Determinants of Discharge against Medical Advice among Paediatric Patients in a Tertiary Hospital in Nigeria: A Retrospective Observational Study.
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BACKGROUND: Discharge Against Medical Advice (DAMA) among children represents a significant public health issue in low-and middle-income countries. DAMA occurs when a patient leaves the hospital contrary to the physician's recommendation. This action can hinder effective healthcare delivery and may lead to increased rates of morbidity and mortality. The aim of this study was to assess the prevalence and underlying reasons for DAMA among paediatric patients at a tertiary healthcare facility in Nigeria. METHODOLOGY: A descriptive retrospective study was carried out from October 1, 2020, to September 30, 2022, at the Department of Pediatrics, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria. Data such as age, gender, diagnosis, duration of hospital stay, insurance status, and the highest educational attainment and occupation of both parents were retrieved from the admission record book. These data were analyzed using proportions and Pearson's chi-square (χ2) test. A p-value of less than 0.05 was considered statistically significant. RESULTS: The prevalence of DAMA was 3.4%, with 30 cases recorded out of 875 admissions. A higher proportion of those discharged were females (18 out of 30; 60.0%), and the majority (27 out of 30; 90.0%) belonged to the lower socioeconomic class. Sepsis, malignancy, malaria, and sickle cell anaemia collectively accounted for 80.2% of the diagnoses. The most common reason for DAMA was financial constraint, cited in 15 out of 30 cases (50.0%). Notably, none of the patients had health insurance. CONCLUSION: Financial constraints were identified as a leading cause of paediatric DAMA in our environment. Given that none of the affected patients were enrolled in any health insurance scheme, there is a need to raise public awareness about the benefits of health insurance.