Discharge against medical advice amongst neonates admitted into a Special Care Baby Unit in Port Harcourt, Nigeria

Abstract

Background: The greatest risk of childhood death occurs during the neonatal period. The World Health Organization estimates that approximately 4 million newborns die each year with most deaths occurring in developing countries. Any discharge against medical advice (DAMA) amongst this vulnerable group can adversely affect morbidity and mortality.Aim: To identify the causes of DAMA and try to find ways to reduce its incidence in neonates in Port Harcourt, Nigeria. Method: This was a retrospective study done amongst neonates admitted into the Special Care Baby Unit of the University of Port Harcourt Teaching Hospital. Case files of all affected neonates over a 2 year period were reviewed and relevant information obtained and analysed.Results: There were 63 cases of DAMA out of 1481 admissions during the period, giving a prevalence rate of 4.3%. 58 case files were retrieved and analysed. There were 37 males and 21 females with a male: female ratio of 1.7: 1. Preterm babies constituted 25.9% of the cases. The commonest diagnoses were neonatal sepsis and birth asphyxia. Most discharges occurred within the first week of admission (mean =5.9± 4.5days). Common reasons for DAMA were lack of funds and falsely perceived improvement. The discharge document was signed by the father in 77.6% of cases.Conclusion: Poverty, mis-conceived ideas, and other social issues contributed to DAMA in this study. Some babies had life threatening conditions and discharges occurred more within the first few days of life. DAMA in neonates will retard progress in achieving millennium development goal 4.