Discharge against medical advice in the neonatal unit of Rivers State University Teaching Hospital, Nigeria: a two-year prospective study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20232874Keywords:
Discharge against medical advice, Neonates, Rivers stateAbstract
Background: Discharge against medical advice (DAMA) is a silent contributor to neonatal morbidity and mortality in Nigeria. Parents' autonomous decision to discontinue medical care of their babies admitted remains an ethical contention that is frustrating for pediatricians and portends poor neonatal outcomes. DAMA remains a challenge arising from an interplay of parental and hospital-related factors. Hence, epidemiologic data are needed, where none previously exists. Aim of the study was to determine the prevalence, neonate and family sociodemographic characteristics, morbidity pattern and reasons for DAMA among neonates admitted to the Rivers State University Teaching Hospital.
Methods: A prospective observational study was conducted among neonates admitted from April 2021 to March 2023.
Results: Of 1830 neonatal admissions, 87 were discharged against medical advice giving a DAMA prevalence of 4.8%, of which 48 (55.8%) were females. Most, 66 (75.9%) were born at term, 51 (58.6%) had normal birth weight, 38 (43.7%) admitted at <2 hours of life and (41.4%) were above 2nd birth order. Forty-seven (54%) of mothers, 41 (47.1%) of fathers had tertiary education and 61 (70.1%) were of low/middle socioeconomic class. Neonatal sepsis (61.2%) and neonatal jaundice (31.8%) were the commonest morbidities. Most, 65 (74.7%) of DAMA cases occurred in the 1st week of life and the father 63 (73.3%) was the main requestor of DAMA. The commonest reason for DAMA was financial constraints 50 (57.5%).
Conclusions: The prevalence of DAMA was 4.8%. Neonatal sepsis and neonatal jaundice were the commonest morbidity with financial constraints being the main reason for DAMA. The father was the requestor for DAMA in the majority of the cases.
References
Abdullahi UI. Neonatal discharge against medical advice: Experience from a rural tertiary hospital in North western Nigeria. Sahel Med J. 2017;20(2):64-6.
Xiu W, Bai R, Gu X, Jiang S, Zhang B, Ding Y, et al. Discharge against medical advice among infants with 24–31 weeks’ gestation admitted to Chinese neonatal intensive care units: A multicenter cohort study. Front Pediatr. 2022;10:943244.
Yang S, Cai S, Liao J, Peng X, Huang J. Risk Factors and Reasons for Discharge Against Medical Advice for Newborns With Neonatal Surgical Diseases: A Preliminary Study From a Tertiary Care Hospital in Beijing, China. Front Pediatr. 2020;8:576270.
Onyiriuka AN. Pediatric discharge against medical advice: Experience from a Nigerian secondary healthcare institution. Med J Islam Repub Iran. 2011;25:194-9.
Sivanandan S, Mondal N. Clinical profile and outcome of newborns discharged against medical advice from a tertiary care centre. Indian Pediatr. 2022;59(10):778-81.
Duru C, Peterside O, Ududua A. Paediatric discharges against medical advice at a tertiary health centre in Bayelsa State, Nigeria. Niger J Paediatr. 2014;41(2):90-5.
Jalo I, Isaac E, Alkali Y, Nduibisi V. Determinants of discharge against medical advice amongst neonates admitted at Federal Teaching Hospital Gombe, Nigeria. Niger J Paediatr. 2019;46(1):5-8.
Opara PI, Eke G. Discharge against medical advice amongst neonates admitted into a Special Care Baby Unit in Port Harcourt, Nigeria. Internet J Pediatr Neonatol. 2009;12(2).
Kumar R. Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India. Int J Contemp Pediatr. 2018;6(1):176-80.
Al-Turkistani HK. Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital. J Fam Community Med. 2013;20(2):113-5.
