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Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa

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Abstract

Purpose

Discharge against medical advice (DAMA) is a worldwide phenomenon. It continues to challenge the healthcare system and has profound effects on outcomes of treatment. It is when a patient leaves the hospital against the treating physician’s recommendation. The objectives of this study are to identify the prevalence, associated factors, and proffer recommendations to mitigate the anomaly in our local/regional healthcare system.

Methods

This was a cross-sectional study with data collected from consecutive patients who sought DAMA at the accident and emergency department of the hospital from October 2020 to March 2022. Data were analyzed using SPSS version 26. Descriptive and inferential statistics were used for data presentation.

Results

Ninety-nine cases of DAMA out of 4608 patients seen at the Emergency Department during the study period, giving a prevalence rate of 2.14%. 70.7% (70) of these patients were aged 16–44 years with male-to-female ratio of 2.5:1. An estimated half the number of the patients who DAMA were traders 44.4% (44), 14.1% (14) were in paid employment, 22.2% (22) were unskilled workers, and 3% (3) unemployed. Financial constraint was the leading cause in 73 (73.7%) cases. The majority of patients had limited or no formal education, and this was significantly associated with DAMA (P = 0.032). Ninety-two patients (92.6%) sought discharge within 72 h of admission and 89 (89.9%) admitted to leaving to seek alternative methods of care.

Conclusion

DAMA is still a problem in our environment. Comprehensive health insurance must be mandatory for all citizens with improved scope and coverage, especially for trauma victims.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, National Orthopaedic Hospital, Lagos, Nigeria

    Adetunji Mapaderun Toluse, Adedamola Dele Onibonoje, Adebola Biala & Taofeek Olanrewaju Adeyemi

Authors
  1. Adetunji Mapaderun Toluse
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  2. Adedamola Dele Onibonoje
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  3. Adebola Biala
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  4. Taofeek Olanrewaju Adeyemi
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Contributions

All authors contributed to the study conception and design. Adetunji Mapaderun Toluse, Adebola Biala, and Adedamola Dele Onibonoje performed material preparation, data collection, and analysis. Adedamola Dele Onibonoje wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Adetunji Mapaderun Toluse.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The Ethics Committee of the National Orthopaedic Hospital, Lagos, granted approval (Date- 11 August 2020 /S. 314/IV No. 970).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Toluse, A.M., Onibonoje, A.D., Biala, A. et al. Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa. International Orthopaedics (SICOT) 47, 1671–1676 (2023). https://doi.org/10.1007/s00264-023-05836-4

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