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Anyaehie UE, Ede O, Edomwonyi EO, Ekwedigwe HC, Toluse AM, Muoghalu ON, Okoh N, Dabkana TM, Esan O, Ajiboye LO, Shodipo OM, Anikwe IA. Discharge against Medical Advice in Eight Tertiary Hospitals in Nigeria: A Prospective Study. Niger J Clin Pract 2023; 26:1927-1933. [PMID: 38158363 DOI: 10.4103/njcp.njcp_511_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Discharge against medical advice (DAMA) is when a patient decides to leave the hospital without the consent of the treating physician. It poses serious clinical, ethical, and legal challenges to the individual physician as well as the hospital. AIM To determine the prevalence and reasons for DAMA in orthopedic departments of eight tertiary hospitals in Nigeria. MATERIALS AND METHODS This was a prospective multi-center descriptive study undertaken in eight tertiary Nigerian hospitals. Consecutive patients who requested for DAMA within 1 year of the study and who consented to participate in the study had face-to-face interviews. Data obtained were documented in a questionnaire and analyzed with SPSS version 20. RESULTS The total number of patients studied was 373 with a mean age 34.7 ± 17.5 years. About a quarter of them (25.5%) were between 31 and 40 years. A prevalence rate of 1.9% was found with financial constraint being the predominant reason for DAMA (40.8%). Other reasons include family preference for unorthodox treatment (18.8%) and treatment dissatisfaction (7.0%) among others. CONCLUSION The study findings indicate a low DAMA rate when compared to previous studies in this region. It also indicates that financial constraints, family preference for unorthodox care, and low educational status are major drivers of DAMA. Deepened health insurance and other measures that can reduce the prevalence of DAMA should be prioritized to improve treatment outcomes.
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Affiliation(s)
- U E Anyaehie
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Enugu and Institute of Orthopaedics, Plastic and Reconstructive Surgery, Abia State University, Uturu, Nigeria
| | - O Ede
- Consultant Orthopaedic Surgeon, National Orthopaedic Hospital, Enugu, Nigeria
| | - E O Edomwonyi
- Consultant Orthopaedic Surgeon, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - H C Ekwedigwe
- Consultant Orthopaedic Surgeon, National Orthopaedic Hospital, Enugu, Nigeria
- Consultant Orthopaedic Surgeon, Alex Ekwueme Federal Teaching Hospital, Abakaliki, Nigeria
| | - A M Toluse
- Consultant Orthopaedic Surgeon, National Orthopaedic Hospital, Lagos, Nigeria
| | - O N Muoghalu
- Consultant Orthopaedic Surgeon, National Orthopaedic Hospital, Enugu, Nigeria
| | - N Okoh
- Consultant Orthopaedic Surgeon, National Orthopaedic Hospital, Kano, Nigeria
| | - T M Dabkana
- Deparment of Orthopaedics and Trauma Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - O Esan
- Honorary Consultant Orthopaedic Surgeon and Traumatologist, Obafemi Awolowo University/Teaching Hospital, Ile Ife, Nigeria
| | - L O Ajiboye
- Consultant Orthopaedic, Spine and Trauma Surgeon, Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - O M Shodipo
- Consultant Orthopaedic Surgeon, Federal Medical Centre Bida, Niger State, Nigeria
| | - I A Anikwe
- Consultant Orthopaedic Surgeon, Alex Ekwueme Federal Teaching Hospital, Abakaliki, Nigeria
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Khalili M, Teimouri A, Shahramian I, Sargolzaei N, YazTappeh JS, Farzanehfar M. Discharge against medical advice in paediatric patients. J Taibah Univ Med Sci 2019; 14:262-267. [PMID: 31435415 PMCID: PMC6695015 DOI: 10.1016/j.jtumed.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives Discharge against medical advice (DAMA) from the hospital may negatively impact patients’ well-being. The present study aimed to investigate the main reasons for DAMA among parents of children admitted to the paediatric ward of the Ali Ebne Abitaleb Hospital in Zahedan, Iran. Methods Participants in this case–control study included 130 children who had been admitted to the hospital's paediatric ward. Participants were divided into two equal groups: (1) those with incomplete treatment and (2) those who stayed in the hospital until the completion of their management and followed regular discharge procedures. A self-administered questionnaire was utilised for data collection. Results Participants included 130 children aged <1–18 years with an average of 3.3 ± 3.7 years; 51.5% (67) were girls, and 48.5% (63) were boys. The results showed a significant relationship between DAMA and the father's level of education (p < 0.05), length of hospitalization (p < 0.001), and duration of treatment (p = 0.027). No significant correlation was found for other factors (p > 0.05). Conclusion This study found that the key reasons for DAMA were as follows: lack of satisfaction with physicians and hospital staff, family disturbance due to the presence of other children at home, inadequate economic situation, and being away from home. Providing professional education to parents and expressing the benefits and disadvantages of refusing complete treatment may help parents make better decisions.