Pokhrel RP, Bhurtel R. Discharge against medical advice from NICU in a Tertiary Hospital of central Nepal: A Descriptive Cross-Sectional Study. Pediatr Health Med Ther. 2020;11:307-11.
Onankpa BO, Ali T, Abolodje E. A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria. Int J Med Res Health Sci. 2014;3(2):297-301.
Macrohon BC. Pediatrician’s perspectives on discharge against medical advice (DAMA) among pediatric patients: a qualitative study. BMC Pediatr. 2012;12(1):75.
Devpura B, Bhadesia P, Nimbalkar S, Desai S, Phatak A. Discharge against medical advice at Neonatal Intensive Care Unit in Gujarat, India. Int J Pediatr. 2016;2016:1-8.
Abolodje, E. Predictors of discharge against medical advice in a Neonatal Intensive Care Unit in Southern Nigeria. J Res Bas Clin Sci. 2022;3(1-2):1-6.
Bosco AN, A. S, Rees CA, Wheeler AD, Britto CD, P. N. SR. Reducing rates of discharge against medical advice in the neonatal intensive care unit in a Tertiary Care Hospital in South India: A mixed‐methods study. Trop Med Int Health. 2021;26(7):743-52.
Okagwa J, Obikwu U. Morbidity and mortality pattern of neonates admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital, Nigeria. East Afr Med J. 2017;94(4):259-64.
West TP, Peterside O, Kunle-Olowu O, Etu-Efeotor TP. Neonatal discharges against medical advice at a Tertiary Center in Bayelsa State: Impact of policy changes over 1 10-year period. Adv Res J Med Medical Sci. 2020;9(1):001-5.
Tajkia G, Amin SK, Rahman ME, Setu M, Roy K, Haldar S, et al. Pattern of admission and outcome in a neonatal intensive care unit (NICU) of a Tertiary Care Hospital in Dhaka, Bangladesh. AKMMC J. 2019;10(2):150-8.
Ashish AB, Shashidhar A, Andrew DW, Carl DB, Suman RPN. Reducing rates of discharges against medical advice in the neonatal intensive care unit in a Tertiary Care Hospital in South India: A mixed-methods study. Trop Med Inter Health. 2021;26(7):743-52.
Sealy L, Zwi K, McDonald G, Saavedra A, Crawford L, Gunasekera H. Predictors of discharge against medical advice in a Tertiary Paediatric Hospital. Int J Environ Res Public Health. 2019;16:1326.
Okechukwu AA. Discharge against medical advice in children at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria. J Med Med Sci. 2011;2(7):949-54.
Olasinde YT, Alao MA, Agelebe E. Discharge against medical advice from a Mission Tertiary Hospital, South-west Nigeria. Niger J Clin Pract. 2020;23:1333-8.
Aliyu I, Lawal TO. Signing against medical advice in a Special Care Baby Unit in a Tertiary Center in North-western Nigeria. Trop J Med Res. 2017;20(1).
Onazi SO, Akeredolu FD, Yakubu M, Jiya MN, Hano IJ. Neonatal morbidity and mortality: A 5-year analysis at Federal Medical Centre, Gasau, Zamfara State, Northwest Nigeria. Annals Med Res Pract. 2021;2(10).
Abbas R, Waheed KAI, Waqar T, Anwar M, Gul R, Hayat S, et al. Reasons of self-discharge from nursery of a Tertiary Care Hospital. J Ayub Med Coll Abbottabad. 2017;29(4):658-61.
Al-Sadoon M, Al-Shamousi K. Discharge against medical advice among children in Oman: A University Hospital experience. Sultan Qaboos Univ Med J. 2013;13:534-8.
Adebola OG. Universal Health Coverage in Nigerians and its determinants: The case of National Health Insurance Scheme. Acad Rev Humanities Social Sci. 2020;3(1):97-111.
Jeffrey T. Berger MD. Discharge against medical advice: Ethical considerations and professionals and professional obligations. J Hospital Med. 2008;3(5).
