Magnitude and determinants of discharge against medical advice among pediatric patients at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia, 2023

Abstract

Discharge against medical advice, also known as “self-discharge” or “discharge at own risk,” occurs when a patient is discharged from a hospital without treating team’s agreement. This practice negatively impacts patient well-being. DAMA has been documented in numerous healthcare settings and accounts for between 0.32 and 18% of pediatric discharges worldwide. This study aimed to determine the magnitude and determinants of discharge against medical advice among pediatric patients at Tibebe Ghion Specialized Hospital from August 30, 2022, to September 30, 2023. An institution-based cross-sectional study was conducted with 356 patients in the pediatric age group at Tibebe Ghion Specialized Hospital from August 30, 2022, to September 30, 2023. The study participants were selected using a simple random sampling technique. Data were collected through patient chart review and an interviewer-administered questionnaire. The data were entered using Epi Data version 4.6 statistical software and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression were used to examine the association of each independent variable with the dependent variable. Out of the 356 enrolled patients during the study period, 35 were discharged against medical advice, giving a DAMA rate of 9.8%. Factors significantly associated with DAMA included: admission duration of more than seven days (adjusted odds ratio [AOR] = 2.5; 95% CI: 1.04–6.21; P = 0.039); caregivers who had completed primary school (AOR = 0.24; 95% CI: 0.06–0.95; P = 0.043); and patients whose condition remained terminal or unchanged (AOR = 6.7; 95% CI: 1.94–24.0; P = 0.003). In this study, the magnitude of DAMA was relatively high. Duration of admission, educational status of the caregiver, and the patient’s terminal condition showed a statistically significant association with discharge against medical advice. Therefore, it is recommended that awareness-raising efforts be directed toward caregivers, minimization of hospital stay whenever clinically feasible, and strengthening of Community-Based Health Insurance implementation at all government levels.