AO, Ogun MI. Clinical epidemiology of head injury from road-traffic trauma in a developing country in the current Era. Front Neurol. 2017;8:695. - PMC - PubMed
    1. Adem A, Abebe A, Abduraham M. Pattern of surgical admissions to Tikur Anbessa Hospital, Addis Ababa, Ethiopia. East Cent Afr J Surg. 2001;6:31–4.

LinkOut - more resources