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Affiliation(s)
- Manijeh Khalili
- Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University Medical Sciences, Zahedan, Iran
| | - Iraj Shahramian
- Pediatric Digestive and Hepatic Diseases Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Narjes Sargolzaei
- Department of Community Medicine, Medical School, Zahedan University Medical Sciences, Zahedan, Iran
| | - Jafar S YazTappeh
- Master Student in Clinical Psychology, Department of Psychology, Medical School, Zahedan University Medical Sciences, Zahedan, Iran
| | - Mitra Farzanehfar
- Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University Medical Sciences, Zahedan, Iran
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Mabiala Babela JR, Mboutol Mandavo C, Nika Evrard R, Ossibi Ibara B, Lamah L, Ollandzobo Ikobo LC, Mouko A, Peko JF. [African histoplamosis. A report of three pediatric cases]. J Mycol Med 2017; 27:133-138. [PMID: 28462780 DOI: 10.1016/j.mycmed.2017.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/18/2016] [Accepted: 01/18/2017] [Indexed: 10/19/2022]
Abstract
Histoplasmosis duboisii (Histoplasma capsulatum var duboisii) is uncommon disease especially in children. It is observed in Africa where the incidence is unknown. The authors report a series of three pediatric cases. The report concerned 2 girls and one boy who were 3, 9 and 4 year-old, respectively. Symptoms evolved for more than two months in each case. At admission, we found fever and poor general condition. Observed lesions were lymphnodes localisation disseminated (cases 1 and 2), subcutaneous (cold abscess) and cutaneous simulating molluscum contagiosum (case 2), osteoarticular (cases 2 and 3), abdominal including peritoneal and hepatosplenic (case 1). In all cases, a mild leukocytosis was found and an accelerated erythrocyte sedimentation rate (ESR) greater than 70mm. The HIV serology was negative. The treatment consisted of itraconazole in 2 cases and ketoconazole in one case. The evolution was insidious, leading to the discharge against medical advice. The death occurred at home in all cases. CONCLUSION Histoplasmosis duboisii can realize two main clinical presentations (localized or disseminated), affecting the skin, lymph nodes, bones, sometimes the intra-abdominal organs. HIV serology is not always positive in disseminated forms. The evolution is unpredictable and capricious under antifungal treatment. The disease should be well explained to prevent a possible discharge against medical advice, often pejorative.
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Affiliation(s)
- J R Mabiala Babela
- Service de pédiatrie nourrissons, CHU de Brazzaville, Brazzaville, Congo; Faculté des sciences de la santé, université Marien-Ngouabi, Brazzaville, Congo.
| | - C Mboutol Mandavo
- Faculté des sciences de la santé, université Marien-Ngouabi, Brazzaville, Congo; Service de chirurgie pédiatrique, CHU de Brazzaville, Brazzaville, Congo
| | - R Nika Evrard
- Service de pédiatrie nourrissons, CHU de Brazzaville, Brazzaville, Congo
| | - B Ossibi Ibara
- Faculté des sciences de la santé, université Marien-Ngouabi, Brazzaville, Congo; Service de maladies infectieuses, CHU de Brazzaville, Brazzaville, Congo
| | - L Lamah
- Service de pédiatrie nourrissons, CHU de Brazzaville, Brazzaville, Congo
| | | | - A Mouko
- Service de pédiatrie nourrissons, CHU de Brazzaville, Brazzaville, Congo; Faculté des sciences de la santé, université Marien-Ngouabi, Brazzaville, Congo
| | - J F Peko
- Faculté des sciences de la santé, université Marien-Ngouabi, Brazzaville, Congo; Laboratoire de biologie médicale, unité d'anatomie pathologique, CHU de Brazzaville, Brazzaville, Congo
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Tsiba JB, Mabiala Babela JR, Ngoulou MN, Niambi Poaty G, Moukouyou Ndombo M, Moukassa D. [Professional absenteeism in the pediatric service of the general hospital of Loandjili in Pointe-Noire (Congo)]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2013; 106:286-289. [PMID: 24046005 DOI: 10.1007/s13149-013-0309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Indexed: 06/02/2023]
Abstract
The supply and the quality of care dispensed in a service depend on the quality of the technical and human tray, but also from effective presence of the staff during the work time. The purpose of this study is to determine the absenteeism level of the paramedical staff in General Pediatric and Neonatology of Loandjili General Hospital (Pointe Noire) and identifying causes. A cross-sectional study has been conducted from January 1(st) to June 30(th) 2011 on 21 nurses in General Pediatric and 20 in Neonatology. The absenteeism level was obtained by the link of the number of missing days out of the number of the work days x 100. The absence was justified when it relieved from a reason informed by the administrative texts of the firm; and authorized when it requested the authorization of the administration of the firm. In total, 370 absences have been unregistered, the average absenteeism level was of 8.4%. The absence was justified in 242 cases (65.4%) and authorized in 178 cases (48.1%) which 84 times in writing and 94 times verbally. When the absence was justified, it was the fact of the disease of a member of the family in 82 cases, of the death or the burial of a member of the family in 81 cases, of the agent disease, 84 cases, or other reasons in the remains of cases. The absence occurred between 7 a.m. and 14 p.m. in 57.3%, 14 p.m. and 7 p.m.in, 25.7% and between 7 p.m. and 7 a.m. in 17.0%. The absenteeism was mainly observed (85.7%) for the nurses of about 30 years old and those (59.5%) whom the seniority in the service was inferior or equal 5 years. The absences justified were more observed (p< 10(-4)) for nurses of about 30 years old and those whom the seniority did not pass 5 years. The absenteeism of nurses constitutes a real social and administrative problem that deserves a particular attention considering its impact on the supply and the quality of cares.
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Affiliation(s)
- J B Tsiba
- Service de pédiatrie, Hôpital général de Loandjili, Pointe-Noire, Congo
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