Global Advanced Research Journal of Medicine and Medical Sciences (GARJMMS) ISSN: 2315-5159
November 2020, Vol. 9(1), pp. 001-005
Copyright © 2020 Global Advanced Research Journals
Full Length Research Paper
Neonatal discharges against medical advice at a tertiary center in Bayelsa state: impact of policy changes over a 10-year period
Timipah Peregba West1*, Oliemen Peterside1, Onyaye Kunle-Olowu1 and Theodora Phiemueki Etu-Efeotor2
1Department of Paediatrics and Child Health, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State.
2Department of Haematology, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State.
*Corresponding Author E-mail; email@example.com; Phone numbers; 07030472193, 08115130177
Accepted 23 November, 2020
Discharge against medical advice among neonates is worrisome as there have been no substantial changes in neonatal mortality in Nigeria in the last decade. This study was carried out to determine the trend of discharge against medical advice among neonates in southern Nigeria and the impact of policy changes over a ten-year period. This retrospective study was carried out among neonates at the Special Care Baby Unit of the Niger Delta University Teaching Hospital, Bayelsa State. Relevant information was obtained and analyzed. The prevalence of neonatal discharge against medical advice was 3.97%, with a mean age of 4.81±5.33 days and a male to female ratio of 1.4:1. It declined from 1.82% in 2009 to 0.85% in 2011 and rose sharply to 9.37% in 2013. A50% fees waiver in 2015 had no impact, while a health insurance scheme in 2017 saw a decline to 3.52%. Neonatal sepsis was the most common diagnosis. Most [43 (56.2%)] discharges against medical advice occurred within six days of admission. Forty-three (58.90%) parents were in the low socioeconomic class and none had health insurance. A lack of finance was the major reason in 74% of neonates and in 76.7% of cases fathers were the main signatories. The prevalence of discharge against medical advice among neonates over the 10-year period remained high, with financial constraint being the main reason and sepsis the most common diagnosis. Universal health insurance will impact positively on its prevalence and improve child health.
Keywords: Neonates, Discharge against medical advice, Ten years, Health Insurance and fees waiver
List of abbreviations
BHIS: Bayelsa State Health Insurance Scheme; DAMA: Discharge Against Medical Advice; NDUTH: Niger Delta University Teaching Hospital; SCBU: Special Care Baby Unit
Abdullahi UI (2017). Neonatal discharge against medical advice: Experience from a rural tertiary hospital in North Western Nigeria. Sahel. Med. J. 20:64-66.
Aliyu I, Lawal TO (2017). Signing against medical advice in a special care baby unit in a tertiary center in Northwestern Nigeria. Trop. J. Med. Res. 20:16-19.
Al-Turkistani HK (2013). Discharge against medical advice from Neonatal Intensive Care Unit: 10 yearexperience at a University Hospital. J. Family Community Med. 20(2): 113–115.
Devpura B, Bhadesia P, Nimbalkar S, Desia S, Phatak A (2016). discharge against medical advice at neonatal intensive care unit in Gujarat, India. Int. J. Pediatr. 18897039. Doi:10.1155/2016. 1897039.
Duru CO, Peterside O, Ududua AO (2014). Paediatric discharges against medical advice at a tertiary health centre in Bayelsa State, Nigeria. Niger. J. Paed. 41: 90-95.
Federal Ministry of Health. Nigeria Every Newborn Action Plan: A Plan to End Preventable Newborn Deaths in Nigeria (2016). Abuja: Federal Ministry of Health.
Gabriel O, Anaeto E, Nwabughiogu L, Elebeke E, Onuorji S (2016). Economic recession worse than expected -National Bureau of Statistics – Vanguard news [Internet]. [cited 2020 May 27]. Available from https://www.vanguardngr.com/2016/09/economic-recession-worse-expected-national-bureau-statistics/
Ibekwe RC, Muoneke VU, Nnebe-Agumadu UH, Amadife MU (2009). Factors Influencing Discharge against Medical Advice among Paediatric Patients in Abakaliki, Southeastern Nigeria. J. Trop. Pediatr. 55: 39-43.
Ike EU, Oyetunde MO (2015). Pattern of Diseases and Care Outcomes of Neonates Admitted in Special Care Baby Unit of University College Hospital, Ibadan, Nigeria From 2007 To 2011. IOSR J. Nurs. Health Sci. 4:62-71.
Ikefuna AN, Emodi IJ (2002). An Assessment of Factors influencing Hospital Discharges Against Medical Advice of Paediatric Patients in Enugu: A Review of 67 Cases. Niger. J. Paediatr. 29: 1-4.
Joel-Medewase VI, Adebami OJ, Oyedeji OA (2014). Hospital discharges of sick neonates against medical advice. Int. J. Recent. Sci. Res. 5:3.
National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018 (2019). Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF.
Ndu IK, Asinobi IN, Ekwuochi U, Amadi OF, Osuorah CDI, Ayuk AC et al (2016). Discharge Against Medical Advice (DAMA) among the Paediatric age group in Enugu State University Teaching Hospital Parklane, Enugu. J. Exp. Res. 4: 55-62.
Nwokocha EE (2007). Maternal crisis and the role of African men; the case of a Nigerian community. Afr. Popul. Stud. 22: 39-62.
Onankpa BO, Ali T, Abolodje E (2014). A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria. Int. J. Med. Res. Health Sci. 3: 297-301.
Onyiriuka AN (2011). Paediatric discharges against medical advice: experience from a Nigerian secondary health care institution. Med. J. Islamic Republic Iran. 25(4): 194-199.
Opara P, Eke G (2010). Discharge against medical advice amongst neonates admitted into a Special Care Baby Unit in Port Harcourt, Nigeria. Internet J. Pediatr. Neonatol. 40: 12-15.
Oyedeji GA (1985). Socio-economic and cultural background of hospitalized children in Ilesha. Niger. J. Paed. 12: 111-117.
Pokhrel RP, Bhurtel R (2020). Discharge Against Medical Advice from NICU in a Tertiary Hospital of Central Nepal: A Descriptive Cross-Sectional Study. Pediatric Health Med. Ther. 11:307-311. Published 2020 Aug 26. doi:10.2147/PHMT.S268100.
Taghizadieh A, Azami-Aghdash S, Piri R, Naghavi-Behzad M, Beyrami HJ (2019). Effects of Iranian healthcare transformation plan on discharge against medical advice rate and related factors in 2012 and 2016. BMJ. 9:024291.
We owe LG workers nine-month salary, not 16 – Bayelsa govt – Punch newspapers [Internet]. [cited 2020 May 27]. Available from https://punchng.com/we-owe-lg-workers-nine-month-salary-not-16-bayelsa-govt/
- Timipah Peregba West on Google Scholar
- Timipah Peregba West on Pubmed
- Oliemen Peterside on Google Scholar
- Oliemen Peterside on Pubmed
- Onyaye Kunle-Olowu on Google Scholar
- Onyaye Kunle-Olowu on Pubmed
- Theodora Phiemueki Etu-Efeotor on Google Scholar
- Theodora Phiemueki Etu-Efeotor on Pubmed