Predictors of Discharge against Medical Advice in a Neonatal Intensive Care Unit in Southern Nigeria.

ABSTRACT

Discharge against medical advice (DAMA) has medical, ethical and legal implications. While the medical team should always act in the best interest of a child, parents realize they have autonomy to decide when a child should be discharged especially when they are responsible for paying the medical bills. The reasons for DAMA in a neonatal unit can vary from one patient to another and the decision can be influenced by a number of factors. The aim of the study was to determine the prevalence of DAMA and the factors that predict the likelihood of DAMA in the neonatal unit of the Delta State University Teaching Hospital, Oghara. A review of all the cases of DAMA in the neonatal unit of the Delta State University Teaching Hospital from 1st January 2018 to 31st December 2019 was undertaken. Data extracted from medical records included gender, admitting weight, gestational age, mode of delivery, place of delivery, parity and diagnosis. Other data included maternal educational level and father's occupation.  The collected data were entered into Microsoft Excel spreadsheet and data analysis was by IBM SPSS Statistics for Windows, version 23. One hundred and eighty neonates were admitted over the period under review with 104 (57.8%) males and 76 (42.2%) females. Forty-five (25%) neonates were preterm neonates with respiratory distress syndrome (RDS), 37 (20.6%) had neonatal sepsis, 36 (20%) had birth asphyxia and 32 (17.8%)) had congenital anomalies. There were 42 (23.3%) DAMA cases with more DAMA cases recorded among female neonates (p=0.12), vaginally delivered neonates (p=0.018) and neonates with birth asphyxia (p=0.012). The prevalence of DAMA at the study centre was high with vaginal delivery and asphyxia been the most important predictors of DAMA. The treatment outcome of neonates DAMA is unknown. Counseling of parents against DAMA at the time of admission and afterwards should be initiated for parents of neonates with a high likelihood of been DAMA