Abstract

A STUDY ON PREVALENCE OF DISCHARGE AGAINST MEDICAL ADVICE IN A TERTIARY CARE HOSPITAL IN NIGERIA

Background: The length of hospital stay for every neonate admitted for care is more often than not at the mercy of the parents/caregivers. Aims: To determine the pattern of request for discharge against medical advice of neonates. Methodology: A 5-year cross-sectional study at the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. All babies that were discharged against medical advice (DAMA) between January, 2008 and December, 2012 were recruited. Both baby/maternal information and the indications for the discharge were documented. Statistical analysis was done using SPSS version 20.0 Results: Admission to SCBU for the period was found to be 2,426 (20.2%). Forty two (1.7%) babies were DAMA; males 17 (40.5%), females 25 (59.5%); M: F; 0.7:1.5. Twenty seven (64%) delivered in UDUTH, 15 (36%) outside the facility. Birth weights ranged from 1.0 – 4.8kg with mean SD of 3.03 ± 0.8. 36 (85.7%) were spontaneous vertex deliveries, and term babies accounted for 78.6%. Babies delivered vaginally had more DAMA. Birth asphyxia was the commonest diagnosis. The mean duration of hospital stay was 8.2 ± 5.4 days. Nineteen babies (45.2%) were DAMA in the first 8 days of admission, majority of these were from the low and middle income groups. Four neonates (9.5%) were re-admitted. The commonest reason for DAMA was financed (45.2%) and father was the main signatory to the DAMA (92.9%). Conclusions: Discharge against medical advice remains a paediatric problem in the study area despite adequate counselling.

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