Profiling Discharge Against Medical Advice Among Paediatric Under-five Years Old: Experience From Igbinedion University Teaching Hospital, Nigeria.

Abstract

Background: The increasing children (under-five years) morbidity and mortality rates in Nigeria is worrisome. Paediatric discharge against medical advice (P-DAMA) poses a particular challenge because under-age children lack autonomous power in their health decision-making, which may complicate their health problems. This study aimed at determining the prevalence of under-five P-DAMA and also to document its associated factors in Igbinedion University Teaching Hospital, Okada, Nigeria, with a view to curbing it. Methodology: This retrospective study reviewed all the admissions- and discharge- registers, and case-notes of all the under-five admissions between 2017-2019 in the private-owned Igbinedion University Teaching Hospital, Ok ada, Nigeria. Information extracted included their socio-demographics, clinical diagnoses, hospitalization duration and rationale for DAMA. Retrieved data were analyzed using the SPSS, Version 23.0. Results: There were 99 cases of under-five P-DAMA with complete information out of a total admissions of 3816 giving an overall prevalence of 2.6%.The incidence of P-DAMA (4.0%) was highest among preschoolersaged 31-60 months who constituted 57.6% of them; and girls predominated boys at a ratio of 7:4.Majority (53.5%) were from lower socio-economic class residing mainly in rural villages (53.5%). Infectious diseases, including malaria (26.8%), diarrhea (20.1%), neonatal sepsis(13.4%) and bronchopneumonia(13.4%) were common diagnoses of these children. The mean duration of children hospitalization before DAMA was 5.2 days. Parental/guardian fear of accumulation of hospital bills (25.3%) and perceived improvement in child’s clinical condition(s)(21.2%) were the most frequent reasons adduced for DAMA. However, in 29.3% of cases, the reasons for DAMA were neither reported nor documented in the childrens’ medical records. Conclusion: Parental poverty and ignorance are major factors fuelling P-DAMA in the studied hospital. Government should adopt universal health insurance coverage policies to protect the under-five child-patients from the consequences of such irregular discharges.