Discharge against medical advice amongst patients admitted into the Paediatric wards of the University of Port Harcourt Teaching Hospital

Objectives: To identify the characteristics of patients and factors contributing to DAMA in paediatric patients admitted into the University of Port Harcourt Teaching Hospital and to determine ways to reduce its prevalence. Method: This was a retrospective study of children admitted into the paediatric wards of the Hospital. Case files of affected patients over a two year period were reviewed and relevant information obtained and analyzed. Results: There were 150 of 3981 patients admitted over the period giving a prevalence rate of 3.8%. There were 86 (57.3%) males and 64 females (42.7%) with a male: female ratio of 1.3:1. Neonatal sepsis, birth asphyxia and prematurity were the commonest diagnosis in neonates whilst severe malaria, meningitis and bronchopneumonia were the commonest in other children. Most discharges (54%) occurred within the first week of admission. Majority of patients were from low (35.3%) and middle (41.3%) income classes. The commonest reasons for DAMA were lack of funds (26.6%) and no improvement (26.6%), necessitating need to seek alternative therapy. The discharge document was signed by the father in 61.3% of cases. Conclusion: Children who were DAMA suffered from common causes of childhood mortality. Lack of funds, no improvement and lack/ low decision making power of mothers were contributory factors. There is need for more universal implementation of the National Health Insurance Scheme; effective communication between medical team and parents and female empowerment to reduce rates of DAMA in our environment.