Paediatric Discharges against Medical Advice in Sagamu

Abstract

Background: Frequent changes in the political, economic and health policies which may influence the purchasing powers of the populace may also make it difficult for the average family to pay hospital fees and culminate in a tendency to premature termination of medical care. 

Objectives: To describe cases of paediatric discharges against medical advice seen at the Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu.

Patients and Methods: A retrospective study of the records of children who were discharged against medical advice from January 1995 to December 2004 at the OOUTH, Sagamu, was carried out. Data extracted from the case notes included age, sex, clinical diagnosis, parental occupation, duration of hospital stay, reason(s) for, and signatories to DAMA

Results: The yearly prevalence of DAMA fluctuated with no consistent pattern, ranging from 2.1 to 5.0 percent with a mean of 3.3 percent, of paediatric admissions. The median age was 365 days and the male to female ratio was 1.4:1. The median duration of hospitalization prior to DAMA was four days. Majority (92.1 percent) of the children belonged to the low socioeconomic classes. The signatories to DAMAwere mostly mothers (80.2 percent). Financial constraints in 61.9 percent were the commonest reasons for DAMA. Neonatal conditions, malaria and respiratory disorders were the main clinical diagnoses accounting for 28.5, 20.1 and 9.0 percent, respectively.

Conclusion: Conscious effort must be made by government to create an enabling environment for financial empowerment of families. Hospitals should have avenues of defending the rights of children to life and health. 

Keywords: Discharges against medical advice, Sagamu.