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. 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.

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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

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