Discharge against medical advice in children at the Universi | 18062
International Research Journals

Discharge against medical advice in children at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria


AA Okechukwu

Discharge against medical advice is not an uncommon practice encountered by health care providers in resource limited settings. The peculiarity of paediatric cases is that the index subjects are not party to the decision taken on their behalf. This practice usually occurs with ill children and may contribute to poorer outcome. The aim of this study is to document the prevalence and reason(s) for discharge against medical advice in a new Teaching Hospital in the Federal Capital Territory, Abuja, Nigeria. A one-year retrospective review of all cases of discharge against medical advice from January to December 2009 was carried out to determine the prevalence and reason(s) for such action. Of a total of 1,385 children admitted into the three paediatric wards during the one-year review period, 102 (7.4 %) were discharge against medical advice. Fifty six (54.9 %) of the 102 were males and 46 (45.1%) females, m:f ratio of 1.3:1. Fifty three (51.9%) of discharge against medical advice occurred in the emergency paediatric unit of paediatric ward, 29 (28.4%) in the special care baby unit, and 20 (19.6%) in the paediatric medical ward. The three commonest ailments of the children in respect of whom discharge against medical advice were requested were severe malaria (12.7%), protein energy malnutrition (9.8%), and gastroenteritis with dehydration (8.8%). Financial constraint (42.2%), and resort to alternative medicine (20.5%) were the two main reasons for parents/guardians requesting for discharge against medical advice of their children/wards. Discharge against medical advice occurred most frequently in the first (30.3%), and the second (17.6%) years of life, within the first 14 days (86.4%) of admission, and in children from low (66.7%) and middle (29.4%) socio-economic classes. The prevalence of discharge against medical advice was high in our environment, and was most common in the less privileged and vulnerable group, and in those with life threatening emergencies. Implementation and sustenance of national health insurance scheme at all levels of the society or provision of free or highly subsided emergency medical services in most health institutions will assist in no small way in mitigating this ugly trend in children.

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