• Roland Chidi Ibekwe, Vivan U Muoneke, Uche H Nnebe-Agumadu, and Mary-Ann U Amadife.
• Department of Paediatrics, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria. roland_ibekwe@yahoo.com
• J. Trop. Pediatr. 2009 Feb 1; 55 (1): 39-41.

AbstractDischarge against medical advice (DAMA) has become a major problem in health care delivery in Nigeria. Children are the victims because most of the times they are not the one taking the decision, and may not understand or contribute to it. This retrospective study was undertaken to identify the factors that influence DAMA among paediatric patients in Ebonyi State University Teaching Hospital, Abakaliki in southeastern Nigeria, with a view at curbing it. There were 97 cases of DAMA out of a total admission of 6505 giving a prevalence rate of 1.5%. Infants constituted 52.2% of them, of which 37.8% were neonates. Majority (96.7%) were from lower social classes residing in rural villages (61.1%).Neonatal conditions (36.7%) were the most common condition for which DAMA was sought, followed by severe malaria (22.2%) and road traffic accident with fractures (12.2%). The common reasons given for DAMA were financial constraint (33.3%), resort to native treatment (25%) and hopelessness of the disease condition (15%). DAMA at the study site is closely asssociated with parental poverty and ignorance. Neonates and older children with surgical conditions are the most vulnerable group. Policies should be targeted at protecting these groups.

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