Discharge Against Medical Advice at the Benue State University Teaching Hospital Makurdi, North Central Nigeria

Abstract

Discharge against medical advice (DAMA) is defined as a patient choosing to leave the hospital against the advice of the managing physician. It is a common practice encountered by health care providers in resource limited settings. This has become a major problem in health care delivery in Nigeria and in most instances, children are the victims because most of the times they are not the ones taking the decision, and may not understand or contribute to it. Hence this study sought to determine the prevalence of DAMA and the associated factors at the Benue State University Teaching Hospital Makurdi, Benue State. A5-year (2018-2022) retrospective study was carried out at the Department of Pediatrics, Benue State University Teaching Hospital. Records of children admitted into the department during the period under review and who were discharged against medical advice were retrieved and reviewed using SPSS version 23. Out of 3417 admissions, 144 were discharged against medical advice giving a prevalence of 4.2%. Majority of the children that DAMAwere aged 1-5 years (77.8%), mostly from social class 4 and 5 combined (85%) and had spent about 1-7 days on admission (77.5%). The most common reasons for DAMA were financial constraint (29.1%) and family request (26.6%). Most of the parents/relatives were counseled against DAMA (97%), mostly by a nurse (68.9%), DAMA was signed mostly by fathers (61.8%) and only 15.3% returned for follow-up. Financial constraint remains the most important reason why children are discharged against medical advice.